Hancock II bioprosthesis: A glance at the microscope in mid–long-term explants

Bottio, Tomaso; Thiene, Gaetano; Pettenazzo, Elena; Ius, Paolo; Bortolotti, Uberto; Rizzoli, Giulio; Valfré, Carlo; Casarotto, D; Valente, Marialuisa

doi:10.1016/s0022-5223(03)00131-4

Cited by 60 publications

(46 citation statements)

References 21 publications

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“…146,147 Since some surfactants such as sodium dodecyl sulfate reduce mineralization, these are used in commercial products, such as commercial porcine valves. 148,149 To prevent calcification induced by glutaraldehyde, chemical modification of the device surface has been investigated [e.g., using hyaluronic acid, 152 sulfonated poly(ethylene oxide) and heparin, 151,152 protamine, 153,154 bovine pericardium, [155][156][157] and l-arginine 156,157 ].…”

Section: Calcification Of Implantable Devicesmentioning

confidence: 99%

A Review of the Biocompatibility of Implantable Devices: Current Challenges to Overcome Foreign Body Response

Onuki

Bhardwaj

Papadimitrakopoulos

et al. 2008

J Diabetes Sci Technol

349

282

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In recent years, a variety of devices (drug-eluting stents, artificial organs, biosensors, catheters, scaffolds for tissue engineering, heart valves, etc.) have been developed for implantation into patients. However, when such devices are implanted into the body, the body can react to these in a number of different ways. These reactions can result in an unexpected risk for patients. Therefore, it is important to assess and optimize the biocompatibility of implantable devices. To date, numerous strategies have been investigated to overcome body reactions induced by the implantation of devices. This review focuses on the foreign body response and the approaches that have been taken to overcome this. The biological response following device implantation and the methods for biocompatibility evaluation are summarized. Then the risks of implantable devices and the challenges to overcome these problems are introduced. Specifically, the challenges used to overcome the functional loss of glucose sensors, restenosis after stent implantation, and calcification induced by implantable devices are discussed.

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Section: Calcification Of Implantable Devicesmentioning

confidence: 99%

A Review of the Biocompatibility of Implantable Devices: Current Challenges to Overcome Foreign Body Response

Onuki

Bhardwaj

Papadimitrakopoulos

et al. 2008

J Diabetes Sci Technol

349

282

View full text Add to dashboard Cite

show abstract

“…The cross-links reduce the antigenicity and biodegradability of the tissue, reduce its thrombogenicity and sterilize the tissue [23]. Bioprosthetic valves have a possibility of prosthetic valve failure due to calcification, pannus formation and tissue degeneration; several reagents have been investigated to inhibit them [5,6,18]. Polyepoxy compounds reduce calcification, degeneration and thrombosis of biological tissue and have lower cross-linking cytotoxic reaction [17,22].…”

Section: Discussionmentioning

confidence: 99%

“…There are different types of xenograft bioprosthetic valves that are routinely cross-linked during manufacturing using glutaraldehyde because of the antigenicity and sterility [4,8]. Bioprosthetic valves have a possibility of prosthetic valve failure due to calcification, pannus formation and tissue degeneration; several reagents have been extensively investigated to inhibit them [5,6,18]. Polyepoxy compound (Denacol EX-313) was developed in order to reduce calcification, degeneration and thrombosis [17,22].…”

mentioning

confidence: 99%

Long-Term Clinical Evaluation of Mitral Valve Replacement with Porcine Bioprosthetic Valves in Dogs

