Heart valve replacement with reinforced aortic heterografts. Technique and results.

Summary Because of the disadvantages connected with the use of prosthetic valves, a technique for heart valve replacement was developed using reinforced heterologous aortic valves. Two types of graft were used clinically. One of them, a reconstructed aortic valve reinforced with a semirigid Teflon ring, was used for mitral valve replacement only. The second one, an aortic valve attached to a Dacron-covered titanium frame, was used for replacing the mitral, aortic, and tricuspid valves. The technique for preparing and inserting these grafts is briefly described. Since February, 1967, 63 patients were operated upon by means of this technique. In 48 patients the mitral valve was replaced, in 9 the aortic, in 3 the mitral and tricuspid valves, in 2 the mitral, aortic and tricuspid valves, and in 1 patient the tricuspid valve only. There have been thirteen deaths. Ten patients died within the first 6 weeks postoperatively from causes not related to the graft, and 3 died 7, 8, and 16 weeks, respectively, after the operation because of graft failure. These 3 patients were operated upon early in this series and had the grafts reinforced with a Teflon ring. Fifty patients were greatly benefited by surgery. No systemic embolization occurred, although anticoagulants were not used for more than 4 to 6 weeks postoperatively. Data concerning follow-up studies up to 14 months since the operation are presented to evaluate the results obtained (clinical condition, mechanograms, catheter findings, angiography). Technical and biologic reasons for using this method are given and the long-term fate of devitalized aortic heterografts as heart valve replacement, with clinical and experimental data, is discussed. The authors are grateful to Miss M. Gallagher, Miss E. Loach, and Miss P. Massey, Dr. Y. A. S. Mashhour, Dr. B. J. Garcia, and Dr. A. Barankay for their help in the operating theatre and in the postoperative management of these patients.