Related Experiment Videos
Mitral valve replacement with homograft
D B Doty1, J H Flores, J R Doty
1Department of Surgery, LDS Hospital, Salt Lake City, UT, USA.
Abstract:
The purpose of this study was to review the results of mitral valve replacement with mitral valve homograft, applying the method described by Acar, to determine if the method could be reproduced and was safe to use. Fourteen patients had replacement of the mitral valve with homograft. The diseased valve was excised and replaced with a cryopreserved homograft. The papillary muscles of the graft were attached to the papillary muscles of the patient in side-to-side fashion, using multiple stitches of fine monofilament suture. The annulus of the graft was attached to the patient annulus by continuous suture. The repair was supported by annuloplasty ring. All patients had intraoperative echocardiography. Patients were monitored clinically for up to 1.5 years. There were five men and nine women ranging in age from 16 to 70 years (mean = 43 years). Seven had rheumatic, six had degenerative, and one congenital morphology. Concomitant Maze III procedure was performed in three patients. All patients survived and are currently alive and in New York Heart Association functional class I. Thirteen patients have normal sinus rhythm. Only one patient has intermittent atrial fibrillation and is taking digoxin and warfarin. One patient had dehiscence of the recipient papillary muscle that required reoperation for mitral valve replacement with prosthesis. Three patients have moderate mitral valve regurgitation. Mitral valve replacement with homograft may be accomplished safely and reproducibly using the Acar method. Good short-term functional results and maintenance of normal sinus rhythm may be expected. Anticoagulant therapy should not be required.
Insights
Mitral valve replacement using the Acar method with homografts is safe and reproducible. This procedure offers good short-term results and maintains normal sinus rhythm, potentially avoiding lifelong anticoagulation.
Area of Science:
- Cardiovascular Surgery
- Cardiac Transplantation
- Valvular Heart Disease
Background:
- Mitral valve homograft transplantation offers a potential alternative for valve replacement.
- The Acar method provides a specific surgical technique for mitral valve homograft implantation.
Purpose of the Study:
- To evaluate the reproducibility and safety of the Acar method for mitral valve replacement using homografts.
- To assess the clinical outcomes and functional status of patients undergoing this procedure.
Main Methods:
- Fourteen patients underwent mitral valve replacement with cryopreserved homografts using the Acar technique.
- Surgical implantation involved papillary muscle and annular suturing, supported by an annuloplasty ring.
- Intraoperative echocardiography and clinical monitoring for up to 1.5 years were performed.
Main Results:
- All fourteen patients survived the procedure and remained alive at follow-up.
- Thirteen patients maintained normal sinus rhythm; one experienced intermittent atrial fibrillation.
- One patient required reoperation due to papillary muscle dehiscence; three had moderate mitral regurgitation.
Conclusions:
- Mitral valve replacement with homograft using the Acar method is safe and reproducible.
- The procedure yields good short-term functional results and sinus rhythm maintenance.
- Routine anticoagulant therapy may not be necessary following this type of mitral valve replacement.