Replacement of heart valves with frame-mounted tissue grafts

Abstract

Ionescu, M. I., Pakrashi, B. C., Mary, D. A. S., Bartek, I. T., and Wooler, G. H. (1974). Thorax, 29, 56-67. Replacement of heart valves with frame-mounted tissue grafts. Between April 1969 and March 1973, 213 patients had heart valve replacement with frame-mounted autologous or homologous fascia lata or with heterologous pericardial grafts. There were 111 single aortic, 95 single mitral, and seven tricuspid valve replacements. The incidence of hospital and late mortality was each 10% for the entire series 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 cardiothoracic ratio and in the voltage of the electrocardiogram. Regurgitant murmurs developed in 11·6% of aortic patients and in 51·6% after mitral replacement (in 37·5% the murmur has not increased in intensity while in 14·1% it has gradually progressed). None of these mitral patients requires 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 six grafts have been removed due to failure. All six were made of autologous fascia and all showed varying degrees of thickening and retraction of cusps. There were six episodes of peripheral embolization (five transient) and one left atrial thrombosis. All seven patients are alive. Anticoagulants were not used. The results of haemodynamic studies and in vitro 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 of up to 54 months post-operatively has shown encouraging results.