Six-year follow-up of glutaraldehyde-preserved heterografts. With particular reference to the treatment of congenital valve malformations.

Abstract

Glutaraldehyde preservation for the preparation of heterograft valves, a process which we introduced in 1968, has been responsible for considerable improvements in long-term clinical results. We have based this report on results obtained in the first 104 patients operated upon between March, 1968, and March, 1973. Eighty-two patients had acquired valvular disease, and the other 22 had congenital valvular malformations, including 7 with Ebstein's anomaly and 8 with absence of the pulmonary valve. The hospital mortality rate was 18 per cent in the group with congenital disease and 11 per cent in the group with acquired valvular disease. We noted that 6.5 per cent of the deaths occurred in single valve replacement and 16 per cent in multiple valve replacement. Three late deaths were valve related. There were 2 cases of acute bacterial endocarditis postoperatively and 7 cases of valve dysfunction 1, 4, 4.5, and 5 years after the operation. Histologic examination showed no evidence of immunologic reaction. Cusp perforations developed as a result of localized areas of collagen degeneration. In 67 patients, valve function remains excellent. Hemodynamic data are available in 11 patients. The various factors affecting valve preparation and durability are discussed in this report, and the present role of the glutaraldehyde-preserved heterograft valve in cardiac valve replacement is evaluated.