Aortic valve replacement in the young.

Abstract

The attractiveness of the aortic allograft in any form, whether it be free style or root, is the high 10-year freedom from thromboembolism, absence of requirement for anticoagulants, use in active infections, excellent hemodynamics, and freedom from reoperation. The 10-year freedom from all valve related complications has been reported to be around 92% versus only 75% for the porcine bioprosthetic valve. Gradients across the allograft aortic valve are comparable to that of the St. Jude valve (St. Jude Medical, St. Paul, MN, USA) with valve areas approaching 2 cm2 in the extremely large homograft. Between November 1986 and September 1993, the author used the aortic allograft as a freehand procedure in 51 patients and for root replacement in 22 patients. Stimulus for use of limited root replacement with the allograft in aortic valve replacement has occurred because of the unpredictability of the freehand operation with regard to valve insufficiency. This has been done in spite of the Ross modification of retaining the noncoronary sinus. Evaluation of freehand allograft function by echo analysis has demonstrated an unacceptable incidence of insufficiency not found when a small segment of the allograft root is used. The native coronary arteries, however, must be transposed to the donor root, which of itself has the potential of introducing new problems not seen with other valve substitutes. Complications with the freehand allograft have consisted of explanation in eight patients, four early and four late. Six of the early and late explanations have been for insufficiency. Techniques of valve and valve root implantation will be presented in detail.(ABSTRACT TRUNCATED AT 250 WORDS)