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Clinical report on stentless mitral allografts
A C Yankah1, H H Sievers, P E Lange
1Department of Cardiovascular Surgery, University of Kiel, German Heart Institute, Berlin.
The Journal of Heart Valve Disease
|January 1, 1995
Summary
Allograft mitral valve replacement using a transpapillary epicardial suture technique showed early success but later graft failure due to chordal rupture or papillary muscle issues. These failures were sudden and unpredictable, despite being non-thrombogenic.
Area of Science:
- Cardiovascular Surgery
- Cardiac Transplantation
- Valvular Heart Disease
Background:
- Mitral valve replacement with allografts, including the subvalvular apparatus, was performed using a transpapillary epicardial suture technique.
- This technique aimed to support the union site between the graft and native papillary muscles.
Observation:
- Early postoperative recovery was uneventful in all three patients, with no early or late mortality.
- Trivial, non-progressive mitral regurgitation was noted postoperatively.
- Patients remained in NYHA class II or III for up to 44 months.
Findings:
- Sudden, severe mitral incompetence led to emergency reoperations and graft explantation in all three patients.
- Graft failures occurred at 2, 9, and 44 months, attributed to chordal rupture (technical error, endocarditis) and scarred graft papillary muscle rupture.
- No thromboembolic episodes were observed during the period without anticoagulation.
Implications:
- Stentless mitral allografts can restore native valve function and are non-thrombogenic.
- However, graft failure can be sudden and unpredictable, necessitating further research into long-term allograft durability.
- This highlights potential risks associated with allograft use in mitral valve replacement.