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European Heart Journal Advance Access originally published online on January 18, 2008
European Heart Journal 2008 29(11):1446-1453; doi:10.1093/eurheartj/ehm589
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Autograft or allograft aortic valve replacement in young adult patients with congenital aortic valve disease

Loes M.A. Klieverik1,*, Jos A. Bekkers1, Jolien W. Roos2, M.J.C. Eijkemans3, Goris Bol Raap1, Ad. J.J.C. Bogers1 and Johanna J.M. Takkenberg1

1 Department of Cardio Thoracic Surgery, Bd 571, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands
2 Department of Cardiology, Erasmus University Medical Center Rotterdam, the Netherlands
3 Department of Public Health, Erasmus University Medical Center Rotterdam, the Netherlands

Received 26 June 2007; revised 29 October 2007; accepted 22 November 2007; online publish-ahead-of-print 18 January 2008.

* Corresponding author. Tel: +31 10 4634481, Fax: +31 10 4633993, Email: l.klieverik{at}erasmusmc.nl

Aims: We analysed the outcome of young adults with congenital aortic valve disease who underwent allograft or autograft aortic valve or root replacement in our institution and evaluated whether there is a preference for either valve substitute.

Methods and results: Between 1987 and 2007, 169 consecutive patients with congenital aortic valve disease aged 16–55, participating in our ongoing prospective follow-up study, underwent 63 autograft and 106 allograft aortic valve replacements (AVRs). Mean age was 35 years (SD 10.8), 71% were males. Aetiology was 71% bicuspid valve, 14% other congenital, and 15% BV endocarditis. Twenty-two percent underwent previous cardiac surgery; 11% had an ascending aorta aneurysm. Two patients died in hospital. During follow-up six more patients died and 45 patients required valve-related re-operations. Thirteen-year survival was 97% for autograft and 93% for allograft recipients, 13 year freedom from valve-related re-operation was 63% for autograft and 69% for allograft patients.

Conclusion: In patients with congenital aortic valve disease, autograft and allograft AVR show comparable satisfactory early and long-term results, with the increasing re-operation risk in the second decade after operation remaining a major concern.

Key Words: Aortic valve replacement • Congenital aortic valve disease • Young adults • Prosthetic valve selection • Autograft • Allograft

Presented at the World Congress of Cardiology in Barcelona, Spain, 2–6 September 2006.


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