Mitral valve surgery utilizing homografts: Early results
Standard
Mitral valve surgery utilizing homografts: Early results. / Gulbins, Helmut; Kreuzer, Eckart; Uhlig, Antje; Reichart, Bruno.
in: J HEART VALVE DIS, Jahrgang 9, Nr. 2, 03.2000, S. 222-229.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Mitral valve surgery utilizing homografts: Early results
AU - Gulbins, Helmut
AU - Kreuzer, Eckart
AU - Uhlig, Antje
AU - Reichart, Bruno
PY - 2000/3
Y1 - 2000/3
N2 - Background and aim of the study: Mitral valve repair is superior to prosthetic valve replacement due to preservation of the subvalvular apparatus. We used cryopreserved homografts for mitral valve replacement in selected cases, in whom valve repair would not have been successful. Methods: Cryopreserved homografts were used in 10 patients (four males, six females; mean age 47 ± 8 years; range: 27-65 years), for either complete (n = 7) or partial (n = 3) mitral valve replacement. Surgery was indicated due to acute endocarditis (n = 3), stenosis (n = 4) or combined mitral valve disease (n = 3). Transesophageal-echocardiography (TEE) was performed to determine correct homograft size; these values were compared with intraoperative measurements of valvular dimensions. The function of the implanted grafts was examined intraoperatively by TEE. Follow up included clinical examination, electrocardiography and echocardiography. Results: All patients survived surgery. Intraoperative TEE revealed mild insufficiency (grade I) in six cases and no insufficiency in four. The papillary muscle-mitral annulus distance was the most reliable preoperative echocardiographic parameter to determine the required homograft. Mean pressure gradients were 3.2 ± 0.7 mmHg for complete and 2.4 ± 0.5 mmHg for partial homograft replacement. Sinus rhythm was present in all cases at discharge. Mean follow up was 24 months (range: 6-36 months). At six-month and one-year follow up, the pressure gradients had risen slightly to 3.4 ± 0.6 mmHg (complete) and 2.8 ± 0.6 mmHg (partial). To date, four patients had competent grafts, and six presented with an insufficiency (grade I). All patients had normal left ventricular function (EF 65 + 6%) at their last follow up; there were no signs of endocarditis during the follow up period. Conclusion: Mitral homografts for valve replacement or repair are recommended in selected cases in whom conservative reconstruction techniques are not possible. The avoidance of long-term anticoagulation therapy and preservation of left ventricular geometry are clear advantages to other mitral valve prostheses.
AB - Background and aim of the study: Mitral valve repair is superior to prosthetic valve replacement due to preservation of the subvalvular apparatus. We used cryopreserved homografts for mitral valve replacement in selected cases, in whom valve repair would not have been successful. Methods: Cryopreserved homografts were used in 10 patients (four males, six females; mean age 47 ± 8 years; range: 27-65 years), for either complete (n = 7) or partial (n = 3) mitral valve replacement. Surgery was indicated due to acute endocarditis (n = 3), stenosis (n = 4) or combined mitral valve disease (n = 3). Transesophageal-echocardiography (TEE) was performed to determine correct homograft size; these values were compared with intraoperative measurements of valvular dimensions. The function of the implanted grafts was examined intraoperatively by TEE. Follow up included clinical examination, electrocardiography and echocardiography. Results: All patients survived surgery. Intraoperative TEE revealed mild insufficiency (grade I) in six cases and no insufficiency in four. The papillary muscle-mitral annulus distance was the most reliable preoperative echocardiographic parameter to determine the required homograft. Mean pressure gradients were 3.2 ± 0.7 mmHg for complete and 2.4 ± 0.5 mmHg for partial homograft replacement. Sinus rhythm was present in all cases at discharge. Mean follow up was 24 months (range: 6-36 months). At six-month and one-year follow up, the pressure gradients had risen slightly to 3.4 ± 0.6 mmHg (complete) and 2.8 ± 0.6 mmHg (partial). To date, four patients had competent grafts, and six presented with an insufficiency (grade I). All patients had normal left ventricular function (EF 65 + 6%) at their last follow up; there were no signs of endocarditis during the follow up period. Conclusion: Mitral homografts for valve replacement or repair are recommended in selected cases in whom conservative reconstruction techniques are not possible. The avoidance of long-term anticoagulation therapy and preservation of left ventricular geometry are clear advantages to other mitral valve prostheses.
UR - http://www.scopus.com/inward/record.url?scp=0034027339&partnerID=8YFLogxK
M3 - SCORING: Journal article
C2 - 10772040
AN - SCOPUS:0034027339
VL - 9
SP - 222
EP - 229
IS - 2
ER -