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Long-Term Structural Valve Degeneration in Cryopreserved Mitral and Aortic Homograft: Is Pregnancy a Factor?

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DOI: 10.4236/wjcd.2014.46036    2,438 Downloads   3,342 Views  

ABSTRACT

Objective: This study reports the outcomes of the cryopreserved mitral homograft in 119 patients prospectively followed with clinical, echocardiographic and structural valve deterioration assessments. Methods: 119 patients undergoing mitral and aortic homograft implantation. Patient’s causes of mitral disease were: rheumatic disease (n = 75), endocarditis (n = 37) and others (n = 7). There were 40 partial homografts and 88 total homografts. Mitro-aortic homograft valve replacement was performed in 29 cases. Results: Mean follow-up was 9.8 ± 6.3 years (up to 19.2 yrs). There were 7 early (<3 months) and 16 late deaths. There have been 9 early (<3 months) and 35 late reoperations. Nine patients had an endocarditis and 6 had ischemic/haemorrhagic event. As compared to baseline, follow-up echography showed progression of MR grade (from 0.4 to 1.3 p < 0.001) with stenosis (elevated gradient: from 3.9 to 7.0 mmHg p < 0.001 and decreased valve area: from 2.3 to 1.7 cm2 p < 0.001). Proportion of patients free from structural valve deterioration (SVD) was 90%, 76% and 65% at 5 years, 10 years and 15 years respectively. Pregnancy and endocarditis etiology were found to be the main determinants of SVD. Stenosis related to SVD was more pronounced for age < 40 years and ring size 30 mm. Mitro aortic homograft valve replacement was the preferred choice in complex infective endocarditis. Pathological analysis of the explanted homografts almost invariably showed dense fibrosis with calcification and no cellularity. Conclusion: Mitral homografting could be accomplished with early echographic results similar to those of valve repair. SVD produced mixed stenosis with insufficiency and its incidence was comparable to that of bioprostheses SVD. An improvement in the preservation mode of valvular homografts is warranted. Double cryopreserved homograft implantation in the context of infective endocarditis might be an effective strategy especially if the mitro-aortic continuity is involved. However, a particular attention should be paid to in women in childbearing age because pregnancy might accelerate structural degeneration of the cryopreserved homografts.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Nappi, F. , Spadaccio, C. , Chello, M. , Lusini, M. and Acar, C. (2014) Long-Term Structural Valve Degeneration in Cryopreserved Mitral and Aortic Homograft: Is Pregnancy a Factor?. World Journal of Cardiovascular Diseases, 4, 277-286. doi: 10.4236/wjcd.2014.46036.

