Sixty-seven metal-frame-supported autologous fascia lata mitral valves were placed in 67 patients. There was an operative mortality of 25% and an overall mortality of 40% within 20 months. Most of the late deaths were due to valve malfunction which occurred in 50% of survivors. Female patients demonstrated a much higher rate of valve dysfunction than did men. This mal-function of the fascial valves in the mitral position, which has not been observed in the aortic position, may be due to inappropriate design for the mitral position. The fascia is not exposed to the continued and reproducible mechanical stimulation in the atrioventricular position that it has when used as an aortic valve substitute. The mechanical properties of fascia may make it suitable for human valve substitutes but it is clear that an inverted three-cusped semilunar fascial valve will not be adequate for mitral or tricuspid valve replacements because of the haemodynamic characteristics of the atrioventricular position.
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