1. Long-term Performance of Fresh Autologous Pericardium for Mitral Valve Leaflet Repair
- Author
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Mehrdad Ghoreishi, James S. Gammie, Nathaniel Foster, Chetan Pasrija, Libin Wang, Rachael W. Quinn, and Murtaza Y. Dawood
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Heart Valve Diseases ,030204 cardiovascular system & hematology ,Dehiscence ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,medicine ,Humans ,Endocarditis ,cardiovascular diseases ,Cardiac Surgical Procedures ,Survival rate ,Retrospective Studies ,Mitral valve repair ,Mitral regurgitation ,business.industry ,Calcinosis ,Mitral Valve Insufficiency ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,030228 respiratory system ,Infective endocarditis ,cardiovascular system ,Mitral Valve ,Female ,Cardiology and Cardiovascular Medicine ,business ,Pericardium ,Calcification - Abstract
Background Glutaraldehyde-fixed autologous or bovine pericardial patches used for mitral valve leaflet reconstruction have been associated with late calcification. Fresh autologous pericardium (FAP) may be a durable alternative. Methods Transthoracic echocardiography was used to assess valve function (regurgitation, mean pressure gradient, patch pliability, and calcification) in patients undergoing FAP mitral leaflet repairs. Pliability was scored between 1 (similar to native leaflets) and 4 (rigid). Calcification was scored between 1 (echobrightness similar to native leaflets) and 4 (very bright). Results Between 2002 and 2018, 62 consecutive patients (50% male, 51 ± 2 years, 69% infective endocarditis) underwent mitral valve repair with FAP, and Patch placement was on the anterior (31 of 62), posterior (27 of 62), or both (1 of 62) leaflets. Late echocardiographic follow-up was available for 43 of 62 patients (median follow-up, 3.6 years; range, 0.5-6 years). Average pliability scores were unchanged between discharge (1.2 ± 0.1) and follow-up (1.2 ± 0.2, P = .79). Average brightness scores increased modestly (predischarge, 1.6 ± 0.1; follow-up, 1.8 ± 0.1; P = .01). Three patients had recurrent severe mitral regurgitation, and 2 underwent reoperation, 1 at 1 year postoperatively for recurrent endocarditis and 1 at 6 years postoperatively for degenerative disease progression. At reoperation, patches were pliable, free from calcification, and comparable in thickness to adjacent native leaflet. One patient developed suture line leak, which was repaired. No other evidence of patch dehiscence, retraction, or aneurysm was observed. The 10-year freedom from reoperation of 82% and survival rate of 84% are comparable to repair with glutaraldehyde-fixed or bovine pericardial patches. Conclusions FAP is an excellent substrate for complex mitral valve leaflet patch repairs and can be used with the expectation of durable, long-term valve function, without evidence of late patch calcification, stiffness, or aneurysmal degeneration.
- Published
- 2020