Aortic Valve Replacement by Pulmonary Autogrbft: Technical Advances and Follow-up

M Aftabuddin, OS Khan, AA Rama, C Acar, A Pavee, I Grandjbakhch

Background: Autograft is the best choice of graft material in every place especially in cardiac
surgery to avoid all type of anti-coagulant related hazard, immunological reactions and considering
cost involvement. Study was designed on the basis of above facts.
Methods: All patients underwent surgery with standard Cardiopulmonary By-pass under moderate
hypothermia using median stemotomy incision. Aortic valve was excised and the right and left
coronary buttons were fashioned. Also the pulmonary root was excised. A running suture technique
was used to insert the autograft in to the aortic annulus. A pulmonary homograft made by pericardium
with three pulmonary valves of appropriate size (22-29 mm) was then inserted.
Results: Between July 2001 to July 2002, 30 patients underwent the modified Ross Procedure at LaPitie Salpitriere Hospital, Paris, France. Out of 30 patients 16 were male and 14 were female with the
mean age of 29 years. Indication of operation was aortic stenosis in 6 cases, aortic insufficiency in 9
cases and mixed aortic valve lesion in 15 cases. The mean intra operative cross clamp time was 120
minutes (range: 70-170 minutes), mean cardiopulmonary bypass time was 150 minutes (range: 110-
195 minutes). Postoperativee chocardiogramsr evealed no significant pulmonary or aortic valvular
dysfunction. Three patients, early in the series required reopening for post operative bleeding.
Overall a mean of 2.5 units of bloods (0-10) were transfused per patient. Atrial fibrillation occurred
in 2 patients which wsre managed accordingly. Among 30 patients, there was one perioperative
death (3%), one patient was lost to follow-up and one patient refused to late post operative
echocardiography. Twenty four caseso ut of the twenty seven patients available for functional
follow-up were in NYHA class I, 2 patients in NYHA class II and one patient in NYHA class III.
Conclusions: Pulmonary autografts in aortic position give good short-term result but for its long
{erm effrcacy and safety needs more study.