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Heart, Lung and Circulation

Auto-Pericardial Mitral Valve Implantation: A Pilot Study

Published:October 13, 2021DOI:https://doi.org/10.1016/j.hlc.2021.09.015

      Introduction

      Developing nations continue to grapple with rheumatic heart disease, particularly in the young. There is a need for an alternative to prosthetic mitral valve replacement in irreparable mitral valves, which avoids the need for anticoagulation and risks of thromboembolism.

      Methods

      Twelve (12) patients with irreparable severe mitral valve disease underwent auto-pericardial mitral valve implantation from August 2020 to February 2021. The mitral valve leaflets were excised. Autologous pericardium treated with 0.5% glutaraldehyde for 8 minutes was fashioned into anterior and posterior mitral leaflets as per the dimensions on an indigenously designed template based on the studies by Ranganathan and Lam. The pericardial leaflets were sutured onto an appropriately sized mitral annuloplasty ring. The ring with the leaflets was implanted onto the mitral annulus. The leaflets were supported with neo-chordae prepared with Gore-Tex (W L Gore and Associates, Inc. Newark, DE, USA) and polyester sutures to mimic a repaired mitral valve in its structure and dynamics.

      Results

      The mean cross-clamp time was 138±21.7 minutes. None of the patients required re-exploration. On the third postoperative day, a mean mitral valve orifice area of 3±0.47 cm and mean mitral valve gradient of 2±1.04 were observed. None of the patients had any more than 1+ mitral regurgitation. None of them have required a re-intervention for mitral insufficiency to date.

      Discussion

      Auto-pericardial mitral valve re-implantation is a safe and effective procedure for severe, irreparable, mitral valve pathologies. However, the mid-term and long-term results need to be compared with conventional mitral valve replacement with a prosthetic valve in a randomised controlled trial.

