Five Years of Experience with Mitral Valve Homografts

Abstract

Mitral homografts can be used with acceptable mid-term results in selected cases with good left ventricular function and only slightly dilated left ventricles. Partial mitral homografts represent an additional technique, especially for mitral valve repair in patients with acute endocarditis. The susceptibility to bacterial infections of a homograft makes strict prophylaxis against endocarditis mandatory.

Impact of Structural Valve Deterioration on Outcomes in the Cryopreserved Mitral Homograft Valve

“…One death in our series was due to technical difficulty in replacing an entirely calcified aortic homograft root . Mortality of reoperation following mitral homograft (8.6%) did not substantially differ from reported rates for reintervention on bioprostheses …”

“…14 Mortality of reoperation following mitral homograft (8.6%) did not substantially differ from reported rates for reintervention on bioprostheses. 15,16 At 10 years, one mitral valve homograft out of four had structural deterioration. Although the increased rate of structural deterioration in patients below 40 years of age did not reach statistical significance (Table 3), the stenotic process was clearly accelerated with a higher gradient and lower valve area as compared to older patients ( Table 2).…”

Left Atrial Septal Ventricularization Complicated by Paravalvular Leak, After Reoperation for Mitral Valve Replacement

“…The reason for the dissection in these cases was generally noted to be the result of oversizing of the mitral valve prosthesis and likely overzealous excision of mitral valve tissue. This lead to suturing of the new mitral prosthesis into atrial septal tissue leading to subsequent dissection 1–4 . Since dissection of the interatrial septum is a catastrophic event, this diagnosis should be rapidly excluded upon identification of a false chamber which expands during systole and communicates with adjacent structures.…”

Advances in Heart Valve Surgery

“…For the mitral valve homografts have been introduced recently 32 . It was hoped that their hemodynamic performance would be superior to stented prostheses.…”

“…With a similar intention 33 stentless mitral prostheses were designed in order not to be dependent on the scarce homografts. Mid‐term results for both options have not been very promising 32 , 34,35 . There has been a significant rate of early reoperations for regurgitation, most likely caused by anatomical variations or judgment errors during implantation 34,35 .…”