Failure of a bioprosthetic mitral valve due to attachment of a residual chorda

A simplified concept for a bileaflet atrioventricular valve that maintains annular-papillary muscle continuity

We have developed a simplified concept for a bileaflet atrioventricular prosthesis that can be constructed from a simple sheet of glutaraldehyde preserved pericardium. The valve has no rigid ring or stent and no cloth sewing ring. Insertion of the valve reestablishes normal continuity between the annulus and the papillary muscles. We have replaced the mitral valve in nine dogs using this prosthesis. All valves have been competent with excellent valve opening areas as confirmed by echo-Doppler assessment. Studies up to 4 1/2 months have confirmed excellent hemodynamics and there has been no evidence of early tissue failure. Possible advantages of this simple valve design are improved hemodynamics, ease of construction and insertion, and low cost.

The in vivo durability of bioprosthetic heart valves--modes of failure observed in explanted valves

This paper describes the results of a detailed investigation of 59 explanted bioprosthetic heart valves. The mean time of implantation was 5 years 9 months with 84 per cent of the valves implanted for more than 2 years 6 months. Valves were subjected to gross examination, radiography, and hydrodynamic testing prior to dissection and histological studies in order to establish the primary cause of failure or dysfunction. Typical failure modes were determined for the major types of bioprosthesis studied. The factors influencing bioprosthetic valve dysfunction are discussed.