Biological tissue heart valve replacement

Abstract

Between April 1969 and September 1973 241 patients had heart valve replacement with frame-mounted autologous or homologous fascia lata or with heterologous pericardial grafts. There were 131 single aortic 103 single mitral and 7 tricuspid valve replacements.

The incidence of each hospital and late mortality for the entire series was 10% and the main causes were myocardial failure and infective endocarditis.

The majority of patients obtained significant symptomatic improvement. In patients with aortic replacement there was a statistically significant reduction in cardio-thoracic ratio and in the voltage of the electrocardiogram.

Regurgitant murmurs developed in 12.6% of aortic patients and in 45.5% after mitral replacement (in 33.1% the murmur has not increased in intensity while in 12.4% it has gradually progressed). None of these mitral patients require reoperation. Grafts in the tricuspid position have not shown signs of dysfunction or failure. Graft failure has not occurred in the aortic replacement series. From the mitral position 6 grafts have been removed due to failure. All 6 were made of autologous fascia and all showed varying degrees of thickening and retraction of cusps. There were 6 episodes of peripheral embolisation (5 transient) and one left atrial thrombosis. All 7 patients are alive. Anticoagulants were not used.

The results of haemodynamic studies and invitro hydrodynamic experiments are discussed and an explanation for graft dysfunction in the mitral position is presented.

The actuarial analysis of this series of patients over a period up to 57 months post-operatively has shown encouraging results.