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Mitral valve replacement with glutaraldehyde preserved aortic allografts
C A Salles1, E Buffolo, J C Andrade
1Hospital Felicio Rocho, Federal University of Minas Gerais, Medical School, Belo Horizonte, Brazil. fsalles@gold.com.br
Summary
This study shows stent-mounted glutaraldehyde-preserved aortic allografts offer superior long-term durability for mitral valve replacement in patients over 15. These allografts demonstrate a low incidence of primary valve failure, outperforming porcine bioprostheses in this age group.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Transplantation Immunology
Background:
- Biological tissue preservation techniques are crucial for prosthetic heart valves.
- Allografts offer potential advantages over xenografts when appropriately processed.
- Glutaraldehyde fixation is a common method for preserving biological tissues for valve replacement.
Purpose of the Study:
- To evaluate the long-term outcomes of mitral valve replacement using stent-mounted, glutaraldehyde-preserved aortic allografts.
- To compare the performance of these allografts with porcine bioprostheses in patients over 15 years old.
- To assess the durability and complication rates of allograft valves over a 12-year period.
Main Methods:
- Mitral valve replacement was performed in 70 patients (aged 16-77 years) using glutaraldehyde-preserved aortic allografts mounted on flexible stents.
- Human aortic valves were sourced from autopsies and processed using the same glutaraldehyde technique as porcine bioprostheses.
- Follow-up included clinical assessment and echocardiography for up to 12 years, with a total follow-up of 543.1 patient-years.
Main Results:
- Hospital mortality was 1.4%. The 12-year actuarial survival rate was 92.4%.
- Late mortality was 0.7% per patient-year. The incidence of late complications was 5.2% per patient-year, with allograft failure occurring at a low rate.
- The 12-year actuarial freedom from primary valve failure was 81.0%. Reoperation incidence was 1.5% per patient-year, mainly due to prosthetic endocarditis.
Conclusions:
- Stent-mounted glutaraldehyde-preserved aortic allografts demonstrate a very low incidence of primary failure in mitral valve replacement for patients over 15.
- These allografts show superior durability compared to porcine bioprostheses in the same patient demographic.
- This investigational valve represents a significant advancement in cardiac valve surgery, offering improved long-term outcomes.