Allogeneous Transplantation of the Mitral Valve. An Open Question

Sievers, HH; Pe, Lange; Ac, Yankah; Wessel, Armin; Bernhard, A

doi:10.1055/s-2007-1014126

Cited by 27 publications

(10 citation statements)

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“…25 Later, in the 1980s, homograft mitral valve replacements were performed. 26,27 Despite further research, the risk for tissue failure and the technical problems of matching donor and host remain. 28 -33 The use of mitral valve xenografts has been promising, but long-term follow-up data are missing.…”

Section: Options For Mitral Valve Surgerymentioning

confidence: 99%

Early Clinical Results After Stentless Mitral Valve Implantation and Comparison With Conventional Valve Repair or Replacement

Walther

Walther²,

Falk³

et al. 1999

Circulation

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Background-A new quadricusp stentless mitral bioprosthetic valve (QMV) is evaluated and compared with current standards. Methods and Results-Since August 1997, 67 patients were prospectively evaluated: 23 patients received a QMV, 23 had mitral valve repair (MVR), and 21 received conventional mitral valve replacement (MVP). Patient age was 69Ϯ8, 64Ϯ10, and 62Ϯ9 years for QMV, MVR, and MVP treatment, respectively. The underlying pathology was mitral stenosis, incompetence, and mixed disease in a corresponding 8, 9, and 6 patients for QMV, 1, 22, and 0 patients for MVR, and 2, 12, and 7 patients for MVP. The papillary muscles were sufficient in all QMV cases to suspend the valve. Cross-clamp time was 59Ϯ19 minutes for QMV implantation. In-hospital mortality for QMV, MVR, and MVP was 1, 0, and 0 patients, respectively, and thoracotomy had to be performed again in 1, 1, and 2 patients, respectively (these outcomes were not valve related). At baseline transthoracic echocardiography, respective maximum flow velocities were 1.6, 1.4, and 1.7 m/s, and valve orifice area was 2.6, 3.5, and 3.4 cm 2. Mild transvalvular reflux was seen in 8, 7, and 2 patients; moderate reflux, in 1, 1, and 1 patients. Left ventricular ejection fraction was 52%, 54%, and 51% in the respective treatment groups. At follow-up, hemodynamic parameters had further improved in all groups. Conclusions-One year after clinical implantation, the QMV appears to function well and has no additional risks compared with MVR or MVP. The subvalvular apparatus is preserved by suspending the QMV at the papillary muscles; this arrangement is hemodynamically advantageous. Echocardiography reveals an excellent valve performance that resembles native mitral valve morphology and hemodynamic function. The QMV is a promising alternative for biological mitral valve replacement. (Circulation. 1999;100[suppl II]:II-78-II-83.) Key Words: mitral valve Ⅲ surgery Ⅲ echocardiography Ⅲ prosthesis M itral valve surgery is characterized by improved methods of valve repair in selected patients. Mitral valve replacement (MVP) is indicated mainly for advanced disease with severe destruction or calcification. Although a routine operation, valve selection is still controversial, since no ideal artificial heart valve is available at the moment. 1,2 Bioprostheses are usually indicated in patients older than 70 years. 3 Nevertheless, complications such as structural valve failure, calcification, thrombosis, and anticoagulation-related hemorrhage are associated with artificial heart valves. 4-6 In the mitral position, freedom from these complications is Ϸ70% at 10 years and 35% at 15 years for porcine bioprostheses and Ϸ77% at 10 years for pericardial bioprostheses. 7-9 Currently, no standard for valve selection exists; the best option would be a durable, flexible biological prosthesis resembling the native mitral valve. Anatomically, the mitral valve is a complex structure, like the individual fingerprint. Perfect function is guaranteed through the interaction of valve leaflets, chordae, ...

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Section: Options For Mitral Valve Surgerymentioning

confidence: 99%

Early Clinical Results After Stentless Mitral Valve Implantation and Comparison With Conventional Valve Repair or Replacement

Walther

Walther²,

Falk³

et al. 1999

Circulation

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“…Ali et al (2004) report a 5 % reoperation rate due to MA failure within the first 3 months following MA transplantation. Due to its complexity and poor, unpredictable results at most centers, therefore, this method has never been widely used in clinical practice (Sievers et al 1985). Only a few surgeons have documented very good results with MA transplantation into the mitral position (Acar et al 1994b(Acar et al , 1996.…”

