Long-Term Structural Valve Degeneration in Cryopreserved Mitral and Aortic Homograft: Is Pregnancy a Factor?

Francesco Nappi,Massimo Chello,Mario Lusini,Cristophe Acar,Cristiano Spadaccio

doi:10.4236/wjcd.2014.46036

Abstract

Objective: This study reports the outcomes of the cryopreserved mitral homograft in 119 patients prospectively followed with clinical, echocardiographic and structural valve deterioration assessments. Methods: 119 patients undergoing mitral and aortic homograft implantation. Patient’s causes of mitral disease were: rheumatic disease (n = 75), endocarditis (n = 37) and others (n = 7). There were 40 partial homografts and 88 total homografts. Mitro-aortic homograft valve replacement was performed in 29 cases. Results: Mean follow-up was 9.8 ± 6.3 years (up to 19.2 yrs). There were 7 early (2 p

Highlights

Despite the controversial and different choice of surgeons, the allogenous transplantation of the mitral valve has remained an open question [1]
The aim of the present study was to evaluate the durability of the cryopreserved mitral homograft valve over a period extending for up to 19 years focusing on structural valve deterioration and to evaluate the clinical outcomes of double homograft implantation in case of complex endocarditis involving the mitro-aortic continuity
The aetiology of mitral valve disease was: rheumatic valve disease (n = 75), bacterial endocarditis (n = 37) including 5 cases involving a previously diseased mitral valve, autoimmune disorder (n = 4), marasmic endocarditis (n = 1), Barlow disease (n = 1) and congenital stenosis (n = 1). 23 patients were in chronic atrial fibrillation while the remnant 105 showed no EKG alterations. 40% of the patients with acute articular rheumatism were from the New Caledonia and Tahiti and were of Polynesian race, 40% were white Eurasians and 20% were from the Antilles

Summary

Introduction

Despite the controversial and different choice of surgeons, the allogenous transplantation of the mitral valve has remained an open question [1]. In the beginning of the nineties isolated cases of complete mitral homograft replacement [2] were reported including the description from our group of an original technique based on a side-to-side suturing of the homograft papillary muscles with multiple interrupted stitches together with prosthetic ring implantation [3]. In 1996 the technique applied in a series of 43 patients proved to be safe and reproducible [4] and the eight years follow-up results were further reported by our group [5]. The aim of the present study was to evaluate the durability of the cryopreserved mitral homograft valve over a period extending for up to 19 years focusing on structural valve deterioration and to evaluate the clinical outcomes of double homograft implantation in case of complex endocarditis involving the mitro-aortic continuity

Methods

Results

Discussion

Conclusion