Fresh autologous pericardium for leaflet perforation repair in mitral valve infective endocarditis.
OBJECTIVE
There is clear evidence that mitral valve (MV) repair is superior to replacement for MV infective endocarditis (IE). Leaflet perforation is a common pathologic finding in MV IE, and leaflet patch repair with glutaraldehyde-treated autologous or bovine pericardium is the currently accepted method of MV repair. In the present study, fresh autologous pericardium (FAP) was used universally to treat leaflet perforation in MV IE, and the mid-term clinical and echocardiographic outcomes were determined.


METHODS
Between 2002 and 2009, a total of 20 patients with leaflet perforations from MV IE underwent patch repair with FAP. Follow up echocardiography was performed in a core laboratory.


RESULTS
There was one operative death (5%) secondary to sepsis, and three late deaths (15%). Late echocardiograms were available for review from 16 of the 19 patients (84%) who survived surgery. The mean time to follow up echocardiography was 793 +/- 663 days. The mitral regurgitation (MR) grade was mild or less in 14/16 patients (88%), moderate in one patient (6%), and severe in one patient (6%). The mean gradient was 4.8 +/- 2.7 mmHg, and the ejection fraction was preserved in all patients (63 +/- 4%). No expansion, retraction or calcification of the patches was observed. Freedom from reoperation, reinfection and thromboembolism was 100%.


CONCLUSIONS
Fresh autologous pericardium for MV leaflet patch repair in IE is associated with good mid-term valve function. Given the association between late calcification and the glutaraldehyde treatment of bioprosthetic valves and this favorable experience, it is believed that FAP is an acceptable alternative for leaflet repair in MV IE.
Department of Surgery, Division of Cardiac Surgery, The University of Maryland School of Medicine, Baltimore, MD 20201, USA.
Charles F
CF
Evans
Christopher R
CR
DeFilippi
Eric
E
Shang
Bartley P
BP
Griffith
James S
JS
Gammie
D000328:Adult; D002114:Calcinosis / Q000209:etiology / Q000517:prevention & control; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D004452:Echocardiography / Q000379:methods; D004697:Endocarditis, Bacterial / Q000150:complications*; D005260:Female; D005976:Glutaral / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D008991:Monitoring, Physiologic / Q000379:methods; D010496:Pericardium / Q000187:drug effects / Q000637:transplantation; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D016019:Survival Analysis; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control; D014182:Transplantation, Autologous / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome
D005976:Glutaral