References

[1] Sievers, H.H., Lange, P.E., Yankah, A.C., Wessel, A. and Bernhard, A. (1985) Allogeneous Transplantation of the Mitral Valve. An Open Question. The Thoracic and Cardiovascular Surgeon, 33, 227-229.
http://dx.doi.org/10.1055/s-2007-1014126
[2] Kumar, A.S. and Trehan H. (1994) Homograft Mitral Valve Replacement—A Case Report. The Journal of Heart Valve Disease, 3, 473-475.
[3] Acar, C., Farge, A., Ramsheyi, A., Chachques, J.C., Mihaileanu, S., Gouezo, R., Gerota, J. and Carpentier, A.F. (1994) Mitral Valve Replacement Using a Cryopreserved Mitral Homograft. The Annals of Thoracic Surgery, 57, 746-748.
http://dx.doi.org/10.1016/0003-4975(94)90582-7
[4] Acar, C., Tolan, M., Berrebi, A., Gaer, J., Gouezo, R., Marchix, T., Gerota, J., Chauvaud, S., Fabiani, J.N., Deloche, A. and Carpentier, A. (1996) Homograft Replacement of the Mitral Valve. Graft Selection, Technique of Implantation, and Results in Forty-Three Patients. The Journal of Thoracic and Cardiovascular Surgery, 111, 367-380.
http://dx.doi.org/10.1016/S0022-5223(96)70446-4
[5] Ali, M., Iung, B., Lansac, E., Bruneval, P. and Acar, C. (2004) Homograft Replacement of the Mitral Valve: Eight-Year Results. The Journal of Thoracic and Cardiovascular Surgery, 128, 529-534.
http://dx.doi.org/10.1016/j.jtcvs.2003.11.076
[6] Doty, D.B. and Acar, C. (1998) Mitral Valve Replacement with Homograft. The Annals of Thoracic Surgery, 66, 2127-2131.
http://dx.doi.org/10.1016/S0003-4975(98)01089-3
[7] Akins, C.W., Miller, D.C., Turina, M.I., Kouchoukos, N.T., Blackstone, E.H., Grunkemeier, G.L., Takkenberg, J.J., David, T.E., Butchart, E.G., Adams, D.H., Shahian, D.M., Hagl, S., Mayer, J.E. and Lytle, B.W. (2008) Guidelines for Reporting Mortality and Morbidity after Cardiac Valve Interventions. The Journal of Thoracic and Cardiovascular Surgery, 135, 732-738.
http://dx.doi.org/10.1016/j.jtcvs.2007.12.002
[8] Amado-Cattaneo, R. (1998) Combined Mitral and Aortic Homograft Valve Replacement for Acute Bacterial Endocarditis. Ann Thorac Surg, 66, 267-268.
http://dx.doi.org/10.1016/S0003-4975(98)00406-8
[9] Reardon, M.J., Vinnerkvist, A. and LeMaire, S.A. (1999) Mitral Valve Homograft for Mitral Valve Replacement in Acute Bacterial Endocarditis. The Journal of Heart Valve Disease, 8, 71-73.
[10] Plunkett, M.D., Schneider, D.J., Shah, J.J., Bash, S.E., Bond, L.M. and Geiss, D.M. (1998) Homograft Replacement of Mitral Valve in Children. The Annals of Thoracic Surgery, 66, 849-852.
http://dx.doi.org/10.1016/S0003-4975(98)00645-6
[11] Doty, D.B., Flores, J.H., Doty, J.R. and Millar, R.C. (1999) Mitral Valve Replacement with Homograft. Seminars in Thoracic and Cardiovascular Surgery, 11, 191-193.
[12] Gulbins, H., Kreuzer, E., Uhlig, A. and Reichart, B. (2000) Mitral Valve Surgery Utilizing Homografts: Early Results. The Journal of Heart Valve Disease, 9, 222-229.
[13] Yankah, A.C., Sievers, H.H., Lange, P.E. and Bernhard, A. (1995) Clinical Report on Stentless mitral Allografts. The Journal of Heart Valve Disease, 4, 40-44.
[14] Kumar, A.S., Choudhary, S.K., Mathur, A., Saxena, A., Roy, R. and Chopra, P. (2000) Homograft Mitral Valve Replacement: Five Years’ Results. The Journal of Thoracic and Cardiovascular Surgery, 120, 450-458.
http://dx.doi.org/10.1067/mtc.2000.107829
[15] Gulbins, H., Anderson, I., Kilian, E., Schrepfer, S., Uhlig, A., Kreuzer, E. and Reichart, B. (2002) Five Years of Experience with Mitral Valve Homografts. The Thoracic and Cardiovascular Surgeon, 50, 223-229.
http://dx.doi.org/10.1055/s-2002-33094
