Long-term Performance of Fresh Autologous Pericardium for Mitral Valve Leaflet Repair

• Published in: The Annals of thoracic surgery Vol. 109; no. 1; pp. 36 - 41
• Main Authors: Quinn, Rachael W., Wang, Libin, Foster, Nathaniel, Pasrija, Chetan, Ghoreishi, Mehrdad, Dawood, Murtaza, Gammie, James S.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01-01-2020
• Subjects: Calcinosis - surgery; Cardiac Surgical Procedures - methods; Female; Heart Valve Diseases - surgery; Humans; Male; Middle Aged; Mitral Valve - surgery; Mitral Valve Insufficiency - surgery; Pericardium - transplantation; Retrospective Studies; Time Factors; Treatment Outcome
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2019.05.045

Glutaraldehyde-fixed autologous or bovine pericardial patches used for mitral valve leaflet reconstruction have been associated with late calcification. Fresh autologous pericardium (FAP) may be a durable alternative.
Transthoracic echocardiography was used to assess valve function (regurgitation, mean pressure gradient, patch pliability, and calcification) in patients undergoing FAP mitral leaflet repairs. Pliability was scored between 1 (similar to native leaflets) and 4 (rigid). Calcification was scored between 1 (echobrightness similar to native leaflets) and 4 (very bright).
Between 2002 and 2018, 62 consecutive patients (50% male, 51 ± 2 years, 69% infective endocarditis) underwent mitral valve repair with FAP, and Patch placement was on the anterior (31 of 62), posterior (27 of 62), or both (1 of 62) leaflets. Late echocardiographic follow-up was available for 43 of 62 patients (median follow-up, 3.6 years; range, 0.5-6 years). Average pliability scores were unchanged between discharge (1.2 ± 0.1) and follow-up (1.2 ± 0.2, P = .79). Average brightness scores increased modestly (predischarge, 1.6 ± 0.1; follow-up, 1.8 ± 0.1; P = .01). Three patients had recurrent severe mitral regurgitation, and 2 underwent reoperation, 1 at 1 year postoperatively for recurrent endocarditis and 1 at 6 years postoperatively for degenerative disease progression. At reoperation, patches were pliable, free from calcification, and comparable in thickness to adjacent native leaflet. One patient developed suture line leak, which was repaired. No other evidence of patch dehiscence, retraction, or aneurysm was observed. The 10-year freedom from reoperation of 82% and survival rate of 84% are comparable to repair with glutaraldehyde-fixed or bovine pericardial patches.
FAP is an excellent substrate for complex mitral valve leaflet patch repairs and can be used with the expectation of durable, long-term valve function, without evidence of late patch calcification, stiffness, or aneurysmal degeneration.