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Published on: May 21, 2017
Mitral valve surgery utilizing homografts: early results
H Gulbins1, E Kreuzer, A Uhlig
1Department of Cardiac Surgery, University Hospital Grosshadern, Munich, Germany.
The Journal of Heart Valve Disease
|April 20, 2000
Summary
Cryopreserved homografts offer a viable alternative for mitral valve replacement when repair is not feasible. These homografts preserve left ventricular geometry and avoid anticoagulation, showing good short-term outcomes in selected patients.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Replacement
- Transplantation Immunology
Background:
- Mitral valve repair is generally preferred over prosthetic valve replacement due to subvalvular apparatus preservation.
- Cryopreserved homografts were utilized in specific cases where mitral valve repair was not a viable option.
Purpose of the Study:
- To evaluate the efficacy and safety of cryopreserved homografts for mitral valve replacement in selected patients.
- To assess the functional outcomes and hemodynamic performance of mitral homografts.
Main Methods:
- Ten patients underwent complete (n=7) or partial (n=3) mitral valve replacement using cryopreserved homografts.
- Indications included acute endocarditis, stenosis, or combined mitral valve disease.
- Transesophageal echocardiography (TEE) guided homograft sizing and assessed intraoperative function; follow-up included clinical and echocardiographic evaluations.
Main Results:
- All patients survived the surgery.
- Intraoperative TEE showed mild insufficiency (grade I) in six patients and no insufficiency in four.
- Papillary muscle-mitral annulus distance was the most reliable preoperative parameter for homograft sizing.
- Mean pressure gradients were low and remained stable throughout the follow-up period (mean 24 months).
- All patients maintained normal left ventricular function, with no signs of endocarditis.
Conclusions:
- Mitral homografts are recommended for selected patients when conservative reconstruction is not possible.
- Advantages include avoidance of long-term anticoagulation and preservation of left ventricular geometry compared to other prosthetic valves.
