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Homograft replacement of the mitral valve

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Presentation on theme: "Homograft replacement of the mitral valve"— Presentation transcript:

1 Homograft replacement of the mitral valve
Christophe Acar, MDa(by invitation), Michael Tolan, MDa(by invitation), Alain Berrebi, MDa(by invitation), Jullien Gaer, MDa(by invitation), Roger Gouezo, BSb(by invitation), Thierry Marchix, BSb(by invitation), Jean Gerota, MDb(by invitation), Sylvain Chauvaud, MDa(by invitation), Jean-Noel Fabiani, MDa(by invitation), Alain Deloche, MDa(by invitation), Alain Carpentier, MD, PhD  The Journal of Thoracic and Cardiovascular Surgery  Volume 111, Issue 2, Pages (February 1996) DOI: /S (96) Copyright © 1996 Mosby, Inc. Terms and Conditions

2 Fig. 1 Mitral homograft 10 months after implantation in a goat. Note normal leaflet tissue and chordae with moderate fibrosis of papillary muscles. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

3 Fig. 2 Identification card with mean dimensions of 82 mitral homografts: height of the anterior leaflet, 25 mm distance between anulus and papillary muscle (anterior 21 mm and posterior 26 mm), schematic representation of cross section of papillary muscles, morphologic type of papillary muscles, and dimensions according to Carpentier ring obturator. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

4 Fig. 3 Classification of papillary muscles (cross-sectional views are shown below the main diagram). TYPE I, Simple, single muscle; TYPE II, division in the sagittal plane forming an individual head supporting the posterior leaflet; TYPE III, division in the coronal plane forming an individual head supporting a commissure; TYPE IV, divisions with multiple levels of origin from the ventricular wall. Short commissural chordae inserted on an isolated muscular band. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

5 Fig. 4 Echocardiographic measurements of the valve via a sagittal view (aortic valve and papillary muscle were visible). Height of the anterior leaflet (H) was measured in diastole (a). In systole, anteroposterior diameter of the anulus (Ø) was measured (b), as well as distance (D) between anulus and papillary muscle (c). The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

6 Fig. 5 Surgical technique of mitral homograft implantation: A, Resection of the diseased mitral valve. B, Division of the lateral attachments of the papillary muscles using traction on the valve leaflets by division of muscular band. C, Positioning of the homograft papillary muscle into the slit between the native papillary muscle and the ventricular wall. D, Fixation of the papillary muscle: Mattress sutures at the base secured by multiple interrupted sutures. E, Annuloplasty stitches placed before attachment of the homograft leaflets. F, Circumferential fixation of the homograft leaflets to the anulus. Continuous suture anchoring successively the posteromedial commissure, the anterior leaflet, the anterolateral commissure, and the posterior leaflet. G, Completed homograft replacement of the mitral valve with an annuloplasty ring in place. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

7 Fig. 5 Surgical technique of mitral homograft implantation: A, Resection of the diseased mitral valve. B, Division of the lateral attachments of the papillary muscles using traction on the valve leaflets by division of muscular band. C, Positioning of the homograft papillary muscle into the slit between the native papillary muscle and the ventricular wall. D, Fixation of the papillary muscle: Mattress sutures at the base secured by multiple interrupted sutures. E, Annuloplasty stitches placed before attachment of the homograft leaflets. F, Circumferential fixation of the homograft leaflets to the anulus. Continuous suture anchoring successively the posteromedial commissure, the anterior leaflet, the anterolateral commissure, and the posterior leaflet. G, Completed homograft replacement of the mitral valve with an annuloplasty ring in place. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

8 Fig. 5 Surgical technique of mitral homograft implantation: A, Resection of the diseased mitral valve. B, Division of the lateral attachments of the papillary muscles using traction on the valve leaflets by division of muscular band. C, Positioning of the homograft papillary muscle into the slit between the native papillary muscle and the ventricular wall. D, Fixation of the papillary muscle: Mattress sutures at the base secured by multiple interrupted sutures. E, Annuloplasty stitches placed before attachment of the homograft leaflets. F, Circumferential fixation of the homograft leaflets to the anulus. Continuous suture anchoring successively the posteromedial commissure, the anterior leaflet, the anterolateral commissure, and the posterior leaflet. G, Completed homograft replacement of the mitral valve with an annuloplasty ring in place. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

9 Fig. 5 Surgical technique of mitral homograft implantation: A, Resection of the diseased mitral valve. B, Division of the lateral attachments of the papillary muscles using traction on the valve leaflets by division of muscular band. C, Positioning of the homograft papillary muscle into the slit between the native papillary muscle and the ventricular wall. D, Fixation of the papillary muscle: Mattress sutures at the base secured by multiple interrupted sutures. E, Annuloplasty stitches placed before attachment of the homograft leaflets. F, Circumferential fixation of the homograft leaflets to the anulus. Continuous suture anchoring successively the posteromedial commissure, the anterior leaflet, the anterolateral commissure, and the posterior leaflet. G, Completed homograft replacement of the mitral valve with an annuloplasty ring in place. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

