Isolated mitral replacement with stent-mounted antibiotic-treated aortic allograft valves

Area of Science:

• Cardiac Surgery
• Biomaterials Science
• Clinical Outcomes Research

Background:

• Mitral valve disease affects a significant patient population, often requiring surgical intervention.
• Previous valve replacement strategies have limitations, necessitating novel approaches.
• Stent-mounted allograft valves offer a potential alternative for mitral valve repair.

Purpose of the Study:

• To report the outcomes of mitral valve replacement using stent-mounted antibiotic-treated aortic allograft valves.
• To assess the safety and efficacy of this specific valve prosthesis in a clinical setting.
• To identify complications and failure modes associated with this device.

Main Methods:

• A cohort of 129 patients with isolated mitral valve disease underwent valve replacement.
• The prosthesis used was a stent-mounted antibiotic-treated aortic allograft valve.
• Patients were followed to assess hospital mortality, late mortality, reoperation rates, and valve-related complications.

Main Results:

• Hospital mortality was 3.9%.
• The cumulative complication-free rate at 5 years was only 37%.
• Major complications included late death (21%), reoperation (15%), embolic episodes (4%), and significant valve incompetence (4%).
• Valve failure was primarily due to detachment of the aortic wall remnant from the stent, with a 16% incidence at 5 years.

Conclusions:

• The stent-mounted antibiotic-treated aortic allograft valve demonstrated a high rate of complications in the mitral position.
• Detachment of the valve from the stent was a significant failure mechanism.
• Due to the observed complications, the use of this device in mitral valve replacement has been discontinued.