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J Thorac Cardiovasc Surg 2003;126:240-245
© 2003 The American Association for Thoracic Surgery

Surgery for congenital heart disease

Comparison of autograft and allograft aortic valve replacement in children

^a Division of Cardiac Surgery, Phoenix, Ariz, USA
^b Division of Cardiology, Phoenix Children’s Hospital, Phoenix, Ariz, USA
^c Division of The Cleveland Clinic, Cleveland, Ohio, USA
^d Division of the University of Washington, Seattle, Wash, USA

Read at the Twenty-seventh Annual Meeting of The Western Thoracic Surgical Association, Big Sky, Mont, June 19-22, 2002.

Received for publication June 27, 2002; accepted for publication October 17, 2002.

^* Address for reprints: Flavian M. Lupinetti, MD, Phoenix Children’s Hospital, 1144 East McDowell Rd, Suite 204, Phoenix, AZ 85006, USA
fmlupinetti{at}hotmail.com

OBJECTIVE: This study was undertaken to compare the clinical and hemodynamic results following aortic valve replacement with a pulmonary valve autograft (Ross procedure) or an allograft valve in children.

METHODS: The records of 107 pediatric aortic valve replacements from 1994 through 2001 were reviewed, including 78 autografts and 25 allografts. Four mechanical aortic valve replacements performed during this period were excluded from analysis.

RESULTS: There were 3 perioperative deaths and 1 late death. Reoperations were required in 5 autograft recipients (with autograft preservation in 4) and in 3 allograft recipients (all requiring valve re-replacement). Seven-year survival (96% in both groups) and reoperation-free survival (88% in the autograft group; 73% in the allograft group, P = .5) were not significantly different. Serial echocardiographic studies showed that in the autograft group, left ventricular outflow tract maximal velocity (2.0-1.8 m/s, P = .02) and left ventricular thickness (10.1-8.4 mm, P < .0001) fell significantly. In the allograft group, maximal velocity (2.3-3.0 m/s, P = .03) increased significantly and left ventricular thickness (9.5-9.0 mm, P = .2) showed minimal change. Analysis according to preoperative physiology (aortic stenosis versus insufficiency), congenital cardiac anatomy, number or type of previous operations, age of patient, and use of balloon valvotomy did not predict outcomes.

CONCLUSIONS: Aortic valve replacement with either the autograft or allograft provides excellent clinical results in children during an intermediate duration of observation. The Ross procedure achieves a superior hemodynamic result, which may be clinically important with longer follow-up.

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