10 Fig. 5 Surgical technique of mitral homograft implantation: A, Resection of the diseased mitral valve. B, Division of the lateral attachments of the papillary muscles using traction on the valve leaflets by division of muscular band. C, Positioning of the homograft papillary muscle into the slit between the native papillary muscle and the ventricular wall. D, Fixation of the papillary muscle: Mattress sutures at the base secured by multiple interrupted sutures. E, Annuloplasty stitches placed before attachment of the homograft leaflets. F, Circumferential fixation of the homograft leaflets to the anulus. Continuous suture anchoring successively the posteromedial commissure, the anterior leaflet, the anterolateral commissure, and the posterior leaflet. G, Completed homograft replacement of the mitral valve with an annuloplasty ring in place. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

11 Fig. 5 Surgical technique of mitral homograft implantation: A, Resection of the diseased mitral valve. B, Division of the lateral attachments of the papillary muscles using traction on the valve leaflets by division of muscular band. C, Positioning of the homograft papillary muscle into the slit between the native papillary muscle and the ventricular wall. D, Fixation of the papillary muscle: Mattress sutures at the base secured by multiple interrupted sutures. E, Annuloplasty stitches placed before attachment of the homograft leaflets. F, Circumferential fixation of the homograft leaflets to the anulus. Continuous suture anchoring successively the posteromedial commissure, the anterior leaflet, the anterolateral commissure, and the posterior leaflet. G, Completed homograft replacement of the mitral valve with an annuloplasty ring in place. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

12 Fig. 5 Surgical technique of mitral homograft implantation: A, Resection of the diseased mitral valve. B, Division of the lateral attachments of the papillary muscles using traction on the valve leaflets by division of muscular band. C, Positioning of the homograft papillary muscle into the slit between the native papillary muscle and the ventricular wall. D, Fixation of the papillary muscle: Mattress sutures at the base secured by multiple interrupted sutures. E, Annuloplasty stitches placed before attachment of the homograft leaflets. F, Circumferential fixation of the homograft leaflets to the anulus. Continuous suture anchoring successively the posteromedial commissure, the anterior leaflet, the anterolateral commissure, and the posterior leaflet. G, Completed homograft replacement of the mitral valve with an annuloplasty ring in place. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

13 Fig. 6 Sites of partial homograft.
The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

14 Fig. 7 Partial mitral homograft implantation for calcific mitral stenosis: A, Localized calcification affecting the anterior commissure. B, Resection of the calcification with the underlying chordae. C, Partial mitral homograft showing the anterior commissure with adjacent portions of leaflets and subvalvular apparatus (arrow). D, Result after reconstruction with partial homograft and annuloplasty. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

15 Fig. 7 Partial mitral homograft implantation for calcific mitral stenosis: A, Localized calcification affecting the anterior commissure. B, Resection of the calcification with the underlying chordae. C, Partial mitral homograft showing the anterior commissure with adjacent portions of leaflets and subvalvular apparatus (arrow). D, Result after reconstruction with partial homograft and annuloplasty. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

16 Fig. 7 Partial mitral homograft implantation for calcific mitral stenosis: A, Localized calcification affecting the anterior commissure. B, Resection of the calcification with the underlying chordae. C, Partial mitral homograft showing the anterior commissure with adjacent portions of leaflets and subvalvular apparatus (arrow). D, Result after reconstruction with partial homograft and annuloplasty. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

17 Fig. 7 Partial mitral homograft implantation for calcific mitral stenosis: A, Localized calcification affecting the anterior commissure. B, Resection of the calcification with the underlying chordae. C, Partial mitral homograft showing the anterior commissure with adjacent portions of leaflets and subvalvular apparatus (arrow). D, Result after reconstruction with partial homograft and annuloplasty. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

18 Fig. 8 Partial homograft implantation for acute endocarditis: A, Acute infective endocarditis with vegetations and valvular abscess. B, Partial mitral homograft showing the posteromedial hemivalve and its subvalvular apparatus (arrow). C, Result after partial replacement. Note the suture line between the native valve and homograft. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

19 Fig. 8 Partial homograft implantation for acute endocarditis: A, Acute infective endocarditis with vegetations and valvular abscess. B, Partial mitral homograft showing the posteromedial hemivalve and its subvalvular apparatus (arrow). C, Result after partial replacement. Note the suture line between the native valve and homograft. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

20 Fig. 8 Partial homograft implantation for acute endocarditis: A, Acute infective endocarditis with vegetations and valvular abscess. B, Partial mitral homograft showing the posteromedial hemivalve and its subvalvular apparatus (arrow). C, Result after partial replacement. Note the suture line between the native valve and homograft. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /S (96) ) Copyright © 1996 Mosby, Inc. Terms and Conditions

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