BACKGROUND: Pulmonary autograft mitral valve replacement (PA-MVR) was introduced clinically by Ross in 1967 and recently modified by Kabbani, but has been rarely utilized in North America and Europe. The aim of this study is to review our continued experience with PA-MVR.

METHODS: Since June 2002, 9patients between 12 to 46 years of age with outgrown mechanical valves(n=3), failed MV repair for rheumatic or congenital MV disease(n=5) and irreparable bileaflet myxoid prolapse(n=1) underwent PA-MVR. The pulmonary autograft was harvested and replaced using a cryopreserved pulmonary homograft.

RESULTS: There were no early or late deaths. Intraoperative echocardiography confirmed a trivial(n=8) or mild(n=1) regurgitation. Follow-up (range 2months to 6years) echocardiography in 5patients showed no increase in MV gradient or regurgitation. Four patients have required reoperation:due to progression of trivial-to-moderate regurgitation due to stretching of a single autograft leaflet producing prolapse(n=3),and a moderate gradient due to retention of excessive native mitral leaflet and subannular chordal tissue(n=1). All 4patients had an uneventful PA-MVR using a mechanical prosthesis. Freedom from reoperation is 56% at 6years.

CONCLUSIONS: PA-MVR offers selected patients a potentially lifelong autologous valve without the need for long-term anticoagulation. The PA-MVR technique deserves careful consideration in younger patients in sinus rhythm. Postoperative systemic hypertension should be treated aggressively to prevent excessive stress on the PA particularly in the early postoperative months. The Dacron external support should not be oversized. Long term follow-up of more patients is required to determine the long-term utility of this very attractive alternative to prosthetic MVR in young patients.