A heart valve is no stronger than its weakest link: The need to improve durability of pericardial leaflets

Padala, Muralidhar

doi:10.1016/j.jtcvs.2018.03.034

Cited by 5 publications

(3 citation statements)

References 6 publications

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“…Partial phospholipid membrane extraction with alcohols, for instance, has found its way into some commercial tissue valves. LivaNova uses octanediol-ethanol for its FREE treatment, St. Jude/Abbot uses ethanol for its Linx-treatment of its Trifecta valve and so does Edwards Life-Sciences in its Thermafix heat treatment used for its Perimount valves (84). Single centre, long-term studies with these valves have shown remarkably encouraging results in young patients (85).…”

Section: Patients In Need Of Cardiac Surgery and Patient's Needsmentioning

confidence: 99%

A glimpse of hope: cardiac surgery in low- and middle-income countries (LMICs)

Zilla¹,

Bolman²,

Boateng³

et al. 2020

Cardiovasc Diagn Ther

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Currently, more than five times more people live in low-and middle-income countries (LMICs) than in high-income countries (HICs). As such, the downward trend in cardiac surgical needs in HICs reflects only the situation of one sixth of the world population while the vast majority living in LMICs has still no or limited access to life saving heart operations. In these countries, rheumatic heart disease (RHD) still accounts for a significant proportion of cardiac surgical needs. In low-and lower-middle income countries it remains the single most common cardiovascular disease in young adult and adolescent patients in need of heart surgery outweighing other indications such as congenital cardiac defects almost 4-fold.Compared to HICs with their predominance of calcific aortic stenosis in the elderly mitral valve surgery is required in >90% of the largely young patients with RHD in low-income countries (LICs) and still in 70% of the often middle aged patients in middle-income countries (MICs). Although recent government initiatives in LICs led to the establishment of local, independent cardiac surgical services gradually replacing fly-in missions, these centers still only cover less than 2% of the needs of their populations. In MICs, cardiac surgical needs continually grow with the emergence of degenerative diseases. As such, in spite of the concomitant growth of cardiac surgical capacity, significantly less than half the estimated patients in need have access. Capacities in LICs range from 0.5 to 7 cardiac operations/million population; 100-481/million in MICs and >1,200/million in HICs such as the USA and Germany. While a new level of awareness of the scope and magnitude of the problem has begun to emerge in LICs and the establishment of local cardiac surgical capacity has given rise to a glimpse of hope, the challenges of expanding these fledgling services to a significant proportion of the population still seem insurmountable. Challenges in MICs are on the other hand the widening gap between private cardiac medicine for the affluent few and overwhelmed public services for the many and the rural urban divide with the underappreciation of the ongoing dominance of RHD in the rural and indigent population on the other. Overshadowing all LMICs is the low level of valverepair skills associated with insufficient cardiac surgical capacity and the unavailability of suitable replacement valves which address the young age of the patients and the difficulties of anticoagulation in a socioeconomic environment distinctly different from the elderly patients of HICs.

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Section: Patients In Need Of Cardiac Surgery and Patient's Needsmentioning

confidence: 99%

A glimpse of hope: cardiac surgery in low- and middle-income countries (LMICs)

Zilla¹,

Bolman²,

Boateng³

et al. 2020

Cardiovasc Diagn Ther

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“…Therefore, the additional fixation and stabilization of the collagen scaffold with GA might be required [ 17 ]. However, the free aldehyde groups of GA are associated with cellular toxicity [ 18 ], while conjugated GA may contribute to graft calcification [ 19 , 20 ]. Washing and detoxifying with solutions that can bind the free aldehyde groups prior to implantation can improve durability and biocompatibility [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of Three Different Processing Techniques on the Strength and Structure of Juvenile Ovine Pulmonary Homografts

et al. 2022

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Homografts are routinely stored by cryopreservation; however, donor cells and remnants contribute to immunogenicity. Although decellularization strategies can address immunogenicity, additional fixation might be required to maintain strength. This study investigated the effect of cryopreservation, decellularization, and decellularization with additional glutaraldhyde fixation on the strength and structure of ovine pulmonary homografts harvested 48 h post-mortem. Cells and cellular remnants were present for the cryopreserved group, while the decellularized groups were acellular. The decellularized group had large interfibrillar spaces in the extracellular matrix with uniform collagen distribution, while the additional fixation led to the collagen network becoming dense and compacted. The collagen of the cryopreserved group was collapsed and appeared disrupted and fractured. There were no significant differences in strength and elasticity between the groups. Compared to cryopreservation, decellularization without fixation can be considered an alternative processing technique to maintain a well-organized collagen matrix and tissue strength of homografts.

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“…Among these processes, fixing tissues with glutaraldehyde and rendering them inert to the recipient's body is most widely adopted, despite significant drawbacks of such a method as described earlier. 2 Decellularization of xenografts and their use as replacement scaffolds has been an area of much interest, as such tissue maintains a highly complex, 3-dimensional extracellular matrix structure with a mix of different proteins that are often challenging to replicate using human-made methods such as 3-dimensional printing and electrospinning. Devoid of donor cells, these bare extracellular matrix materials could not only provide scaffolding at the implant site but potentially recellularize with the recipient's cells for in situ tissue reconstitution.…”

mentioning

confidence: 99%

Commentary: Pouring life into dead tissues: A brief history of the porcine small intestine submucosa (SIS) in cardiovascular surgery—success, failures, hype, and hope

Kalra

Padala

2020

The Journal of Thoracic and Cardiovascular Surgery

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A heart valve is no stronger than its weakest link: The need to improve durability of pericardial leaflets

Abstract: Central Message Innovative anticalcification treatments can improve the durability of surgical and transcatheter valve bioprostheses.

Cited by 5 publications

References 6 publications

A glimpse of hope: cardiac surgery in low- and middle-income countries (LMICs)

A glimpse of hope: cardiac surgery in low- and middle-income countries (LMICs)

Impact of Three Different Processing Techniques on the Strength and Structure of Juvenile Ovine Pulmonary Homografts

Commentary: Pouring life into dead tissues: A brief history of the porcine small intestine submucosa (SIS) in cardiovascular surgery—success, failures, hype, and hope

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