Dog mitral valve homografts and heterografts

Παππάς, Γεώργιος; Titus, Jack L.; Berghuis, Jacob; McKenzie, Malcolm B.; Ellis, F. Henry

doi:10.1097/00007890-196705000-00041

Cited by 3 publications

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“…WALTHER et al (1) implantaram, em cães, próteses em posição mitral; MACKENZIE et al (2) ; PAPPAS et al (3) ; BIANCO et al (4) também em posição mitral e, em posição aórtica, LAM et al (5) .…”

Section: Animalunclassified

Implante de tubo valvulado bioprótese "stentless" em posição aórtica: estudo experimental em ovinos

Santos¹,

Gerola²,

Pessa³

et al. 2002

Rev Bras Cir Cardiovasc

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E -Implante de tubo valvulado bioprótese "stentless" em posição aórtica: estudo experimental em ovinos. Rev Bras Cir Cardiovasc 2002; 17(1): 90-8. INTRODUÇÃOO tratamento das lesões valvares representa um grande desafio dentro da cirurgia cardiovascular, pois, até os dias atuais, não temos um substituto ideal para as valvas do coração.Ao contrário das lesões da valva mitral, em que é possível realizar procedimentos conservad o r e s , a t u a n d o -s e e m t o d a s a s e s t r u t u r a s RESUMO: Introdução: O tratamento das lesões valvares representa um grande desafio dentro da cirurgia cardiovascular, pois, até os dias atuais, não temos um substituto ideal para as valvas do coração. As próteses atualmente disponíveis apresentam vantagens e desvantagens; as mecânicas exigem anticoagulação definitiva e as biológicas apresentam baixa durabilidade. Para se chegar a um substituto ideal, são necessárias várias fases, desde a escolha e o preparo do material até o implante em animal de grande porte. Esta última é muito importante, pois a escolha do animal deve ser criteriosa. Ovinos juvenís são animais dóceis de fácil manipulação e suas características anatômicas e biológicas se assemelham muito ao que ocorre com o ser humano e as próteses "stentless" são substitutos mais próximos dos homoenxertos.Material e Método: Foram operados 30 ovinos juvenís com idade variando de 4,4 a 6,3 meses, peso de 25 a 37 kg, sendo 28 machos. Todos os animais foram submetidos a circulação extracorpórea para implante de bioprótese "stentless" montada em tubo de aorta porcina, com reimplante de artérias coronárias. A operação foi realizada com hipotermia moderada e cardioplegia gelada. O período de seguimento foi de 30 dias e, ao final, realizado ecocardiograma.Resultados: Houve 8 (26,6%) óbitos no intra-operatório e 6 (27,7%) óbitos no seguimento. O tempo médio de CEC foi de 98 min. Foi realizado ecocardiograma em 16 animais e em nenhum caso foram vistos sinais de endocardite ou outras alterações; a fração média de ejeção foi de 74%.Conclusão: Este modelo experimental utilizando ovinos para o estudo de biopróteses "stentless" em posição aórtica mostrou-se bem reprodutível e a performance do enxerto bastante factível de ser avaliada, pois ovinos são animais dóceis e de fácil manipulação no seguimento tardio. DESCRITORES: Valva aórtica, cirurgia. Implantle de prótese vascular. Biopróteses.RBCCV anatômicas desde o anel valvar até os múscu-los papilares; a valva aórtica possui estrutura anatômica mais simples, onde os procedimentos conservadores são menos variados e com resultados pouco satisfatórios quando comparados com as plastias realizadas na valva mitral. Por esta razão, com raras exceções, o tratamento das lesões severas da valva aórtica, quase sempre, representa a troca da mesma.

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Section: Animalunclassified

Implante de tubo valvulado bioprótese "stentless" em posição aórtica: estudo experimental em ovinos

Santos¹,

Gerola²,

Pessa³

et al. 2002

Rev Bras Cir Cardiovasc

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“…Berghuis, Rastelli, Van Vliet, Titus, Swan, and Ellis, (1964), Hubka, Siska, Brozman, and Holec (1966), Pappas, Titus, Berghuis, McKenzie, and Ellis (1966), Rastelli, Berghuis, and Swan (1965), and Van Vliet, Titus, Berghuis, and Ellis (1965) used mitral valve homotransplants in dogs with few encouraging results. Lower and Shumway (1963) transplanted a homologous pulmonary valve in the mitral annulus, and Lower, Stofer, and Shumway (1961) replaced the mitral valve with an autologous pulmonary valve with better results.…”

