摘要
Objective The objective of this study was to assess whether the mitral homograft represents a valuable alternative for complete or partial mitral valve replacement. Methods Since 1993, 104 patients underwent mitral homograft replacement surgery. The mean age was 38±15 years. The causes of mitral valve disease were rheumatic disease (n=76), infective endocarditis (n=24), and others (n=4). Sixty-five of these procedures were total homografts, and 39 were partial homografts. Results The mean follow-up was 52±35 months (maximum, 117 months). Overall hospital mortality was 4 (3.8%) of 104 patients and 2.5%versus 8.7%for patients without endocarditis and with endocarditis, respectively (P< .19). There were 9 late deaths (cardiac, 4; noncardiac, 5). There have been 5 early (< 3 months) and 10 late reoperations. Of the remaining 77 patients, New York Heart Association class was Ⅰin 61, Ⅱin 14, and Ⅲin 2. Four patients had endocarditis, and 5 had an ischemic or hemorrhagic event. Freedom from major cardiac events was 71%±6%at 8 years (partial at 81%vs total at 63%, P< .19). Among patients with a total homograft, freedom from major cardiac events was 61%±9%and 85%±8%at 6 years in patients younger than and older than 40 years, respectively(P=.09) Conclusion The risk of early dysfunction related to a mismatch between the mitral homograft and the patient’s valve is the main pitfall of the technique. Beyond that stage, the results were comparable with those of bioprostheses in a cohort of young patients.
Objective The objective of this study was to assess whether the mitral homograft represents a valuable alternative for complete or partial mitral valve replacement. Methods Since 1993, 104 patients underwent mitral homograft replacement surgery. The mean age was 38±15 years. The causes of mitral valve disease were rheumatic disease (n=76), infective endocarditis (n=24), and others (n=4). Sixty-five of these procedures were total homografts, and 39 were partial homografts. Results The mean follow-up was 52±35 months (maximum, 117 months). Overall hospital mortality was 4 (3.8%) of 104 patients and 2.5%versus 8.7%for patients without endocarditis and with endocarditis, respectively (P< .19). There were 9 late deaths (cardiac, 4; noncardiac, 5). There have been 5 early (< 3 months) and 10 late reoperations. Of the remaining 77 patients, New York Heart Association class was Ⅰin 61, Ⅱin 14, and Ⅲin 2. Four patients had endocarditis, and 5 had an ischemic or hemorrhagic event. Freedom from major cardiac events was 71%±6%at 8 years (partial at 81%vs total at 63%, P< .19). Among patients with a total homograft, freedom from major cardiac events was 61%±9%and 85%±8%at 6 years in patients younger than and older than 40 years, respectively(P=.09) Conclusion The risk of early dysfunction related to a mismatch between the mitral homograft and the patient's valve is the main pitfall of the technique. Beyond that stage, the results were comparable with those of bioprostheses in a cohort of young patients.
