Mitral valve replacement with a pulmonary autograft: initial experience

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Biomedical Engineering

Background:

• Mechanical prostheses require lifelong anticoagulation, posing challenges in developing countries.
• Xenografts have limited durability in younger populations, and homografts are not yet established.
• Previous research in 1967 explored autograft concepts for valve replacement.

Purpose of the Study:

• To evaluate the feasibility and efficacy of using a pulmonary autograft for mitral valve replacement.
• To address the limitations of existing prosthetic and homograft options for mitral valve substitution.

Main Methods:

• The Ross procedure was adapted to use an inverted pulmonary autograft within a Dacron conduit for mitral valve replacement.
• The autograft-conduit was sutured to the mitral annulus, with the proximal end attached to the atrial wall.
• Right ventricular outflow reconstruction was performed using homografts or xenografts.

Main Results:

• One patient experienced a fatal cerebrovascular accident, likely due to a misplaced pericardial collar.
• Another patient required autograft replacement due to early bacterial endocarditis.
• Echocardiography demonstrated excellent function of the remaining autografts up to 16 months postoperatively.

Conclusions:

• The pulmonary autograft is presented as a potentially valid option for mitral valve replacement.
• This technique may offer a suitable alternative in specific patient populations and healthcare settings.