[16] Jamieson, W.R.E., Marchand, M.A., Pelletier, C.L., Norton, R., Pellerin, M., Dubiel, T.W., Aupart, M.R., Daenen, W.J., Holden, M.P., David, T.E., Ryba, E.A. and Anderson Jr., W.N. (1999) Structural Valve Deterioration in Mitral Replacement Surgery: Comparison of Carpentier-Edwards Supra-Annular Porcine and Perimount Pericardial Bioprostheses. Journal of Thoracic and Cardiovascular Surgery, 118, 297-305.
http://dx.doi.org/10.1016/S0022-5223(99)70220-5
[17] Chauvaud, S., Waldmann, T., d’Attellis, N., Bruneval, P., Acar, C., Gerota, J., Jarraya, M. and Carpentier, A. (2003) Homograft Replacement of the Mitral Valve in Young Recipients: Mid-Term Results. European Journal Cardio-Thoracic Surgery, 23, 560-566.
http://dx.doi.org/10.1016/S1010-7940(03)00003-4
[18] O’Brien, M.F., Harrocks, S., Stafford, E.G., Gardner, M.A., Pohlner, P.G., Tesar, P.J. and Stephens, F. (2001) The Homograft Aortic Valve: A 29-Year, 99.3% Follow up of 1,022 Valve Replacements. Journal of Heart Valve Disease, 10, 334-344.
[19] Hung, L. and Rahimtoola, S.H. (2003) Prosthetic Heart Valves and Pregnancy. Circulation, 107, 1240-1246.
[20] Hanania, G., Thomas, D., Michel, P.L., Garbarz, E., Age, C., Millaire, A. and Acar, J. (1994) Pregnancy and Prosthetic Heart Valves: A French Cooperative Retrospective Study of 155 Cases. European Heart Journal, 15, 1651-1658.
[21] Badduke, B.R., Jamieson, W.R., Miyagishima, R.T., Munro, A.I., Gerein, A.N., MacNab, J. and Tyers, G.F. (1991) Pregnancy and Childbearing in a Population with Biologic Valvular Prostheses. Journal of Thoracic and Cardiovascular Surgery, 102, 179-186.
[22] Nishida, H., Takahara, Y., Takeuchi, S., Mogi, K. and Murayama, H. (2005) Long-Term Evaluation of Bovine Pericardial Bioprostheses in Young Women: Influence of Pregnancy. Japanese Journal of Thoracic and Cardiovascular Surgery, 53, 557-561.
http://dx.doi.org/10.1007/s11748-005-0067-x
[23] Cleuziou, J., Hörer, J., Kaemmerer, H., Teodorowicz, A., Kasnar-Samprec, J., Schreiber, C. and Lange, R. (2010) Pregnancy Does Not Accelerate Biological Valve Degeneration. International Journal of Cardiology, 145, 418-421.
http://dx.doi.org/10.1016/j.ijcard.2010.04.095
[24] Sbarouni, E. and Oakley, C.M. (1994) Outcome of Pregnancy in Women with Valve Prostheses. British Heart Journal, 71, 196-201.
http://dx.doi.org/10.1136/hrt.71.2.196
[25] Jamieson, W.R., Miller, D.C., Akins, C.W., Munro, A.I., Glower, D.D., Moore, K.A. and Henderson, C. (1995) Pregnancy and Bioprostheses: Influence on Structural Valve Deterioration. Annals of Thoracic Surgery, 60, S282-S286.
http://dx.doi.org/10.1016/0003-4975(95)00308-8
[26] Tanaka, H., Okita, Y., Kasegawa, H., Takamoto, S., Tabayashi, K., Yagihara, T., Ueda, Y., Aoyagi, S., Komeda, M., Eishi, K. and Kurosawa, H. (2010) The Fate of Bioprostheses in Middle-Aged Patients: The Japanese Experience. Journal of Heart Valve Disease, 19, 561-567.
[27] Olivito, S., Lalande, S., Nappi, F., Hammoudi, N., D’Alessandro, C., Fouret, P. and Acar, C. (2012) Structural Deterioration of the Cryopreserved Mitral Homograft Valve. Journal of Thoracic and Cardiovascular Surgery, 144, 313-320.
http://dx.doi.org/10.1016/j.jtcvs.2011.06.041
[28] Koolbergen, D.R., Hazekamp, M.G., de Heer, E., Bruggemans, E.F., Huysmans, H.A., Dion, R.A. and Bruijn, J.A. (2002) The Pathology of Fresh and Cryopreserved Homograft Heart Valves: An Analysis of Forty Explanted Homograft Valves. Journal of Thoracic and Cardiovascular Surgery, 124, 689-697.
http://dx.doi.org/10.1067/mtc.2002.124514
[29] Wilhelmi, M.H., Bara, C., Kofidis, T., Wilhelmi, M., Pichlmaier, M. and Haverich, A. (2006) Long-Term Cardiac Allograft Valves after Heart Transplant Are Functionally and Structurally Preserved, in Contrast to Homografts and Bioprostheses. Journal of Heart Valve Disease, 15, 777-782.

  
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