Aortic valve-sparing repair with autologous pericardial leaflet extension has a greater early re-operation rate in congenital versus acquired valve disease☆

Zerda, David J. De La; Cohen, Oved; Fishbein, Michael C.; Odim, Jonah; Calderon, Carlos A; Hekmat, Diana; Dinov, Ivo D.; Laks, Hillel

doi:10.1016/j.ejcts.2006.11.027

Cited by 23 publications

(14 citation statements)

References 13 publications

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“…Major concerns are related to possible patch dehiscence, calcification, degeneration, thickening and retraction. Several authors have reported on the use of several materials for cardiac reconstruction [1][2][3][4], with various short-and long-term results. The ideal patch should be a bioscaffold, which would be pliable, haemostatic and resistant to tearing; should not shrink or calcify; should not induce an inflammation cascade and should grow with the patient and promote regeneration of native tissue.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, we currently avoid using the SIS-ECM scaffold for reconstruction of small PAs in infants. Different techniques of semilunar valve repair have been proposed in the current literature so as to preserve the native valve, such as the leaflet extension technique with pericardium [1,10], which has provided generally good early results in the acquired and congenitally affected AoV. It is well known that the limiting factor of the longterm function of extended aortic leaflets is the durability of the material used for extensions.…”

Section: Discussionmentioning

confidence: 99%

“…However, most CHD-related surgical procedures require the use of prosthetic material for reconstruction of intracardiac and extracardiac structures. Several different biological and prosthetic materials are commonly used in surgery for CHDs, such as autologous pericardium (with or without glutaraldehyde rinsing) [1], preserved homograft, bovine pericardium [2] and polytetrafluoroethylene [3,4]. None of the above-mentioned represents the ideal prosthetic tissue, which should be pliable and easy to handle, resistant to tearing, calcification or shrinkage, and most importantly should have growth potential and should not induce remodelling of scar tissue.…”

Section: Introductionmentioning

confidence: 99%

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Early and mid-term clinical experience with extracellular matrix scaffold for congenital cardiac and vascular reconstructive surgery: a multicentric Italian study

Padalino

Quarti

Angeli

et al. 2015

Interact CardioVasc Thorac Surg

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Early and mid-term clinical experience with extracellular matrix scaffold for congenital cardiac and vascular reconstructive surgery: a multicentric Italian study

Padalino

Quarti

Angeli

et al. 2015

Interact CardioVasc Thorac Surg

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“…It was demonstrated that killing of pericardial cells with ethanol or glutaraldehyde fixation does prevent the accelerated degeneration of living pericardium [15] and is essential if a pericardial leaflet structure is expected to be long-lasting. Although the immunologic response and its effect on long-term durability is not completely understood [16,17], it becomes increasingly clear that autologous pericardium, treated with glutaraldehyde has a good longterm durability in aortic position [18][19][20]. Al Halees et al [14] published the largest series of autologous pericardial aortic valve prosthesis in 65 patients with a mean age of 30 years and the longest follow-up of 16 years.…”

Section: Discussionmentioning

confidence: 99%

Truly stentless molded autologous pericardial aortic valve prosthesis with single point attached commissures in a sheep model☆

Goetz

Tan

Lim

et al. 2008

European Journal of Cardio-Thoracic Surgery

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Objective: Aortic valve cusp extension and free-hand aortic valve replacement with autologous pericardium has been described. The longterm results were shown to be comparable with commercially available aortic bioprostheses. Nevertheless the relatively demanding surgical technique could not find wide acceptance. We developed a new design of a molded aortic valve, fashioned from autologous pericardium, treated briefly with glutaraldehyde, and simplified the implantation technique using single point attached commissures (SPAC). Methods: Molded autologous valve prostheses were implanted in the subcoronary aortic position in 10 sheep with the commissures connected to the aortic wall at three single commissural points (SPAC). The prosthesis mean size was 21.6 AE 1.3 mm and the construction time (excluding 10 min glutaraldehyde treatment) was 6.2 AE 1.2 min. Cardiopulmonary bypass and cross-clamp time was 111.1 AE 12.4 min and 75.0 AE 16.3 min, respectively. Six sheep were euthanized after 201.2 AE 10.3 days (6 months) and four sheep were euthanized after 330.8 AE 6.5 days (11 months) postoperatively. Results: In all sheep, the valve was immediately competent. At sacrifice, SPAC has proven to be well anchored to the aortic wall and the pericardial valve to be pliable in all cases. The maximum transvalvular gradient after cardiopulmonary bypass and at sacrifice was 3.7 AE 2.2 mmHg and 10.6 AE 5.2 mmHg, respectively. Conclusions: This new truly stentless molded autologous aortic valve with simplified implantation technique (SPAC) makes a reliable implantation in a standard timeframe possible. The simplicity of construction, low cost and absent need for anticoagulation of this molded autologous aortic bioprosthesis offers an attractive alternative and not only for patients in the developing world. #

