Abstract
Our research was focused on finding the optimal technique of cryopreserved mitral allograft implantation into the tricuspid valve position in a sheep experiment. We prepared 20 cryopreserved mitral valve allografts preoperatively. These were implanted into the tricuspid position in 20 sheep via right thoracotomy, using extracorporeal circulation with cardioplegic heart arrest. We consider the transventricular papillary muscle fixation to be the best technique for obtaining optimal allograft geometry and long-term durability. We evaluated the valve function by epicardial echo before and after implantation, respectively. The findings were confirmed by haemodynamic measurements as well. It was proved that mitral allografts, harvested, processed, and stored according to the Cardiovascular Tissue Bank Protocol remained mechanically strong enough for implantation into the tricuspid position. It was demonstrated that the mitral allograft transplantation into the tricuspid position is feasible. The immediate postoperative haemodynamic performance was excellent in all animals. The mid-term results are currently being evaluated - prior to the possible application of the technique in humans at our institutions.
Highlights
After half a century of history, cardiac valve surgery has become routine in developed countries
Biological valve prostheses were simultaneously perfected in two lines - the commercial interest was focused mainly on the xenograft heart valve substitute construction, while much scientific interest was paid to the clinical use of allograft heart valves in smaller cohorts of patients
Mechanical valves in the tricuspid position show a higher risk of thromboembolic complications and the use of biological valves in younger patients is accompanied with the risk of valve degeneration (Glower et al 1995; Kaplan et al 2002; Nakano et al 2001)
Summary
After half a century of history, cardiac valve surgery has become routine in developed countries. Biological valve prostheses were simultaneously perfected in two lines - the commercial interest was focused mainly on the xenograft heart valve substitute construction, while much scientific interest was paid to the clinical use of allograft heart valves in smaller cohorts of patients. - At the same time, the improvement of mitral valve repair techniques together with the availability of high quality mechanical and xenograft prosthetic valves shifted the attention of cardiac surgeons away from MA. Mechanical valves in the tricuspid position show a higher risk of thromboembolic complications and the use of biological valves in younger patients is accompanied with the risk of valve degeneration (Glower et al 1995; Kaplan et al 2002; Nakano et al 2001). We planned to investigate immediate postoperative function of the MA in the tricuspid position by means of epicardial echocardiography
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