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J Thorac Cardiovasc Surg 2004;128:529-534
© 2004 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Homograft replacement of the mitral valve: Eight-year results

^a Department of Cardiac Surgery, Hopital de la Salpétrière, Paris, France
^b Department of Cardiology, Hopital Bichat, Paris, France
^c Department of Anatomopathology, Hopital Georges Pompidou, Paris, France

Received for publication July 22, 2003; revisions received November 4, 2003; accepted for publication November 10, 2003.

^* Address for reprints: Christophe Acar, MD, Department of Cardiac Surgery, Hopital de la Salpétrière, 50-56 Bd Vincent Auriol, 75013 Paris, France
c.acar{at}psl.ap-hop-paris.fr

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 I in 61, II in 14, and III in 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.

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