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confidence: 99%

“…A number of authors (Bigelow, Yao, Aldridge, Heimbecker, and Murray, 1964;Heimbecker et al, 1962;McKenzie, Pappas, Titus, and Ellis, 1966a;Murray et al, 1956;Pappas et al, 1966;Willman, Zafiracopoulos, and Hanlon, 1961) transplanted a homologous aortic valve segment in the mitral area, suturing the base of the transplant to the mitral annulus and the tops of the three commissures inside the left ventricle.…”

Section: )mentioning

confidence: 99%

Mitral valve replacement with aortic heterografts in humans

Ionescu

Wooler

Smith

et al. 1967

Thorax

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The complications associated with the implantation of prosthetic valves and the experimental attempts to graft the mitral valve are described. Because of the disadvantages connected with the use of artificial valves and as the experimental methods of grafting the mitral valve did not prove satisfactory for clinical use, the authors developed a technique for mitral valve replacement using heterologous aortic valves-reinforced by a semirigid Teflon ring-placed above the mitral annulus inside the atrial cavity. The technique of collecting, preparing, and inserting these grafts is described in detail. Using this method, seven patients with mitral incompetence or mitral disease were operated upon between February and April, 1967. One patient died five weeks after the operation from bacterial endocarditis in a period of severe hospital infection with staphylococcus. The other six patients had a very good clinical result immediately after surgery. At the present time they are symptom-free and have normal heart sounds. Clinical and experimental data: are discussed concerning the long-term fate of aortic heterografts in the mitral position.Mitral valve replacement remains a surgical challenge. Clinical experience with prosthetic valves has shown a good percentage of satisfactory results, but at the same time the number of complications and accidents is high enough to state that there is no perfect artificial valve yet available. The variety of prosthetic valves in current use to-day lends support to this statement (Cart-

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“…The problem is mainly related to difficulties of insertion and matching of chordal and annulus dimensions both acutely, in anticipation of a subsequent change of dimensions post-bypass, and in the long run, as the left ventricle becomes smaller after successful correction. This problem is lessened in the experimental animal, where the normal valve can be matched or a larger valve used, but, in spite of this, the results of mitral homograft replacement in animals are not good (Hubka, SIska, and Holec, 1967;Pappas, Titus, Berghuis, McKenzie, and Ellis, 1966). Replacement with 'mitral valves' fashioned from autologous fascia lata accurately matched for size is no better (Flege, Rossi, Auer, and Ehrenhaft, 1967).…”

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Experimental mitral valve replacement with a heterograft aortic valve in a rigid metal ring

Proctor

1968

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A mitral valve replacement is described in which a heterograft (pig) aortic valve is supported in a rigid metal ring having three spurs to support the commissures. The ring frame is completely covered by the heterograft, and no artificial material is in contact with the blood stream. Completely fabricated and tested for competency beforehand, it requires only one row of interrupted sutures-after the manner of the Starr-Edwards prosthesis-for insertion, and can be used in either the mitral or the aortic position. Experimental results in the dog indicate that the valve may require only temporary anticoagulation to cover the immediate post-operative period.The success, in suitable cases, of the homograft aortic valve placed in the sub-coronary position (Ross, 1962(Ross, , 1963(Ross, , 1964(Ross, , 1967Barratt-Boyes, 1964) and the problems associated with metal and plastic prostheses (Bjork and Malers, 1964;Hughes, 1965;Kloster, Bristow, and Griswold, 1965) have prompted much research towards replacing the diseased mitral valve with a homograft mitral valve. This has proved more difficult than aortic valve replacement. The problem is mainly related to difficulties of insertion and matching of chordal and annulus dimensions both acutely, in anticipation of a subsequent change of dimensions post-bypass, and in the long run, as the left ventricle becomes smaller after successful correction. This problem is lessened in the experimental animal, where the normal valve can be matched or a larger valve used, but, in spite of this, the results of mitral homograft replacement in animals are not good (Hubka, SIska, and Holec, 1967;Pappas, Titus, Berghuis, McKenzie, and Ellis, 1966). Replacement with 'mitral valves' fashioned from autologous fascia lata accurately matched for size is no better (Flege, Rossi, Auer, and Ehrenhaft, 1967).Another approach, which avoids the problems associated with chordal dimensions and ventricular fixation, is to use semi-lunar valves. Experimentally, the mitral valve has been replaced with an autologous pulmonary valve (Lower, Stofer, and Shumway, 1961)

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Dog mitral valve homografts and heterografts

Cited by 3 publications

References 0 publications

Implante de tubo valvulado bioprótese "stentless" em posição aórtica: estudo experimental em ovinos

Implante de tubo valvulado bioprótese "stentless" em posição aórtica: estudo experimental em ovinos

Mitral valve replacement with aortic heterografts in humans

Experimental mitral valve replacement with a heterograft aortic valve in a rigid metal ring

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