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J Thorac Cardiovasc Surg 1996;112:1407-1408
© 1996 Mosby, Inc.

LETTERS TO THE EDITOR

Extended survival with a porcine mitral valve bioprosthesis

John J. Trujillo, MD, Ramiro de la Llana, MD, Fernando O'Connor, MD, Ali Alswies, MD, Manuel Gil-Aguado, MD

Department of Cardiac Surgery
Hospital Universitario San Carlos
Universidad Complutense
Madrid, Spain

To the Editor:

We are reporting what we believe to be the longest survival after mitral valve replacement (MVR) with a porcine bioprosthesis. The patient was operated on in our institution.

A 57-year old woman had undergone MVR on March 12, 1976, at the age of 38 years, with a 29 mm glutaraldehyde-fixed Hancock I porcine bioprosthesis (Johnson & Johnson Cardiovascular, King of Prussia, Pa.). One year before her current admission, having previously been doing well, she began having progressive dyspnea, orthopnea, and edema. A two-dimensional echocardiogram showed moderate stenosis with a 1.5 cm2 prosthetic area, a transmitral gradient of 6 mm Hg, no incompetence, and tricuspid regurgitation with pulmonary hypertension (pulmonary artery pressure 45 mm Hg). The chest x-ray film showed vascular redistribution with a severely increased heart size, and the electrocardiogram indicated controlled atrial fibrillation.

Reoperation was performed on October 25, 1995, 19 years after the initial MVR. The porcine mitral bioprosthesis was successfully replaced with a 29 mm St. Jude Medical valve (St. Jude Medical, Inc., St. Paul, Minn.), and tricuspid annuloplasty with a Gomez-Duran 31 mm ring (Medtronic Cardiovascular Surgery, Minneapolis, Minn.) was performed. On gross inspection, the explanted Hancock I porcine bioprosthesis was stenotic as a result of fibrosis, pannus, and severe calcification. After gross examination, the manufacturers said that the left cusp was flexible and the right and noncoronary cusps were partially flexible. Tears and abrasions associated with visible mineralization were noted on the inflow and outflow portions of the valve. The roentgenograms showed moderate areas of mineralization over all commissures and over the right cusp near the septal shelf.

The Hancock porcine bioprostheses have a limited durability because of progressive structural deterioration.Go Go 1-3 The findings in this case indicate that this valve performed very well for a bioprosthetic valve that had been implanted for almost 20 years in a patient. Occasionally, such devices may offer extended durability.Go 4

References

  1. Bortolotti U, Milano A, Mazzucco A, Valfré C, Fasoli C, Valente M, et al. Longevity of the formaldehyde-preserved Hancock porcine heterograft. J THORAC CARDIOVASC SURG1982;84:451-53.
  2. Milano A, Bortolotti U, Talenti E, Valfré C, Arbustini E, Valente M, et al. Calcific degeneration as the main cause of porcine bioprosthetic valve failure. Am J Cardiol 1984;53:1066-70.[Medline]
  3. Bortolotti U, Talenti E, Milano A, Thiene G, Galluci V. Formaldehyde vs. glutaraldehyde-processed porcine bioprotheses in the aortic valve position: long-term follow-up. Am J Cardiol 1984;54:681-2.[Medline]
  4. Bortolotti U, Milano A, Thiene G, Mazzucco A, Galluci V. Extended survival with a porcine mitral valve bioprosthesis. Chest 1990;98:784.[Medline]



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