The feasibility and function of autologous pericardial valved conduit for right ventricular outflow tract reconstruction in the Ross operation were assessed. Between June 1997 and April 2002, 31 patients underwent this procedure at our institution; one was lost to follow-up. The other 26 males and 4 females were aged 17 to 60 years (mean, 36.6 years). Causes of aortic valve disease were infective endocarditis in 26 and rheumatic valve disease in 4. Mean follow-up was 16.7 months (range, 1-58 months). Preoperatively, 9 patients were in functional class II, 19 in class III, and 2 in class IV. Concomitant procedures included coronary artery bypass (1), mitral valve replacement (6), tricuspid valve replacement (1), and ventricular septal defect closure (1). Mean aortic crossclamp time was 199.4 min. There were 4 (13.3%) hospital deaths and no late death. Mean postoperative functional class was 1.17 with +0.36 aortic regurgitation, a peak gradient of 21.9 mm Hg (range, 6-59 mm Hg) across the conduit, and grade +0.96 pulmonary regurgitation. No conduit-related complication was detected. Use of autologous valved conduit for the Ross operation is feasible. Long-term follow-up is mandatory to assess durability.

Between October 1997 and December 1999, 78 patients underwent mitral valve repair using an autologous pericardial ring for posterior annuloplasty. Five patients with congenital heart disease were excluded from the study, and 1 was lost to follow-up. The remaining patients comprised 45 males and 27 females, aged 17 to 74 years (mean, 43.8 years). Follow-up ranged from 3 to 30 months (mean, 17.6 months). Mitral valve repair was required for rheumatic disease (37), degenerative disease (26), infective endocarditis (4), and ischemic heart disease (5). Isolated valve repair was performed in 42 patients, associated operations were aortic valve replacement with autologous pericardium (5), aortic valve replacement (4), aortic valve repair (3), aortic valve replacement with pulmonary autograft (1), tricuspid valve repair (9), and coronary artery bypass (4). The most frequent surgical procedures were posterior annuloplasty, resection of secondary chordae, and suture annuloplasty (average repair procedures per patient was 4.4). There were 2 hospital deaths; one from acute respiratory failure and one from low cardiac output. Three patients needed mitral valve replacement. Use of an autologous pericardial ring is a safe alternative technique for mitral valve annuloplasty but long-term follow-up is mandatory.

From March 1994 to December 1999, polytetrafluoroethylene suture was used for chordal replacement during mitral valve repair in 30 patients. Follow-up ranged from 4 to 70 months with a mean of 36.6 months and was complete in 29 patients: 14 males and 15 females with a mean age of 40.6 years. Most (17) had rheumatic heart disease, 5 had degenerative disease, 6 had infective endocarditis, and 1 had ischemic heart disease. Preoperatively, 26 patients were in functional class III and IV. Operations comprised isolated mitral valve repair (15), combined mitral and tricuspid valve repair (4), mitral valve repair and aortic valve replacement (3), and others (7). The most frequent additional procedures were commissurotomy, papillotomy, resection of primary or secondary chordae, and chordal splitting. The mean cardiopulmonary bypass and aortic crossclamp times were 155.3 and 120.5 minutes, respectively. There was no hospital mortality. One patient died 20 months postoperatively from chronic obstructive lung disease. All survivors were in functional class I and II. Mitral regurgitation was reduced from a preoperative mean of +3.1 degrees to +0.43 degrees. No thromboembolic event or valve failure occurred during follow-up. It was concluded that polytetrafluoroethylene suture was safe and effective for mitral valve repair.