| Abstract: | Currently used standard mechanical and bioprosthetic heart valves all have limitations that produce less than optimal results. The pulmonary autograft offers a promising alternative with theoretical advantages that have to be proven for final judgement of this innovative surgical technique. METHODS AND RESULTS: A survey including the international registry with 2523 patients enrolled since 1987 is provided along with the author's 10 years experience of 157 patients. The age of the patients ranges between one and 79 years. The indication is expanding integrating concomitant procedures like repair or replacement of aneurysms of the aortic root and ascending aorta, mitral valve reconstruction, coronary bypass grafting, etc. The operative mortality ranges between 0.6 and 2.5%. No anticoagulation is necessary. The function of the autograft is excellent. Late incidence of significant aortic insufficiency (> 2+) remains less than 5%. Even at exercise there is no pressure gradient across the autograft. Autograft failure with autograft revision or replacement stands at 1-4%. Homograft function is also found to be excellent. Right ventricular outflow tract revision rate ranges between 1-1.3%. In a few patients (7%), maximal pressure gradients between 20 and 35 mmHg developed across the homograft without major impairment of right ventricular function. CONCLUSIONS: The multicenter data confirm the superior performance of the autograft not matched by any other biological or mechanical valve replacement. Scientific efforts are required to further improve long-term function especially of the neopulmonary valve. |
