Donor mitral valve repair in cardiac transplantation

For many patients suffering from end-stage heart failure, heart transplantation remains the only hope for survival, but the shortage of donor organ is increasing. The growing number of patients awaiting heart transplantation has led many centers to expand the donor pool by liberalizing donor criteria, including advances in surgical techniques on the donor heart, such as valve repair.

We subjected 4 donor hearts to bench repair of the mitral valve. The first heart was from a 35-year-old woman whose echocardiogram showed mild to moderate sclerotic leaflets. We performed a posteromedial commissurotomy and posterior annuloplasty. Transthoracic echocardiography at 57 months after transplantation demonstrated mild mitral regurgitation and no enlargement of VE. The second organ was from a 17-year-old woman with no history of heart disease and an echocardiogram that showed evidence of slightly sclerotic leaflets and mild mitral regurgitation. We performed a posterior annuloplasty. Echocardiography at 12 months demonstrated minimal mitral regurgitation. The third heart was from a 28-year-old woman with a normal echocardiogram. After harvesting, we found a torn head of the posterior papillary muscle, which was reimplanted. Two weeks later, the echocardiogram showed no mitral regurgitation. The fourth was from a 47-year-old woman with no history of heart disease and a normal echocardiogram. Examination before implantation showed central insufficiency, for which we performed posterior annuloplasty. Echocardiography at 12 months showed no mitral regurgitation.

An aggressive approach to use hearts from marginal donors expands the pool and decreases waiting time for patients who desire heart transplantation.