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Structural deterioration of the cryopreserved mitral homograft valve

Silvio Olivito1, Stéphanie Lalande, Francesco Nappi

  • 1Department of Cardiac Surgery, Hôpital Pitié-Salpétrière, Paris, France.

The Journal of Thoracic and Cardiovascular Surgery
|August 23, 2011
PubMed

Insights

Cryopreserved mitral homografts showed significant structural valve deterioration over time, leading to mixed stenosis and insufficiency. Further improvements in homograft preservation are needed for better long-term outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Biomaterials Science
  • Transplantation Immunology

Background:

  • Cryopreserved homografts are used for mitral valve replacement.
  • Long-term structural valve deterioration (SVD) is a concern for homograft longevity.

Purpose of the Study:

  • To evaluate the long-term fate of cryopreserved mitral homografts.
  • To focus on the incidence and characteristics of structural valve deterioration.

Main Methods:

  • 106 patients underwent mitral valve homograft replacement.
  • Follow-up included echocardiography and pathological analysis of explanted valves.
  • Causes of disease included rheumatic disease (75) and endocarditis (24).

Main Results:

  • Mean follow-up was 9.3 years; 5-year, 10-year, and 15-year freedom from SVD was 90%, 76%, and 65%.
  • SVD led to increased mitral regurgitation and stenosis, with decreased valve area.
  • SVD was more frequent in total homografts, during pregnancy, in patients <40 years, and with smaller ring sizes.

Conclusions:

  • Mitral homografting yields early results comparable to valve repair.
  • SVD results in mixed stenosis and insufficiency, with incidence similar to bioprostheses.
  • Improved preservation methods for valvular homografts are necessary.
Abstract

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