EXPERIENCE WITH HOMOGRAFT MITRAL-VALVE REPLACEMENT

Background and aims of the study: Homograft mitral valve replacement m ay offer a superior alternative to replacement with a prosthetic valve . The authors' early experience with this technique is reported. Metho ds: Between May 1994 and May 1995, 24 patients (19 males, five females ; age range 17 to 49 years) underwent homograft mitral valve replaceme nt (HMVR) at the authors' institution. The etiology was rheumatic in a ll patients; 22 had severe calcific mitral stenosis (MS) and two had c ombined MS and severe mitral regurgitation (MR). Results: There were t hree early deaths (12%) and two late deaths (8%). In three patients th e homograft had to be explanted due to severe MR at six weeks, 10 week s and 12 months, respectively. Mean follow up was 18 months (range: 12 to 25 months). Postoperative echocardiography showed trivial or mild MR in 12 patients and moderate MR in four. Mitral stenosis was absent in all patients (mean mitral valve area 2.5 cm(2)). Sixteen patients s howed satisfactory homograft valve function at follow up. The valve ex planted after six weeks showed normal cusp architecture, endothelial g rowth and incorporation of the pericardial strip and complete healing of the papillary muscle junction. Magnetic resonance imaging in 12 pat ients showed normal appearance and function of the homografts. Conclus ions: The authors' experience suggests that homograft mitral valve rep lacement can be performed with good early results.