Implantation of cryopreserved mitral allograft into the tricuspid position in an experimental study in sheep: technical aspects of implantation and immediate results evaluated by epicardial echocardiography.
OBJECTIVE
Cryopreserved mitral allograft valve (MAV) offers theoretical advantages over conventional mechanical or biological prostheses in tricuspid position, especially in infectious endocarditis patients. MAV processing and tricuspid valve (TV) replacement in a sheep model is described.


RESULTS
In 20 adult sheep, MAV were harvested, processed and cryopreserved. One month later, recipient's TV were excised and the MAVs were transplanted into the tricuspid position in 13 sheep, under general anaesthesia, via a right thoracotomy, with an extracorporeal circulation (ECC) and cardioplegic heart arrest. Both MAV papillary muscles were anchored into the right ventricular wall by transmural stitches and the MAV anulus was sewn into the recipient's tricuspid anulus. After weaning from ECC, the anatomy and function of the MAV in the tricuspid position was assessed by epicardial echocardiography. The average duration of the ECC was 58 minutes (42-88), the cardioplegic heart arrest was 36 minutes (28-45). Weaning from EEC was always uneventful. Right atrial & pulmonary artery pressure measurements and epicardial echocardiography documented good function of all MAVs.


CONCLUSIONS
MAV remained mechanically strong enough for implantation into the tricuspid position. Reproducible technique of MAV transplantation into the tricuspid position with excellent early postoperative haemodynamic performance was developed.
Vojácek
J
J
Department of Cardiac Surgery & Transplant Centre, University Hospital Motol. j.vojacek@fnmotol.cz
Mokrácek
A
A
Spatenka
J
J
Vambera
M
M
Sulda
M
M
Setina
M
M
Burkert
J
J
Pavel
P
P
Pepper
J
J
D000818:Animals; D001705:Bioprosthesis; D001794:Blood Pressure / Q000502:physiology; D015925:Cryopreservation; D004452:Echocardiography; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging / Q000601:surgery; D006325:Heart Atria / Q000000981:diagnostic imaging; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006352:Heart Ventricles / Q000601:surgery; D008943:Mitral Valve; D010210:Papillary Muscles / Q000000981:diagnostic imaging / Q000601:surgery; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D012756:Sheep; D013537:Sutures; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000601:surgery*