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From March 1992 to August 1993, 50 patients underwent mitral valve replacement with the new heterologous stentless mitral bioprosthesis in our institution. The development of this heart valve substitute, its technique of implantation and the results observed in the first group of 50 patients have had us to review the initial experience. The surgical protocol included an accurate mitral valve complex analysis, adequate valve size selection, attachment of the papillary muscle to the new chordal origin and approximation of the stentless mitral to the patient's annulus. There was one hospital death (2%), not related to the valve or to the technique and four reoperations: two due to endocarditis, one because of a perivalvular leak and one due to a mismatched stentless valve. The late mortality (4%) was not valve-related. The follow-up has shown excellent valve performance with improved left ventricular function in the great majority of the patients. Based on the current analysis, it can be stated that reproducibility of the surgical technique and the excellence of the clinical follow-up may contribute favorably to a better quality of life and longer valve durability in patients requiring mitral heart valve replacement.

Bovine pericardial (BP) grafts have been clinical use at Biocor Hospital since 1989 for replacement or repair of the ascending aorta (AsAo) and initial segment of the aortic arch (AoAr). The main advantages of BP grafts that have justified their clinical application are much easier surgical technique, perfect hemostasis and low cost. From Feb/89 to Feb/94, 88 BP grafts were implanted in the AsAo or the AoAr. There were 33 valved conduits, 47 non-valved conduits and 8 patches. The main indication for the procedure was acute dissection of the aorta, accounting for 50% of the cases. The total hospital mortality was 20.4%. Follow-up was obtained in all but two patients. Patients who survived 2 or more years postoperatively (n = 31) underwent either an echocardiographic or an angiographic study in order to access the behavior of the graft, which was perfect in all of them. The current follow-up is short and complications such as calcification may still develop. However the present study has clearly shown the superior handling and better hemostasis of BP grafts compared to the classical Dacron prosthesis.