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“…On the other hand, untreated fresh autologous pericardium might possess true growth, but distensibility as well. Despite good short-and mid-term results, it is associated with a high degeneration rate in the long term (11)(12)(13)(14) and is associated with bacterial endocarditis (8,10,15). Bovine pericardium-used as leaflet extension-has been shown to be less effective as compared to autologous pericardium (16,17), and autologous pericardium has greater resistance to retraction.…”

Section: Currently Used Patch Materials For Valve Repairmentioning

confidence: 99%

Surgical technique: establishing a pre-clinical large animal model to test aortic valve leaflet substitute

et al. 2016

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To overcome current limitations of valve substitutes and tissue substitutes the technology of tissue engineering (TE) continues to offer new perspectives in congenital cardiac surgery. We report our experiences and results implanting a decellularized TE patch in nine sheep in orthotropic position as aortic valve leaflet substitute. Establishing the animal model, feasibility, cardiopulmonary bypass issues and operative technique are highlighted. side effect of lifelong anticoagulation. The lack of an ideal valve substitute has raised interest in alternative techniques, such as repairing the diseased valve rather than replacing it. In the past several years, the percentage of valve repair as compared to AVR has increased (1). For many of the aortic valve repair techniques, a patch is needed as substitute, partial or complete replacement or leaflet extension. So far various cusp tissue substitutes have been tested, but failed to fulfill the requirements for an optimal patch material. Currently used patch material for valve repairAn optimal patch material should be pliable, hemostatic and resistant to tearing, should not shrink or calcify, and should possibly not induce an inflammatory cascade. Since the late 1960s, attempts have been made to use biologic materials like fascia lata, dura mater and bovine pericardium with poor outcomes (4-6). An easily available source for valve repair is the autologous pericardium, which is widely used for partial or total cusp replacement or leaflet extension (7-10). Some groups propagate pretreatment with glutaraldehyde, which prevents secondary shrinking and calcification (9,10). On the other hand, untreated fresh autologous pericardium might possess true growth, but distensibility as well. Despite good short-and mid-term results, it is associated with a high degeneration rate in the long term (11)(12)(13)(14) and is associated with bacterial endocarditis (8,10,15). Bovine pericardium-used as leaflet extension-has been shown to be less effective as compared to autologous pericardium (16,17), and autologous pericardium has greater resistance to retraction. Since polytetrafluoroethylene (PTFE) was successfully used for right ventricular outflow graft reconstruction or in mitral leaflet position with good longterm results (18)(19)(20), it was applied as leaflet extension in the aortic valve position. Nosál' and coworkers reported 13 congenitally affected patients, with the youngest being 22 months old, in whom PTFE leaflet extensions were done with a follow-up till 30 months (21). However, there still remains a higher risk of endocarditis, and concerns have been raised about leaflet thickening and decreased mobility (18,22). Technical and scientific achievements in the field of tissue engineering (TE) may offer new perspectives with the potential of an off-the-shelf starter matrix for guided tissue regeneration. Study rationaleThe ultimate goal is to develop an aortic valve leaflet substitute which is physiological, durable and has the potential for growth, and test it in ...

show abstract

Aortic valve-sparing repair with autologous pericardial leaflet extension has a greater early re-operation rate in congenital versus acquired valve disease☆

Cited by 23 publications

References 13 publications

Early and mid-term clinical experience with extracellular matrix scaffold for congenital cardiac and vascular reconstructive surgery: a multicentric Italian study

Early and mid-term clinical experience with extracellular matrix scaffold for congenital cardiac and vascular reconstructive surgery: a multicentric Italian study

Truly stentless molded autologous pericardial aortic valve prosthesis with single point attached commissures in a sheep model☆

Surgical technique: establishing a pre-clinical large animal model to test aortic valve leaflet substitute

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