Cardiac valve replacement with mitral homograft

The purpose of this study was to review the results of mitral and tricuspid valve replacement with mitral valve homograft. Twenty-two mitral homografts were used to replace cardiac valves in 20 patients. The mitral valve was replaced in 18 patients, applying the method described by Acar. The tricuspid valve was replaced in 2 patients, attaching one papillary muscle of the graft to the anterior papillary muscle and bringing the other papillary muscle of the graft through a tunnel in the anterior wall of the right ventricle. A concomitant Maze III procedure was performed in 3 patients. Accuracy of the repair was confirmed by intraoperative echocardiography. All patients survived operation and are currently alive. One patient was lost to follow-up. Patients have been followed for up to 3.25 years. All patients have good exercise ability (NYHA class I). Five homografts (25%) have been explanted from the mitral position and one from the tricuspid position. All events occurred during the first year after reoperation. Cardiac valve replacement with mitral valve homograft may be accomplished safely. A technically good operation does not guarantee that the valve will remain competent and an unacceptably high early explant rate may be expected. Use of mitral valve homograft for cardiac valve replacement should be restricted to young patients in whom anticoagulant medication is not indicated or undesirable and for those with resistant infection.