Homograft replacement of the mitral valve: Eight-year results

Eight-year results after mitral homograft implantation: survival (all deaths, 80%; cardiac deaths, 91%), freedom from reoperation (81%), and freedom from major cardiac events (71%).

Freedom from major cardiac events (cardiac death and reoperation) was 81% for partial homografts and 63% for total homografts at 7 years (P < .19). The difference is related to a larger number of events in the early postoperative period among patients with a total homograft.

Freedom from major cardiac events (cardiac death and reoperation) in patients with total homografts was 61% ± 9% versus 85% ± 8% at 6 years in patients younger than and older than 40 years of age, respectively (P < .09).

Instantaneous risk of reoperation (actual estimation), showing a peak of reoperation during the first postoperative year (which does not exist with bioprostheses) and a progressive increase over 8 years (comparable with the fate of bioprosthetic valves).

Histologic aspect of a mitral homograft leaflet early after implantation (2 months). Subacute inflammatory reaction with edema and macrophage infiltration, resulting in thickening of the endocardium with preservation of the normal trilaminar architecture, is shown.

Histologic aspect of a mitral homograft leaflet 5 years after implantation. Extensive fibrosis and complete acellularity is shown, with discrete areas of calcification identified by the purple staining.