Pulmonary autograft aortic valve replacement: long-term results.

Since 1967, 339 cases of replacement of the aortic valve with the patient's pulmonary valve have been carried out in the National Heart Hospital and the Harley Street Clinic, London. The operation was introduced following the finding of progressive degeneration in previously placed homograft valves. The longest follow-up is 24 years and the cumulative total follow-up is 3,986 patient-years. Overall hospital mortality is 7.4% (25 cases) but with only one death after 1976. Late mortality is 38 patients and actuarial survival is 80% at 20 years. No anticoagulants have been used and there have been no emboli. Bacterial endocarditis occurred in 11 patients. Reoperation was carried out in 33 patients. Freedom from replacement is 85% at 20 years. There is no evidence of calcification or progressive tissue degeneration and the explanted valves show viable tissue. There is also accumulating evidence that the valve can grow in children. The actuarial freedom from all events is 70% at 20 years. With the current low operative risk and absence of progressive degenerative change plus growth prospects, it offers a potentially permanent valve replacement for infants, children, and young adults.