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The mitral pulmonary autograft: assessment at midterm
Sami S Kabbani1, Hisham Jamil, Abdo Hammoud
1Damascus University Cardiovascular Surgical Center, Damascus, Syria. dam-uncv@net.sy
The Annals of Thoracic Surgery
|June 30, 2004
Summary
The pulmonary autograft offers a promising mitral valve substitute, avoiding lifelong anticoagulation and degeneration. This study shows good outcomes in patients needing mitral valve replacement.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Regenerative Medicine
Background:
- Urgent need for mitral valve substitutes that do not require anticoagulation.
- Existing substitutes are prone to degeneration, particularly in emergent societies.
- Pulmonary autograft presents a potential solution to these challenges.
Purpose of the Study:
- To evaluate the efficacy and safety of mitral valve replacement using a pulmonary autograft.
- To assess the long-term outcomes and durability of the pulmonary autograft in mitral position.
- To determine the suitability of the pulmonary autograft as a mitral substitute in specific patient populations.
Main Methods:
- Retrospective analysis of 80 patients undergoing mitral valve replacement with pulmonary autograft (1997-2003).
- Autograft placed within Dacron tubing; right ventricular outflow reconstructed with xenograft/homograft.
- Microwave ablation used for concurrent atrial fibrillation treatment.
Main Results:
- Successful mitral valve replacement in all 80 patients with adequate valve area and acceptable gradients.
- No or trace mitral regurgitation in 61 patients; mild regurgitation in 19.
- Operative mortality 5.0%; procedure-related late mortality 6.25%. Most survivors (83%) in NYHA Class I.
Conclusions:
- Pulmonary autograft is a viable mitral substitute for cardiac surgeons.
- Ideal for young patients and those for whom lifelong anticoagulation is contraindicated or impractical.
- Demonstrates acceptable long-term stability and functional outcomes.