      Keywords

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      References

        • Galloway A.C.
        • Colvin S.B.
        • Baumann F.G.
        • Grossi E.A.
        • Ribakove G.H.
        • Harty S.
        • et al.
        A comparison of mitral valve reconstruction with mitral valve replacement: intermediate-term results.
        Ann Thorac Surg. 1989; 47: 655-662
        • Sand M.E.
        • Naftel D.C.
        • Blackstone E.H.
        • Kirkhn J.W.
        • Karp R.B.
        A comparison of repair and replacement for mitral valve incompetence.
        J Thorac Cardiovasc Surg. 1987; 94: 208-219
        • Perier P.
        • Deloche A.
        • Chauvaud S.
        • Fabiani J.N.
        • Rossant P.
        • Bessou J.P.
        • et al.
        Comparative evaluation of mitral valve repair and replacement with Starr, Bjork and porcine valve prostheses.
        Circulation. 1984; 70: 1-187
        • Lee E.M.
        • Shapiro L.M.
        • Wells F.C.
        Superiority of mitral valve repair in surgery for degenerative mitral regurgitation.
        Eur Heart J. 1997; 18: 655-663
        • David T.E.
        • Armstrong S.
        • Zhao S.
        • Daniel L.
        Late results of mitral valve repair for mitral regurgitation due to degenerative disease.
        Ann Thorac Surg. 1993; 56: 7-14
        • Orszulak T.A.
        • Schaff H.V.
        • Danielson G.K.
        • Piehler J.M.
        • Pluth J.R.
        • Frye R.L.
        • et al.
        Mitral regurgitation due to ruptured chordae tendinae. Early and late results of valve repair.
        J Thorac Cardiovasc Surg. 1985; 89: 491-498
        • Duran C.G.
        • Revuelta J.M.
        • Gaite L.
        • Alonso C.
        • Fleitas M.G.
        Stability of mitral reconstructive surgery at 10-12 years for predominantly rheumatic valvular disease.
        Circulation. 1988; 78: 1-91-1-96
        • Duran C.M.G.
        • Gometza B.
        • De Vol E.B.
        Valve repair in rheumatic mitral disease.
        Circulation. 1991; 84: III-125-III-132
        • Skoularigis J.
        • Sinovich V.
        • Joubert G.
        • Sareli P.
        Evaluation of the long-term results of mitral valve repair in 254 young patients with rheumatic mitral regurgitation.
        Circulation. 1994; 90: II-167-II-174
        • Fernandez J.
        • Joyce D.H.
        • Hirshfield K.J.
        • Chen C.
        • Yang S.S.
        • Laub G.W.
        • et al.
        Valve-related events and valve-related mortality in 340 mitral valve repairs. A late phase follow-up study.
        Eur J Cardiothorac Surg. 1993; 7: 263-270
      1. (Multiple authors and papers). Sections on 'Stented heterografts (porcine)' and 'Stented heterografts (pericardium).
        Ann Thorac Surg. 1995; 60: S205-S316
        • Piper C.
        • Schulte H.D.
        • Horstkotte D.
        Optimization of oral anticoagulation for patients with mechanical heart valves.
        J Heart Valve Dis. 1995; 4: 127-137
        • Deac R.F.P.
        • Simionescu D.
        • Deac D.
        New evolution in mitral physiology and surgery: mitral stentless pericardial valve.
        Ann Thorac Surg. 1995; 60: S433-S438
        • Lam J.H.C.
        • Ranganathan N.
        • Wigle E.D.
        • Silver M.D.
        Morphology of the human mitral valve. I. Chordae tendineae: a new classification.
        Circulation. 1970; 41: 449-458
        • Lam J.H.C.
        • Ranganathan N.
        • Wigle E.D.
        • Silver M.D.
        Morphology of the human mitral valve II. The valve leaflets.
        Circulation. 1970; 41: 459-467
        • Frater R.W.
        Stentless mitral valves.
        J Thorac Cardiovasc Surg. 2007; 133: 861-864
        • Navia J.L.
        • Doi K.
        • Atik F.A.
        Acute evaluation of in vivo performance of new stentless mitral valves.
        J Thorac Cardiovasc Surg. 2007; 133: 986-994
        • Frater R.M.W.
        • Sussman M.
        • Middlemost S.
        • Walther T.
        • Mohr F.
        • Al Halees Z.
        • et al.
        Quattro valve trial at midterm: Dec 1996-Nov 2004.
        J Heart Valve Dis. 2006; 15: 230-237
        • Vijayan J.
        • Lachma R.N.
        • Mohan Rao P.S.
        • Bhat A.S.
        Autologous pericardial aortic valve reconstruction: early results and comparison with mechanical valve replacement.
        Indian J Thorac Cardiovasc Surg. 2020; 36: 186-192
        • Zhurko S.
        • Olzhayev F.
        • Gamzaev A.
        • Fedorov S.
        • Pimenova P.
        Original methodology of annuloplasty of the mitral valve with a stabilized autopericardium in degenerative heart diseases.
        2020 (International conference “Modern Perspectives For Biomedical Sciences: From Bench To Bedside”; National Laboratory Astana)
        • Chachques J.C.
        • Vasseur B.
        • Perier I.’
        • Balansa J.
        • Chauvaud S.
        • Carpentier A.
        A rapid method to stabilize biological material for cardiovascular surgery.
        Ann NY Acad Sci. 1988; 529: 184-186
        • Kasegawa H.
        • Ushijima T.
        • Takanashi S.
        A repair-like replacement for unrepairable mitral valve.
        Structural Heart. 2021; 5: 4
        • Ozaki S.
        • Kawase I.
        • Yamashita H.
        • Uchida S.
        • Nozawa Y.
        • Takatoh M.
        • et al.
        A total of 404 cases of aortic valve reconstruction with glutaraldehyde-treated autologous pericardium.
        J Thorac Cardiovasc Surg. 2014; 147: 301-306
        • Mohan Rao P.S.
        Autopericardial mitral valve reconstruction: how I do it. April 2020.
        • Ali Sabzi F.I.
        • Gasparyan V.C.
        Gasparyan method of total autologous reconstruction of the mitral valve: case report.
        Cardiovasc Thorac Surg. 2020; 5: 1-3
        • Kasegawa H.
        • Tabata M.
        • Shimizu A.
        • Naito K.
        • Fukui T.
        • Takanashi S.
        A new type of mitral valve operation using a novel stentless mitral valve made from autologous pericardium for unrepairable valve.
        J Heart Valve Dis. 2015; 24 (PMID: 26182620): 53-56