Valvuloplasty with glutaraldehyde-treated autologous pericardium in patients with complex mitral valve pathology

Background. Severe mitral regurgitation associated with complex mitral valv e disease often precludes successful surgical repair. The feasibility and t he results of valvuloplasty with glutaraldehyde-treated autologous pericard ium remain largely unknown. Methods. The cases of 63 patients who underwent operation within an 11-year period were studied. A pretreated autologous pericardial patch was used fo r leaflet extension plasty, for paracommissural plasty, as a substitute for part of the leaner, and for reimplantation of ruptured papillary muscles t o eliminate severe mitral regurgitation. Patients with a severely calcified annulus after en bloc decalcification had straddling endoventricular peric ardial patch annuloplasty for reconstruction of the affected atrioventricul ar groove. Chordal replacement with a strip of pericardium was chosen if no suitable chordae were available. Pericardium-reinforced suture annuloplast y was used in patients with acute endocarditis resistant to medical therapy . Associated valvuloplasty procedures with Carpentier techniques were also employed. Results. There were no operative deaths in this series. At a mean follow-up of 61.1 months (range, 4 to 132 months), mitral regurgitation was absent o r trivial in 92.1% of patients by echocardiography. Freedom from reoperatio n was 95.2% at 1 year and 5 years. Thromboembolic events have not been dete cted. Thirty percent of patients returned to sinus rhythm. Two patients req uired valve replacement. Conclusions. Our beneficial results indicate that glutaraldehyde-treated au tologous pericardium is suitable for valvuloplasty. It provides durable and predictable repair of valves that might otherwise need to be replaced beca use of the complex mitral valve disease. The technique is reliable, allows further efficacious repair possibilities, and improves postoperative outcom es. Whether it can prevent late deterioration and calcification requires mo re investigation. (Ann Thorac Surg 2001;71:78-85) (C) 2001 by The Society o f Thoracic Surgeons.