Premium
Aortic Valve Replacement in the Young
Author(s) -
Jones Ellis L.
Publication year - 1994
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/j.1540-8191.1994.tb00923.x
Subject(s) - medicine , aortic valve , aortic valve replacement , surgery , aortic valve insufficiency , valve replacement , aortic root , cardiology , ross procedure , aorta , stenosis
A bstract 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 homodynamic, and freedom from reparation. 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 cm 2 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 explantation in eight patients, four early and four late. Six of the early and late explantations have been for insufficiency. Techniques of valve and valve root implantation will be presented In detail. In my experience, justification for Its use has been rather rigid and the technique has been used only where insertion of this type of valve would be an obvious advantage to the patient. Follow‐up has included 32 patients having a late echo evaluation for allograft function. In the future, use of the allograft root appears to be the procedure of choice when this valve is the desirable substitute for the aortic valve. This procedure preserves the entire aortic cylinder and guarantees valve competency. ( J Card Surg 1994;9[Suppl):188–191 )