The mitral pulmonary autograft: a follow up cautionary report

BACKGROUND AND AIM OF THE STUDY: The study aim was to alert surgeons embarking on mitral replacement with the pulmonary autograft to the possibility of graft stenosis resulting from kinking of the Dacron tube support. METHODS AND RESULTS: After having used old-style Dacron tubing for pulmonary autograft support in 32 patients, a change was made to a softer variety. This, together with routine retention of the posterior subvalvular apparatus, resulted in Dacron tube angulation and autograft stenosis detected at intraoperative echocardiography in four consecutive patients, This sequela was corrected in one patient by re-adjusting the pericardial collar, and in another by severing the retained chordae. However, in two patients it was necessary to sacrifice the autograft and replace it with a mechanical prosthesis. When the reason for the complication was identified, and a return to the use of a firmer Dacron material instigated, this phenomenon disappeared and surgery was completed in the final three patients, without mishap. CONCLUSION: The use of a newer soft Dacron tubing to support the pulmonary autograft in mitral replacement might result in autograft stenosis. Thus, a firm-type Dacron should be used for this operation.