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The Journal of Thoracic and Cardiovascular Surgery, Vol 102, 51-60, Copyright © 1991 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
G Gerosa, R McKay, J Davies and DN Ross
To assess late results of aortic homograft and pulmonary autograft valves
implanted into the left ventricular outflow tract of children, we reviewed
the case histories of 146 patients 18 years of age or younger who underwent
aortic valve or root replacement between November 1964 and April 1990. One
hundred three patients (mean, 12 +/- 3.9 years) received an aortic
homograft and 43 (mean, 14 +/- 4.1 years) had their own pulmonary valve
transferred to the aortic position. There were 54 valve and 49 root
replacements with homografts and 36 valve and seven root replacements with
autografts. Hospital mortality rate was 15.5% (16 patients) in the
homograft group and 11.6% (five patients) in the autograft group. Survivors
were followed up for a total of 867 (homograft) and 297 (autograft)
patient-years. The late mortality rate was 16.7% (1.9% per patient-year)
for patients with homografts and 13.2% (4.4% per patient-year) for patients
with autografts, whereas the incidence for reoperation per patient-year was
2.9% and 2.0%, respectively. At 15 years actuarial rates for homografts and
autografts for freedom from reoperation were 54% +/- 8.1% and 68% +/-
11.1%; freedom from endocarditis, 97% +/- 2.4% and 75% +/- 10.2%; and
freedom from any complication, 41% +/- 6.5% and 50% +/- 10.3%. Valve
degeneration occurred in 19 homografts (2.2% per patient-year), whereas
there was no definite instance of primary tissue failure among the
pulmonary autografts. This experience would indicate that either the
homograft or the autograft valve can be used with acceptable results in
children. However, the pulmonary autograft gives better long-term
performance and, if growth potential is realized, may be the ideal valve
substitute in children.
ARTICLES
Comparison of the aortic homograft and the pulmonary autograft for aortic valve or root replacement in children
National Heart Hospital, London, England.
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