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J Thorac Cardiovasc Surg 2009;138:359-364
© 2009 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Mitral valve replacement with the pulmonary autograft: Midterm results

Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India

Received for publication July 12, 2008; revisions received September 21, 2008; accepted for publication November 25, 2008.

^_* Address for reprints: Arkalgud Sampath Kumar, MCh, Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India. (Email: asampath_kumar{at}hotmail.com).

Objective: We performed mitral valve replacement with a pulmonary autograft using the technique described by us earlier and present the results.

Methods: Between August 2000 and July 2007, 19 patients (16 male patients; age, 30–58 years) with isolated calcific mitral stenosis (n = 16) or mixed mitral stenosis and regurgitation (n = 3) underwent mitral valve replacement with a pulmonary autograft. Sixteen patients were in New York Heart Association class III and 3 were in New York Heart Association class IV preoperatively. Eight patients were in atrial fibrillation. The autograft implantation was achieved by using a scalloped stent of polytetrafluoroethylene felt for external support of the autograft. No anticoagulants were prescribed.

Results: There were 3 early deaths, one each caused by ventricular dysfunction, ventricular arrhythmias, and autograft dehiscence requiring early reoperation. Follow-up of survivors ranged from 34 to 99 months (mean, 71.9 ± 18.2 months; median, 75 months). The mean valve area was 2.96 ± 0.9 cm² (range, 2.2–4.3 cm²). Fourteen survivors are in New York Heart Association class I, and 2 are in NYHA class II; 4 continue to be in atrial fibrillation. Follow-up echocardiograms (n = 16), magnetic resonance imaging (n = 6), and cardiac catheterization (n = 4) have demonstrated no significant autograft and pulmonary homograft dysfunction. There were no late deaths or reoperations or thromboembolic complications.

Conclusions: Mitral valve replacement with a pulmonary autograft, a complex operation, can be performed in selected patients with acceptable results. The use of our technique of autograft implantation offers several advantages and avoids exposure of the scaffold to the bloodstream.