Section: Discussionmentioning

confidence: 99%

One-Year Results From Cryopreserved Mitral Allograft Transplantation Into the Tricuspid Position in a Sheep Experimental Model

Mokráček

Čanádyová²,

Simunkova³

et al. 2015

Physiol Res

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Mitral allografts are still used only exceptionally in the mitral or tricuspid position. The main indication remains infectious endocarditis of atrioventricular valves for its flexibility and low risk of infection. The aim of our study was to evaluate 1-year results of mitral allografts transplantation into the tricuspid position in a sheep model. Mitral allografts were processed, cryopreserved, and transplanted into the tricuspid position anatomically (Group I – 11 animals) or antianatomically (Group II – 8 animals). All survivors (4 from Group I, and 3 from Group II) were checked at 3, 6, and 12 months by echocardiography with the exception of one survivor from Group II (which was examinated only visually). Examination throughout follow-up included for mitral allograft regurgitation and annuli dilatation. At postmortem, the papillary muscles were healed and firmly anchored to the right ventricular wall in all subjects. Transventricular fixation of the papillary muscles with buttressed sutures was proven to be a stable, reproducible, and safe method for anchoring mitral allograft leaflets. There were no significant differences between the two implantation methods. Annulus support of mitral allografts might be very useful in this type of operation and could prevent annular dilatation.

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“…Despite the controversial and different choice of surgeons, the allogenous transplantation of the mitral valve has remained an open question [1]. In the beginning of the nineties isolated cases of complete mitral homograft replacement [2] were reported including the description from our group of an original technique based on a side-to-side suturing of the homograft papillary muscles with multiple interrupted stitches together with prosthetic ring implantation [3].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Structural Valve Degeneration in Cryopreserved Mitral and Aortic Homograft: Is Pregnancy a Factor?

Nappi¹,

Spadaccio²,

Chello³

et al. 2014

WJCD

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Objective: This study reports the outcomes of the cryopreserved mitral homograft in 119 patients prospectively followed with clinical, echocardiographic and structural valve deterioration assessments. Methods: 119 patients undergoing mitral and aortic homograft implantation. Patient's causes of mitral disease were: rheumatic disease (n = 75), endocarditis (n = 37) and others (n = 7). There were 40 partial homografts and 88 total homografts. Mitro-aortic homograft valve replacement was performed in 29 cases. Results: Mean follow-up was 9.8 ± 6.3 years (up to 19.2 yrs). There were 7 early (<3 months) and 16 late deaths. There have been 9 early (<3 months) and 35 late reoperations. Nine patients had an endocarditis and 6 had ischemic/haemorrhagic event. As compared to baseline, follow-up echography showed progression of MR grade (from 0.4 to 1.3 p < 0.001) with stenosis (elevated gradient: from 3.9 to 7.0 mmHg p < 0.001 and decreased valve area: from 2.3 to 1.7 cm 2 p < 0.001). Proportion of patients free from structural valve deterioration (SVD) was 90%, 76% and 65% at 5 years, 10 years and 15 years respectively. Pregnancy and endocarditis etiology were found to be the main determinants of SVD. Stenosis related to SVD was more pronounced for age < 40 years and ring size 30 mm. Mitro aortic homograft valve replacement was the preferred choice in complex infective endocarditis. Pathological analysis of the explanted homografts almost invariably showed dense fibrosis with calcification and no cellularity. Conclusion: Mitral homografting could be accomplished with early echographic results similar to those of valve repair. SVD produced mixed stenosis with insufficiency and its incidence was comparable to that of bioprostheses SVD. An improvement in the preservation mode of valvular homografts is warranted. Double cryopreserved homograft implantation in the context of infective endocarditis might be an effective strategy especially if the mitro-aortic continuity is involved. However, a par-* Corresponding author. F. Nappi et al. 278 ticular attention should be paid to in women in childbearing age because pregnancy might accelerate structural degeneration of the cryopreserved homografts.

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Allogeneous Transplantation of the Mitral Valve. An Open Question

Cited by 27 publications

References 1 publication

Early Clinical Results After Stentless Mitral Valve Implantation and Comparison With Conventional Valve Repair or Replacement

Early Clinical Results After Stentless Mitral Valve Implantation and Comparison With Conventional Valve Repair or Replacement

One-Year Results From Cryopreserved Mitral Allograft Transplantation Into the Tricuspid Position in a Sheep Experimental Model

Long-Term Structural Valve Degeneration in Cryopreserved Mitral and Aortic Homograft: Is Pregnancy a Factor?

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