Takashima¹,

Soda

Tanaka

et al. 2008

The Journal of Veterinary Medical Science

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ABSTRACT. This study evaluated the long-term clinical performance of newly developed porcine bioprosthetic valves cross-linked with glutaraldehyde and polyepoxy compound for mitral valve replacement (MVR) in dogs. Five beagle dogs underwent MVR using the porcine bioprosthetic valves during cardiopulmonary bypass. Antithrombotic drugs were administered only for one month after MVR. Six months after MVR, transvalvular regurgitation was not observed in all dogs, paravalvular leakage was seen only in one dog. Twelve months after MVR, mild transvalvular regurgitations were observed in two dogs. Although diastolic atrioventricular pressure gradient was increased gradually, no significant differences were observed. Pressure half-time and valve area were within normal ranges as the bioprosthetic value. There was no clinical symptom of the thrombosis and the thrombogenesis was not observed in the porcine bioprosthetic valve and the annulus in all dogs for twelve months after MVR. The clinical findings suggest that antithrombogenicity of the valves were maintained, though the duability might not be enough in the long-term period. Mitral regurgitation (MR) is the most common acquired heart disease that increases with aging in dogs. MR is caused by myxomatous degeneration with disorganized collagen fibers in the mitral valve and increased content of acid mucopolysaccharide. In myxomatous degeneration, the valves are thickened and the valve leaflets become redundant; secondary dilation of the valve annulus contributes to MR. Progressive congestive heart failure and death are the inevitable consequences of severe MR despite any optimal medical treatment [13,19].Surgical treatment for MR has not been established in veterinary medicine, although radical operation is generally performed in human medicine. Mitral valve replacement (MVR) is one of the surgical treatments for MR, and bioprosthetic valves are recommended for dogs, because of their antithrombogenic property [24]. In human medicine, the xenograft valve is a mainstream of the bioprosthetic valve. There are different types of xenograft bioprosthetic valves that are routinely cross-linked during manufacturing using glutaraldehyde because of the antigenicity and sterility [4,8]. Bioprosthetic valves have a possibility of prosthetic valve failure due to calcification, pannus formation and tissue degeneration; several reagents have been extensively investigated to inhibit them [5,6,18]. Polyepoxy compound (Denacol EX-313) was developed in order to reduce calcification, degeneration and thrombosis [17,22].In a previous study, the porcine bioprosthetic valves cross-linked with glutaraldehyde and polyepoxy compounds were newly developed for MVR. MVR procedures under cardiopulmonary bypass (CPB) and the use of the newly developed porcine bioprosthetic valves were shown to have been effective in dogs during short-term evaluation [21]. The aim of this study was to evaluate the long-term clinical performance of newly developed porcine bioprosthetic valves for mitral valve replacem...

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“…Glutaraldehyde has been widely used as a tissue fixative for these bioprosthetic valves and vascular grafts due to its ability to produce collagen crosslinking, reduce tissue antigenicity and sterilize the valves [27]. Bioprosthetic valves have a possibility of the prosthetic valve failure due to calcification, pannus formation and tissue degeneration; several reagents have been extensively investigated to inhibit them [5,22]. Polyepoxy compound (Denacol EX-313) was developed in order to reduce calcification, degeneration and thrombosis [20,26].…”

Section: Discussionmentioning

confidence: 99%

Short-Term Performance of Mitral Valve Replacement with Porcine Bioprosthetic Valves in Dogs

Takashima¹,

Soda

Tanaka

et al. 2007

The Journal of Veterinary Medical Science

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ABSTRACT. Porcine bioprosthetic valves cross-linked with glutaraldehyde and polyepoxy compound were newly developed for mitral valve replacement (MVR) in dogs. Five beagle dogs were performed a left thoracotomy and underwent MVR using the porcine bioprosthetic valves during cardiopulmonary bypass (CPB). A vein catheter inserted into right atrium and a vent catheter inserted into the right ventricle to drain. The hemodynamic conditions of CPB were excellent during surgery. The left atrial pressure was measured before and after MVR; there was no significant difference and it was normal. Thrombosis and the prosthetic valve regurgitation were not observed one week after MVR. Pressure half time (PHT) prolonged significantly (P<0.05) from 31.40 ± 4.0 msec presurgery to 99.20 ± 19.4 msec at seven days after MVR, although it indicated the normal range as the bioprosthetic valve. The symptom of the prosthetic valve failure was not observed. This study indicated that the MVR using porcine bioprosthetic valves under CPB might have been effective in dogs as a short-term evaluation. KEY WORDS: bioprosthetic valve, canine cardiopulmonary bypass, mitral regurgitation, mitral valve replacement.

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Hancock II bioprosthesis: A glance at the microscope in mid–long-term explants

Abstract: These pathologic findings support the clinical results of a delayed occurrence of structural failure of Hancock II bioprostheses and a mitigation of mineralization by the anti-calcification treatment. However, other factors such as lipid insudation may come into play in the long term.

Cited by 60 publications

References 21 publications

A Review of the Biocompatibility of Implantable Devices: Current Challenges to Overcome Foreign Body Response

A Review of the Biocompatibility of Implantable Devices: Current Challenges to Overcome Foreign Body Response

Long-Term Clinical Evaluation of Mitral Valve Replacement with Porcine Bioprosthetic Valves in Dogs

Short-Term Performance of Mitral Valve Replacement with Porcine Bioprosthetic Valves in Dogs

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