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Homograft mitral valve replacement: five years' results
A S Kumar1, S K Choudhary, A Mathur
1Department of Cardiothoracic and Vascular Surgery, Department of Cardiology, and the Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
The Journal of Thoracic and Cardiovascular Surgery
|August 30, 2000
Summary
Mitral homograft valve replacement showed a high failure rate due to severe regurgitation and degeneration, failing to meet expectations for rheumatic mitral valve disease.
Area of Science:
- Cardiovascular Surgery
- Valvular Heart Disease
- Transplantation Immunology
Background:
- Rheumatic mitral valve disease necessitates valve replacement.
- Mitral homografts are an alternative prosthetic option.
- Long-term suitability of mitral homografts requires evaluation.
Purpose of the Study:
- To assess the 5-year efficacy and suitability of mitral homograft replacement.
- To identify factors influencing mitral homograft durability.
Main Methods:
- Thirty-seven patients with rheumatic mitral valve disease underwent mitral valve replacement using mitral homografts.
- Patients received either fresh antibiotic-preserved or cryopreserved homografts.
- Follow-up extended to 60 months to evaluate outcomes.
Main Results:
- Five early deaths occurred. Among survivors, 21 patients developed severe mitral regurgitation, leading to 3 deaths and 8 reoperations.
- Homograft failure was attributed to papillary muscle disruption (early) and cuspal/chordal degeneration (late).
- No significant impact on failure rate was observed based on homograft type, lesion severity, or surgical modifications.
Conclusions:
- Mitral homograft replacement demonstrated a high failure rate, primarily due to severe regurgitation and structural degeneration.
- The procedure did not meet expectations for long-term suitability in treating rheumatic mitral valve disease.
- Explanted homografts showed no viable cells or immunologic injury, indicating mechanical failure as the primary issue.