Clinical report on stentless mitral allografts.

Three patients aged 43, 64 and 54 years (two females and one male) underwent allograft mitral valve replacement including the subvalvular apparatus in 1984 at the Department of Cardiovascular Surgery, University of Kiel. Transpapillary epicardial suture technique was used to support the graft-native papillary muscle union site. Early postoperative course was uneventful in all three patients. There was no early or late postoperative death. Trivial mitral regurgitation was recorded by color Doppler echocardiography but it was not progressive. The regurgitant volume measured at the postoperative catheterization by videodensitometry was less than 10% of the total stroke volume. Two patients were in NYHA class II, nine and 44 months and the third patient was in class III two months after the operation before they suddenly developed severe mitral incompetence which led to emergency reoperations and explantation of their grafts. The early graft failures (two and nine months after insertion) were due to chordal rupture caused by technical error in one and endocarditis in the other, while the late graft failure (44 months after operation) was due to rupture of the scarred graft papillary muscle. No postoperative anticoagulation was given while the homograft mitral valves were in place, and thromboembolic episodes were not observed during that period. All the three patients are alive with prosthetic valves. Although the stentless mitral allograft reinstituted the functional unit of the native mitral valve after replacement and was non-thrombogenic, the graft failure was sudden and unpredictable.(ABSTRACT TRUNCATED AT 250 WORDS)