The Use of Biological Heart Valves: Types of Prosthesis, Durability and Complications

Kueri, Sami; Kari, Fabian A.; Fuentes, Rafael Ayala; Sievers, Hans‐Hinrich; Beyersdorf, Friedhelm; Bothe, Wolfgang

doi:10.3238/arztebl.2019.0423

Cited by 6 publications

(4 citation statements)

References 62 publications

(40 reference statements)

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“…Nevertheless significant differences were observed between individuals of both species and the pericardium thickness does not automatically correlate to inapplicability of material. Also glutaraldehyde fixed porcine pericardium widely used for aortic valve bioprostheses [ 30 ] is much thinner than bovine tissues [ 31 ] and will be implemented in the investigation of tissue heterogeneity in ongoing studies. Depending on the annulus sizing in fabrication of bioprostheses thinner material is used for smaller diameters and comparable thickness for all three cusps is considered and adapted.…”

Section: Discussionmentioning

confidence: 99%

Tissue requirements for the application of aortic valve neocuspidization – appropriate pericardium properties and homogeneity?

Dittfeld,

Bähring,

Welzel

et al. 2024

J Mater Sci: Mater Med

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Objective: Aortic valve neocuspidization (AVNeo) using autologous pericardium is a promising technique. Expected advantages are reduced immune response, appropriate biomechanics and lower treatment expenses. Nevertheless, autologous pericardium can be affected by patient’s age and comorbidities. Usually, glutaraldehyde (GA) - fixed bovine pericardium is the basic material for aortic valve prostheses, easy available and carefully pre-examined in a standardized fabrication process. Aim of the study is the verification of autologous pericardial tissue homogeneity by analysing tissue thickness, biomechanics and extracellular matrix (ECM) composition. Methods: Segments of human GA-fixed pericardium selected by the surgeon based on visual criteria for cusp pre-cut and remaining after surgical AV replacement were investigated in comparison to bovine standard tissue treated equivalently. Pericardium sampling was performed at up to three positions of each sutured cusp for histological or biomechanical analysis, according to tissue availability. Results and Conclusions: Human pericardia exhibited a higher heterogeneity in collagen content, density of vessel structures and elastic moduli. Thickness, vessel density and collagen and elastin content differed significantly between the species. In contrast, significant interindividual differences were detected in most properties investigated for human pericardial samples but only for tissue thickness in bovine tissues. Higher heterogeneity of human pericardium, differing vessel and collagen content compared to bovine state-of-the-art material might be detrimental for long term AV functionality or deterioration and have to be intensely investigated in patients follow up after autologous cusp replacement. Graphical Abstract

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Section: Discussionmentioning

confidence: 99%

Tissue requirements for the application of aortic valve neocuspidization – appropriate pericardium properties and homogeneity?

Dittfeld,

Bähring,

Welzel

et al. 2024

J Mater Sci: Mater Med

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“…This treatment is performed in order to prevent immune rejection and prolong the durability of the prostheses. [ 126 ] However, crosslinked materials can lead to an unfavorable outcome, with slow degradation kinetics and limited cellular infiltration, contributing to the lack of constructive remodeling. [ 127 ] The major motivation behind the use of xenogeneic organs relies on the huge transplant waiting list and on the easy availability of these sources.…”

Section: Kidney Ecmmentioning

confidence: 99%

Renal Regeneration: The Role of Extracellular Matrix and Current ECM‐Based Tissue Engineered Strategies

Sobreiro‐Almeida

Quinteira

Neves

2021

Adv Healthcare Materials

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Natural extracellular matrices (ECM) are currently being studied as an alternative source for organ transplantation or as new solutions to treat kidney injuries, which can evolve to end-stage renal disease, a life devastating condition. This paper provides an overview on the current knowledge in kidney ECM and its usefulness on future investigations. The composition and structure of kidney ECM is herein associated with its intrinsic capacity of remodeling and repair after insult. Moreover, it provides a deeper insight on altered ECM components during disease. The use of decellularized kidney matrices is discussed in the second part of the review, with emphasis on how these matrices contribute to tissue-specific differentiation of embryonic, pluripotent, and other stem cells. The evolution on the field toward different uses of xenogeneic ECM as a biological scaffold material is discussed, namely the major outcomes on whole kidney recellularization and its in vivo implantation. At last, the recent literature on the use of processed kidney decellularized ECM to produce diverse biomaterial substrates, such as hydrogels, membranes, and bioinks are reviewed, with emphasis on future perspectives of its translation into the clinic.

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“…In cardiac valve surgery, the most commonly used prostheses to replace patients’ diseased valves are biological ones, as opposed to mechanical ones [ 1 , 2 ]. Indeed, bioprostheses have several advantages: first of all, life-time anticoagulant therapy is usually deemed not necessary, even if patients might have the indications to take the anticoagulant drugs for a short period [ 3 ]. Secondly, bioprostheses are not noisy, which means that they cause less discomfort to patients.…”

Section: Introductionmentioning

confidence: 99%

Looking Back to Look Forward: What to Expect in a Redo Surgery for a Bioprosthesis Replacement

Giambuzzi

Bonalumi

Ballan

et al. 2022

JCM

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Redo surgeries are becoming more common because of an increased rate of bioprosthesis implantation. We performed a retrospective study on patients who underwent redo replacement of an aortic and/or mitral bioprosthesis between 2005 and 2018 to evaluate intra-hospital mortality and morbidity. Univariate analysis was performed on the propensity score variables to determine predictors of mortality. A total of 180 patients were enrolled in the study: Group A (replacement of aortic bioprosthesis) with 136 patients (75.56%) and group B (replacement of mitral bioprosthesis ± aortic bioprosthesis) with 44 patients (24.44%). NYHA class ≥ 3 and female sex were significantly more common in group B. Cardiopulmonary-bypass time and aortic cross-clamping time in group A and group B were, respectively, 154.95 ± 74.35 and 190.25 ± 77.44 (p = 0.0005) and 115.99 ± 53.54 and 144.91 ± 52.53 (p = 0.0004). Overall mortality was 8.89%. After propensity score adjustment, Group B was confirmed to have an increased risk of death (OR 3.32 CI 95% 1.02–10.88 p < 0.0001), gastrointestinal complications (OR 7.784 CI 95% 1.005–60.282 p < 0.0002) and pulmonary complications (OR 2.381 CI 95% 1.038–5.46 p < 0.0001). At the univariate analysis, endocarditis, cardiopulmonary-bypass and aortic cross clamping time, NYHA class ≥ 3 and urgency setting were significantly associated to death. Intra-hospital outcomes were acceptable regarding mortality and complications. Patients who need redo surgery on mitral bioprosthesis have an increased risk of post-operative pulmonary and gastrointestinal complications and mortality. Therefore the choice of mitral bioprosthesis at time of first surgery should be carefully evaluated.

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The Use of Biological Heart Valves: Types of Prosthesis, Durability and Complications

Cited by 6 publications

References 62 publications

Tissue requirements for the application of aortic valve neocuspidization – appropriate pericardium properties and homogeneity?

Tissue requirements for the application of aortic valve neocuspidization – appropriate pericardium properties and homogeneity?

Renal Regeneration: The Role of Extracellular Matrix and Current ECM‐Based Tissue Engineered Strategies

Looking Back to Look Forward: What to Expect in a Redo Surgery for a Bioprosthesis Replacement

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