Homograft replacement of the mitral valve in young recipients: mid-term results.
OBJECTIVE
Mitral homograft (MH) can represent an interesting alternative for valve replacement in the young. However, concerns have been expressed about the durability of valve allografts in children. We report our experience with MH replacement in young patients.


METHODS
From 1993 to 1997, 13 young patients aged 3-25 years (mean 15+/-6 years) underwent total mitral valve (MV) replacement with a cryopreserved homograft (CH). All but one had previously undergone one or more cardiac operations. The indications were rheumatic disease (6), acute and subacute endocarditis (2), congenital heart disease (4), and systemic lupus endocarditis (1).


RESULTS
No in hospital deaths are reported. Discharge echocardiogram showed a well-functioning MH in all but one patient. One patient was lost to follow-up. Follow-up ranged from 0.7 to 6.6 years (4.1+/-2.2). On follow-up two patients were doing well. Two patients died without reoperation and both had MV stenosis. Seven patients (54%) required reoperation: mean delay 4.17 years (0.7-7). In all cases, thickening, shrinking and calcification of the allograft were present. None of these seven had contributive histopathologic changes. One patient presenting recurrent MV insufficiency will require a reoperation.


CONCLUSIONS
MV homograft is a safe and reproducible technique, but does not provide durable results and should not be used in young patients.
Chauvaud
S
S
Department of Cardiovascular Surgery, Hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015 Paris, France. sylvain.chauvaud@egp.ap-hop-paris.fr
Waldmann
T
T
d'Attellis
N
N
Bruneval
P
P
Acar
C
C
Gerota
J
J
Jarraya
M
M
Carpentier
A
A
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015925:Cryopreservation; D017548:Echocardiography, Transesophageal; D005355:Fibrosis; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008943:Mitral Valve / Q000473:pathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000473:pathology / Q000601:surgery*; D014184:Transplantation, Homologous; D016896:Treatment Outcome