A bicuspid mitral bioprosthesis was prepared by mounting glutaraldehyde-processed porcine pericardium onto commercially available Brownlee-Yates stents. The bioprostheses were inserted into 17 dogs. Haemodynamic performance and long-term function of the valve was assessed. Of the 11 animals in the survival group, eight died within the 24-72 hour postoperative period. The clinical picture of these animals revealed progressive left ventricular failure although the bioprostheses were tested and found competent both at insertion and at necropsy. The causes of the late deaths were deterioration of the porcine pericardium in two, and cerebral embolism in another. The acute haemodynamic studies showed a significantly high closing reflux from within the tubular bioprosthesis, and this reflux was found to be inherent in the design. It was concluded that any stented bicuspid valve where the stent assumes the function of the papillary muscles, has to be tailored so that parts of the tissue can assume the function of the chordae tendineae to minimise the closing reflux.
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