Between December 1964 and March 1969, 11 posterior cusp advancement operations were carried out for patients with mitral valve disease in whom there was posterior cusp deficiency. Seven of the nine long-term survivors have required reoperation for recurrent mitral regurgitation, combined in six instances with stenosis of varying severity, the interval between the first and second operations ranging from five months to nine years (average 57-5 months). Histological examination of the pericardial grafts recovered at re-operation has been made and shows that after an initial period during which the graft retains near normal structure, there is a progressive degeneration with fibrous tissue replacement. This process takes place on both surfaces of the graft where there is evidence of vascularization in the zone between the graft remnant and the overlying and increasingly thick fibrous tissue covering. The conclusion drawn from the experience with this small series is that the long-term performance of pericardial grafts designed to restore function to the posterior cusp of the mitral valve is poor and unpredictable.
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