813-4 A New Surgical Approach for Replacement of Degenerated Mitral Bioprostheses

Abstract

Primary tissue failure is the most frequent indication for reoperation in patients with a porcine bioprosthetic valve (BPV). Technical hazards of this operation include cardiac rupture at the atrio-ventricular junction or posterior left ventricular wall where a strut may be imbedded, damage to the left circumflex coronary artery during removal of the degenerated BPV and insertion of a new prosthesis, and the potential development of a late paravalvular leak. We describe a new surgical technique that circumvents these problems. It consists of 1) excision of only the cusp tissue of the BPV; 2) preservation of the stent and support of the BPV; 3) suturing a reverted St. Jude aortic valve with extended cuff to the atrial side of the preserved BPV cuff. Our laboratory measurements and clinical experience indicate that this allows a St. Jude valve diameter only 2 mm smaller than that of the BPV This particular approach was used in 13 patients, age 59 to 84 (mean 73) years, who had one to four (mean 2.3) previous cardiac operations. There were no hospital deaths. During a mean follow-up of 18 months (2–36). there was one late death due to cancer. All the remaining patients are doing well without paravalvular leaks or other complications. By leaving the BPV stent and cuff intact. the need for extensive dissection is eliminated, thus shortening and simplifying the procedure and diminishing its attendant morbidity. The described technique offers a safe and logical approach to patients requiring replacement of a degenerated BPV and allows the use of a St. Jude valve of comparable size to the BPV.