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European Journal of Cardio-Thoracic Surgery, Vol 10, 1090-1096, Copyright © 1996 by European Association for Cardio-thoracic Surgery
AS Geha and JH Lee
OBJECTIVE: The most common indication for reoperation in patients with a
mitral bioprosthetic valve is primary tissue failure. Explanation of the
bioprosthesis is time-consuming and may be complicated by cardiac rupture
at the atrioventricular junction or the posterior left ventricular wall
where a strut is imbedded, injury to the circumflex artery and late
perivalvular leak. A new approach to avoid these complications by excising
only the bioprosthetic tissue and attaching a reversed aortic St. Jude
valve to the intact stent has been developed and evaluated. METHODS: We
have replaced degenerated mitral bioprostheses with a St. Jude valve in 73
patients during the last 12 years. In 57, including all who had their
operation before 1991, explantation was used. The stent was preserved in 16
patients; in the first four we implanted a mitral St. Jude valve (SJM)
within the stent, but this only allows a SJM 6-8 mm smaller than the
bioprosthesis. We evolved our approach in the last 12 patients to suture a
reversed aortic St. Jude valve with extended cuff to the atrial side of the
bioprosthetic cuff; this allows the use of a St. Jude valve 2 mm smaller
than the bioprosthesis with exact matching of the orifice sizes. The
demographic and clinical profiles of the two groups were similar. RESULTS:
Operative mortality was 8/57 (14%) in the explantation group and none in
the stent-preservation group. Three late perivalvular leaks occurred in the
explanation group, and none in the stent-preservation group. Thirteen late
deaths occurred in the explanation group, with a 5-year survival rate of
68%, and one late death (cancer) in the stent-preservation group, but the
follow-up is significantly shorter. CONCLUSIONS: Leaving the mitral
bioprosthetic stent and cuff intact eliminates the need for extensive
dissection, thus shortening and simplifying the procedure and diminishing
its attendant mortality and morbidity. It offers a safe and logical
approach to replacement of a degenerated mitral bioprosthesis with a St.
Jude valve of comparable size which projects into the left atrium, rather
than a smaller one jammed into the orifice of the bioprosthetic stent.
ARTICLES
New approach for replacement of degenerated mitral bioprostheses
Division of Cardiothoracic Surgery, Case Western Reserve University School of Medicine, Cleveland, OH 44106-5011, USA.
This article has been cited by other articles:
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  T. Shibata, K. Inoue, T. Ikuta, Y. Bito, Y. Yoshioka, and H. Mizoguchi Which valve and which size should we use in the valve-on-valve technique for re-do mitral valve surgery? Interactive CardioVascular and Thoracic Surgery, February 1, 2009; 8(2): 206 - 210. [Abstract] [Full Text] [PDF]
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 J.-P. Chang, C.-L. Kao, K.-T. Tsai, M.-J. Hsieh, and M. Fu Conduit-on-valve replacement of a degenerated mitral bioprosthesis with a bioprosthesis Ann. Thorac. Surg., June 1, 2003; 75(6): 1987 - 1989. [Abstract] [Full Text] [PDF]
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A. S. Geha, M. G. Massad, and N. J. Snow Replacement of degenerated mitral and aortic bioprostheses without explantation Ann. Thorac. Surg., November 1, 2001; 72(5): 1509 - 1514. [Abstract] [Full Text] [PDF]
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 P. Stassano, A. Musumeci, M. A. Losi, C. Gagliardi, and N. Spampinato Mid-term results of the valve-on-valve technique for bioprosthetic failure Eur. J. Cardiothorac. Surg., October 1, 2000; 18(4): 453 - 457. [Abstract] [Full Text] [PDF]
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