Replacement of mitral and tricuspid valves by mitral homograft

Hubka, M; Siska, K; Brozman, M; Halec, V.

doi:10.1097/00007890-196609000-00019

Cited by 3 publications

(3 citation statements)

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“…Replacement of the mitral valve with a homograft was thought of as early as the 1960s when several authors reported their experimental attempts (Hubka et al 1966;O'Brien and Gerbode 1984;Rastelli et al 1965;Van Vliet et al 1965). Early valve failure was almost uniform except for isolated reports (Tamura et al 1994).…”

Section: Historical Backgroundmentioning

confidence: 99%

Allograft Tissue for Use in Valve Replacement

Costa

Ghofaili

Oakley³

2006

Cell Tissue Banking

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Section: Historical Backgroundmentioning

confidence: 99%

Allograft Tissue for Use in Valve Replacement

Costa

Ghofaili

Oakley³

2006

Cell Tissue Banking

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“…Although experiments with MAs were reported even earlier than those with the aortic allograft, MA was never widely used in clinical practice. (Bodnar 1994;Hubka et al 1966) The reasons were following: -MA must be implanted with its subvalvular apparatus, including papillary muscles, which is technically difficult.…”

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confidence: 99%

Transplantation of Mitral Allograft into the Tricuspid Position - a Sheep Experimental Model

Mokráček¹,

Hlubocký²,

Burkert³

et al. 2008

Acta Vet. Brno

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Mokráček A., J. Hlubocký, J. Burkert, J. Vojáček, M. Šulda, M. Vambera, J. Kursa, V. Kroupová, P. Kobylka, J. Špatenka: Transplantation of Mitral Allograft into the Tricuspid Position -a Sheep Experimental Model. Acta Vet. Brno 2008, 77: 89-95. Our research was focused on finding the optimal technique of cryopreserved mitral allograft implantation into the tricuspid valve position in a sheep experiment. We prepared 20 cryopreserved mitral valve allografts preoperatively. These were implanted into the tricuspid position in 20 sheep via right thoracotomy, using extracorporeal circulation with cardioplegic heart arrest. We consider the transventricular papillary muscle fixation to be the best technique for obtaining optimal allograft geometry and long-term durability. We evaluated the valve function by epicardial echo before and after implantation, respectively. The findings were confirmed by haemodynamic measurements as well. It was proved that mitral allografts, harvested, processed, and stored according to the Cardiovascular Tissue Bank Protocol remained mechanically strong enough for implantation into the tricuspid position. It was demonstrated that the mitral allograft transplantation into the tricuspid position is feasible. The immediate postoperative haemodynamic performance was excellent in all animals. The mid-term results are currently being evaluatedprior to the possible application of the technique in humans at our institutions. Mitral homograft, epicardial echocardiography, cryopreservation, extracorporeal circulation, tissue banking, blood transfusion, sheepAfter half a century of history, cardiac valve surgery has become routine in developed countries. From the very beginning, mechanical and biological heart valve substitutes were designed, investigated and developed in parallel. Biological valve prostheses were simultaneously perfected in two lines -the commercial interest was focused mainly on the xenograft heart valve substitute construction, while much scientific interest was paid to the clinical use of allograft heart valves in smaller cohorts of patients. Currently about 49% of patients requiring heart valve replacement receive mechanical valve substitute and about 49% have their valves replaced by xenograft. Only 2% of diseased valves are being replaced by allografts. Nevertheless, none of these types represent an ideal valve substitute. Mechanical valve prostheses are durable, but thrombogenic, e.g. patients need anticoagulation therapy (with related complications) for the rest of life. To the contrary, biological valve substitutes are not thrombogenic, anticoagulation therapy is not necessary, but tissue degeneration remains the main reason for structural valve deterioration.Extensive research is still in progress in many commercial as well as academic centres, when the animal modelling has become a routine to assess the short-term haemodynamic characteristics as well as long-term results of new models of prostheses as well as new and/ or modified surgical implantation techniques....

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“…Fourthly, attempts to graft the aortic or pulmonary valve into the mitral annulus, positioning the graft within the body of the left ventricle, have not been satisfactory. The graft occupies too much space and disruption of the pseudo-chordae from the wall of the left ventricle or roots of papillary muscles have caused failures (McKenzie et al, 1966;O'Brien and Gerbode, 1964;Hubka et al, 1966). More promising results have been obtained by placing grafts of aortic and pulmonary valves from the mitral annulus upwards into the left atrium in the so-called atrial position (Lower, Stofer, and Shumway, 1961;Suzuki and Kay, 1966).…”

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Mitral valve replacement in dogs using pig aortic valve heterografts

Hamilton

Gerbode

1968

Thorax

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Mitral valve replacement using pig aortic valve heterografts has been performed in 27 dogs, siting the grafts in the 'atrial position'. Buffered acid formaldehyde sterilization offered the advantages that it is simple and, by de-naturing the proteins of the graft, may minimize 'rejection' phenomena. It may offer some self-sterilizing property to the graft within the host post-operatively. The question whether heterograft valves will ultimately calcify remains unanswered. The aortic valve has been shown to function satisfactorily in place of the mitral valve for up to four months, producing normal haemodynamic studies. The 'atrial position' of the graft has the advantage that the left ventricular cavity becomes totally available for its pumping activities. The fate of these animals depended upon developing mitral incompetence around the grafts and thrombus, leading to mitral stenosis, rather than to rejection phenomena. The operation described requires accuracy in orientating the graft. Mounting heterografts (with almost the whole of the aortic wall cut away) in a Dacron-covered metal frame pre-operatively provided a valve in a range of sizes which can be inserted in the same manner as any prosthesis in current use. Methods of sterilization and storage and the ultimate fate of heterografts in vivo require further study. Failure such as calcification will probably not develop suddenly. Such a valve could be replaced if necessary. The continued investigation and clinical use of heterografts appears to be justified when viewed against the uncertain outcome of the other methods of valve replacement.

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Replacement of mitral and tricuspid valves by mitral homograft

Cited by 3 publications

References 0 publications

Allograft Tissue for Use in Valve Replacement

Allograft Tissue for Use in Valve Replacement

Transplantation of Mitral Allograft into the Tricuspid Position - a Sheep Experimental Model

Mitral valve replacement in dogs using pig aortic valve heterografts

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