Pulmonary autograft versus aortic homograft for rereplacement of the aortic valve: results from a subset of a prospective randomized trial.

BACKGROUND The use of a pulmonary autograft for rereplacement of the aortic valve has both potential advantages and disadvantages. This study details the early results of a subset of patients enrolled in a prospective randomized trial comparing pulmonary autografts and aortic homografts who have had previous aortic valve replacements. METHODS AND RESULTS A total of 47 patients who had undergone >/=1 previous aortic valve replacement were randomized to receive either a pulmonary autograft (24 patients aged 40+/-11 years) or an aortic homograft (23 patients aged 37+/-11 years) for rereplacement of the aortic valve. One early death occurred in the homograft group, and 1 late (7 months) death occurred in the autograft group. One patient who received a pulmonary autograft was reoperated on for inflammatory pulmonary stenosis. One patient in each group was reopened for bleeding (both within 24 hours). Two patients in the autograft group had postoperative neurological weakness; they fully recovered over 2 months. Hospital stay, blood loss, incidence of perioperative arrhythmia, and markers of coronary ischemia were similar between the 2 groups. At 6-month follow-up (range, 1 to 12 months), left ventricular end-diastolic diameter was similar in both groups (homografts, 5.0+/-0.9 cm; autografts, 5.2+/-0.6 cm; P=NS), and no patient in either group had significant aortic valve dysfunction. CONCLUSIONS Rereplacement of the aortic valve with a pulmonary autograft is feasible and safe in patients aged 14 to 60, regardless of their preoperative diagnosis or clinical condition.