British Heart journal, 1975, 37, 1 I23-I 32.
Tissue valves in the mitral position Five years' experience' David A. S. Mary,2 Brojesh C. Pakrashi, Roger W. Catchpole, and Marian I. Ionescu From the Department of Cardiothoracic Surgery, General Infirmary at Leeds, and Leeds University, Leeds
Between April I969 and November I973 103 patients underwent isolated mitral replacement with three-cusp stented tissue valves. Autologous fascia lata was used in 50 patients, homologous fascia lata in 2I, and heterologous pericardium in 32. The early mortality rate (I4.6%) was influenced by age, the extent of preoperative cardiac disability, and low cardiac output. The survivors were followed up for periods varying from 8 to 6o months (average 37 months). In general, a factor in late death (I3.6%) was high preoperative pulmonary artery pressure. In the autologous fascial series valve failure and infective endocarditis were sigmficantly related to late mortality. The results with homologous fascia and pericardium were better than with autologous fascia valves. The incidence ofpostoperative mitral regurgitation was significantly lower in the homologous fascial and pericardial series and none of these grafts had to be removed. The incidence of thromboembolism was low without anticoagulants. Actuarial analysis showed a survival rate at five years of 82.2percent. We no longer use autologous fascial valves. Though better results have been obtained with both homnologous fascia and pericardium we prefer the physical characteristics of heterologous pericardium and it is easy to obtain. Frame-mounted tissue valves for mitral replacement were first used in our departnent in April I969 (Ionescu and Ross, I969). The technique evolved because of dissatisfaction with mechanical prostheses (Duvoisin et al., I968; Mashhour et al., I969; Starr, Herr, and Wood, I967). Advances in operative techniques and better designed valve substitutes have improved the results of mitral replacement (Beall et al., 1972; Behrendt and Austen, I973; Oxman et al., I972; Winter et al., I972; Zerbini, 1973). Mortality rates and the incidence of certain complications, however, are still related to the amount of preoperative cardiac or pulmonary disability (McGoon et al., I973; Nichols et al., I972), the type of lesion (Behrendt and Austen, I973), and the kind of valve substitute used (Cleland and Molloy, 1973; Hylen, 1972; Roberts, Bulkley, and Morrow, I973; Wiliams et al., 1971). Reports of in vitro hydraulic studies (Swales et al., I973), the progress of in vivo haemodynamic values (Ionescu et al., I974), the assessment of valve performance by echocardiography (Mary et Received iI March 975. 1 This work was supported by the British Heart Foundation. 2 Present address: Cardiovascular Unit, Department of Physiology, University of Leeds, Leeds LS2 9JT.
al., MO74b), the incidence of clinical postoperative complications, and the histopathological fate of mitral stented tissue valves (Ionescu et al., I974) have been published. We report here our five years' experience of isolated mitral replacement with stented fascia lata and pericardial valves. Patients and methods From April I969 to November 1973 mitral replacement with stented tissue valves was undertaken in 103 patients, of whom 45 were men and 58 women. Their ages (Table I) ranged between 9 and 68 years with a mean (± SEM) of 44.5±+I years. The mean ages of patients with mitral stenosis (46 years) and mixed valve disease (44 years) were essentially the same as each other (P > 0.3) but lower (P < 0.05 and P
Tissue valves in the mitral position Five years' experience' David A. S. Mary,2 Brojesh C. Pakrashi, Roger W. Catchpole, and Marian I. Ionescu From the Department of Cardiothoracic Surgery, General Infirmary at Leeds, and Leeds University, Leeds
Between April I969 and November I973 103 patients underwent isolated mitral replacement with three-cusp stented tissue valves. Autologous fascia lata was used in 50 patients, homologous fascia lata in 2I, and heterologous pericardium in 32. The early mortality rate (I4.6%) was influenced by age, the extent of preoperative cardiac disability, and low cardiac output. The survivors were followed up for periods varying from 8 to 6o months (average 37 months). In general, a factor in late death (I3.6%) was high preoperative pulmonary artery pressure. In the autologous fascial series valve failure and infective endocarditis were sigmficantly related to late mortality. The results with homologous fascia and pericardium were better than with autologous fascia valves. The incidence ofpostoperative mitral regurgitation was significantly lower in the homologous fascial and pericardial series and none of these grafts had to be removed. The incidence of thromboembolism was low without anticoagulants. Actuarial analysis showed a survival rate at five years of 82.2percent. We no longer use autologous fascial valves. Though better results have been obtained with both homnologous fascia and pericardium we prefer the physical characteristics of heterologous pericardium and it is easy to obtain. Frame-mounted tissue valves for mitral replacement were first used in our departnent in April I969 (Ionescu and Ross, I969). The technique evolved because of dissatisfaction with mechanical prostheses (Duvoisin et al., I968; Mashhour et al., I969; Starr, Herr, and Wood, I967). Advances in operative techniques and better designed valve substitutes have improved the results of mitral replacement (Beall et al., 1972; Behrendt and Austen, I973; Oxman et al., I972; Winter et al., I972; Zerbini, 1973). Mortality rates and the incidence of certain complications, however, are still related to the amount of preoperative cardiac or pulmonary disability (McGoon et al., I973; Nichols et al., I972), the type of lesion (Behrendt and Austen, I973), and the kind of valve substitute used (Cleland and Molloy, 1973; Hylen, 1972; Roberts, Bulkley, and Morrow, I973; Wiliams et al., 1971). Reports of in vitro hydraulic studies (Swales et al., I973), the progress of in vivo haemodynamic values (Ionescu et al., I974), the assessment of valve performance by echocardiography (Mary et Received iI March 975. 1 This work was supported by the British Heart Foundation. 2 Present address: Cardiovascular Unit, Department of Physiology, University of Leeds, Leeds LS2 9JT.
al., MO74b), the incidence of clinical postoperative complications, and the histopathological fate of mitral stented tissue valves (Ionescu et al., I974) have been published. We report here our five years' experience of isolated mitral replacement with stented fascia lata and pericardial valves. Patients and methods From April I969 to November 1973 mitral replacement with stented tissue valves was undertaken in 103 patients, of whom 45 were men and 58 women. Their ages (Table I) ranged between 9 and 68 years with a mean (± SEM) of 44.5±+I years. The mean ages of patients with mitral stenosis (46 years) and mixed valve disease (44 years) were essentially the same as each other (P > 0.3) but lower (P < 0.05 and P
