Structural deterioration of the cryopreserved mitral homograft valve

Olivito, Silvio; Lalande, Stéphanie; Nappi, Francesco; Hammoudi, Nadjib; D’Alessandro, Cosimo; Fouret, Pierre; Acar, Christophe

doi:10.1016/j.jtcvs.2011.06.041

Cited by 37 publications

(69 citation statements)

References 18 publications

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“…Only a few surgeons have documented very good results with MA transplantation into the mitral position (Acar et al 1994b(Acar et al , 1996. An exceptional series of MA transplantations into mitral position with very good long-term results was published by a Paris group (Ali et al 2004, Olivio et al 2012. They evaluated the fates of 106 patients, wherein mean follow-up was 9.3 years and the longest survival was 17.8 years.…”

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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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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“…Thus, the structural deterioration rate of mitral homografts appears comparable to that of the existing biological valve substitutes. We previously published the long‐term follow‐up of a 106 patient series treated with mitral homografts showing optimal clinical results . Nevertheless, because the implantation technique of the mitral homograft is more challenging and carries a risk of early failure which does not exist with bioprostheses, its use cannot be recommended until a more prolonged durability can be expected.…”

Section: Discussionmentioning

confidence: 99%

“…We previously published the longterm follow-up of a 106 patient series treated with mitral homografts showing optimal clinical results. 22 Nevertheless, because the implantation technique of the mitral homograft is more challenging and carries a risk of early failure which does not exist with bioprostheses, its use cannot be recommended until a more prolonged durability can be expected. In our own practice over the past decade mitral homografts have seldom been used whenever biological mitral valve replacement was needed and bioprostheses were preferred.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2014

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“…Thus, the structural deterioration rate of mitral homografts appears comparable with that of the best existing biological valve substitutes. We previously published the long-term follow-up of a 106 patient series treated with mitral homograft showing optimal clinical results [27]. Nevertheless because the implantation technique of the mitral homograft is more challenging and carries a risk of early failure, which does not exist with bioprostheses, its use cannot be recommended until a more prolonged durability can reasonably be expected.…”

Section: Discussionmentioning

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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Structural deterioration of the cryopreserved mitral homograft valve

Cited by 37 publications

References 18 publications

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

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

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

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

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