Mitral allografts in tricuspid valve position in modern surgery of acquired heart defects: a systematic review

Abstract

Introduction: In severe recurrent infectious lesions in the right heart, one of the alternative options for bioprosthetics is to implant mitral allografts (donor heart valves) in the tricuspid valve position. Allografts offer numerous benefits, including a configuration that closely resembles a native valve, adaptability to high systemic pressure, absence of foreign elements that can could act as entry points for infections, and antibacterial treatment without lifelong anticoagulant therapy.Objective: To study the feasibility of using a mitral allograft in the tricuspid position based on the analysis of literature data and our own experience.Methods: Searches were conducted in Medline (PubMed), Google Scholar, and Russian Science Citation Index databases using search queries, keywords, and logical operators. The last session was conducted on December 21, 2022. In the initial selection of aforementioned search queries, a total of 4,446 results were obtained (Google Scholar — 3,080, Medline — 1,050, Russian Science Citation Index — 316). After analyzing titles and abstracts, 4,390 studies were excluded due to the insufficient data. Of the remaining studies, 25 scientific papers were excluded due to their duplication. The final group included 31 studies.Results: Based on a systematic literature review, the article presents aspects of the explantation, preparation, and implantation of the mitral allograft in the tricuspid position at the present stage of biotechnology development. The article highlights the main complications, rare clinical observations, and immediate and long-term postoperative results of mitral allograft implantation in the tricuspid position.Conclusion: This technique presents an interesting solution for patients with severe structural changes in the tricuspid valve, but further research is necessary at this stage of biotechnology development. Received 9 March 2023. Revised 7 September 2023. Accepted 11 September 2023. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest. Contribution of the authors: The authors contributed equally to this article.