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 ho...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.展开更多
The mechanism of insufficiency in rheumatic valve disease includes 1. annulus dilatation and 2. restricted leaflet motion. Aiming at improving the treatment o f restriction, augmentation of the anterior mitral leaflet...The mechanism of insufficiency in rheumatic valve disease includes 1. annulus dilatation and 2. restricted leaflet motion. Aiming at improving the treatment o f restriction, augmentation of the anterior mitral leaflet (AML) was achieved wi th a piece of autologous pericardium. Methods: between January 1995 and December 1999, out of 274 patients refered for rheumatic mitral disease, 143 patients un derwent a repair (52%), 81%of them had pure regurgitation with no stenosis. Ri ng annuloplasty was performed in all cases. Two techniques used for treating the restrictive componant of the regurgitation were compared in two consecutive coh ort of patients: no AML augmentation (n=62) and AML augmentation (n=81). Mean ag e was 42±3 years and all preoperative variables were comparable except for the incidence of redo patients who all underwent AML extension. Results: in hospital mortality was 0.7%(n=1 with AML extension) and there was one early reoperation for a pericardial patch dehiscence. After a mean follow up of 3.2 years, there was one sudden death (no AML extension). The reoperation rate was lower with (2 .5%) than without (12.9%)AML augmentation (p< 0.05). Echographic study showed a lower incidence of recurrency of mitral insufficiency when AML augmentation ha d been performed (grade 2:9%and grade 3:3%) as compared to no AML augmentation (grade 2:35%and grade 3:14%) (p< 0.05). The mitral orifice area was larger (A ML augmentation: 2.2+0.3 cm2 vs no AML augmentation: 1.8+0.4cm2). Conclusion: ring annuloplasty alone failed to correct rheumatic mitral insufficiency in all cases. AML augmentation improved the quality of the repair and decreased the ris k of reoperation.展开更多
文摘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.
文摘The mechanism of insufficiency in rheumatic valve disease includes 1. annulus dilatation and 2. restricted leaflet motion. Aiming at improving the treatment o f restriction, augmentation of the anterior mitral leaflet (AML) was achieved wi th a piece of autologous pericardium. Methods: between January 1995 and December 1999, out of 274 patients refered for rheumatic mitral disease, 143 patients un derwent a repair (52%), 81%of them had pure regurgitation with no stenosis. Ri ng annuloplasty was performed in all cases. Two techniques used for treating the restrictive componant of the regurgitation were compared in two consecutive coh ort of patients: no AML augmentation (n=62) and AML augmentation (n=81). Mean ag e was 42±3 years and all preoperative variables were comparable except for the incidence of redo patients who all underwent AML extension. Results: in hospital mortality was 0.7%(n=1 with AML extension) and there was one early reoperation for a pericardial patch dehiscence. After a mean follow up of 3.2 years, there was one sudden death (no AML extension). The reoperation rate was lower with (2 .5%) than without (12.9%)AML augmentation (p< 0.05). Echographic study showed a lower incidence of recurrency of mitral insufficiency when AML augmentation ha d been performed (grade 2:9%and grade 3:3%) as compared to no AML augmentation (grade 2:35%and grade 3:14%) (p< 0.05). The mitral orifice area was larger (A ML augmentation: 2.2+0.3 cm2 vs no AML augmentation: 1.8+0.4cm2). Conclusion: ring annuloplasty alone failed to correct rheumatic mitral insufficiency in all cases. AML augmentation improved the quality of the repair and decreased the ris k of reoperation.
