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Saisho H, Geisler I, Scharfschwerdt M, Sadat N, Zhang X, Puehler T, Ensminger S, Fujita B, Aboud A. Ex vivo evaluation of 3 different right ventricular outflow tract substitutes. Eur J Cardiothorac Surg 2024; 65:ezae081. [PMID: 38479833 DOI: 10.1093/ejcts/ezae081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/22/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES The Ross procedure represents an excellent treatment option in younger patients with aortic stenosis but is limited by poor availability of homografts. In this study, we investigated the hydrodynamic performance of 3 different types of right ventricular outflow tract replacement with pericardium or synthetic material. METHODS Three different types of valved conduits were constructed using pericardium and/or synthetic material (Group PEPE: pericardial cusps and pericardial conduit, Group PEPR: pericardial cusps and Dacron conduit, Group PRPR: expanded polytetrafluoroethylene cusps and Dacron conduit). The conduits were designed according to the Ozaki method. Their hydrodynamic performance (effective orifice area, mean pressure gradient and leakage volume) were evaluated in a mock circulation loop at different hydrodynamic conditions. RESULTS Hydrodynamic assessment showed significantly larger effective orifice area of PEPE and PEPR compared to PRPR under all conditions and there were no significant differences between PEPE and PEPR [for condition 2: PEPE 2.43 (2.35-2.54) cm2, PEPR: 2.42 (2.4-2.5) cm2, PRPR: 2.08 (1.97-2.21) cm2, adjusted pairwise comparisons: PEPE versus PEPR: P = 0.80, PEPE versus PRPR: P < 0.001, PEPR versus PRPR: P < 0.001]. Mean pressure gradient was significantly lower for PEPE and PEPR compared with PRPR, whereas no significant differences were seen between PEPE and PEPR. Leakage volume was significantly lower for PEPE and PEPR compared with PRPR under all conditions while leakage was similar between PEPE and PEPR. CONCLUSIONS Pulmonary graft reconstruction with pericardium cusps showed superior hydrodynamic performance compared with polytetrafluoroethylene cusps. Our results suggest that it could be considered as an alternative substitute for right ventricular outflow tract replacement during the Ross procedure.
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Affiliation(s)
- Hiroyuki Saisho
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein, Lübeck, Germany
| | - Ioana Geisler
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein, Lübeck, Germany
| | - Michael Scharfschwerdt
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein, Lübeck, Germany
| | - Najla Sadat
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein, Lübeck, Germany
| | - Xiling Zhang
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein, Lübeck, Germany
| | - Thomas Puehler
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein, Lübeck, Germany
- DZHK (German Center for cardiovascular research), Partner Site Hamburg/Kiel/Luebeck, Germany
| | - Stephan Ensminger
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein, Lübeck, Germany
- DZHK (German Center for cardiovascular research), Partner Site Hamburg/Kiel/Luebeck, Germany
| | - Buntaro Fujita
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein, Lübeck, Germany
- DZHK (German Center for cardiovascular research), Partner Site Hamburg/Kiel/Luebeck, Germany
| | - Anas Aboud
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein, Lübeck, Germany
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Impact of Three Different Processing Techniques on the Strength and Structure of Juvenile Ovine Pulmonary Homografts. Polymers (Basel) 2022; 14:polym14153036. [PMID: 35894000 PMCID: PMC9332750 DOI: 10.3390/polym14153036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/15/2022] [Accepted: 06/20/2022] [Indexed: 01/27/2023] Open
Abstract
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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Abstract
Aortic stenosis is the most common valvular disease requiring valve replacement. Valve replacement therapies have undergone progressive evolution since the 1960s. Over the last 20 years, transcatheter aortic valve replacement has radically transformed the care of aortic stenosis, such that it is now the treatment of choice for many, particularly elderly, patients. This review provides an overview of the pathophysiology, presentation, diagnosis, indications for intervention, and current therapeutic options for aortic stenosis.
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Affiliation(s)
- Marko T Boskovski
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA
| | - Thomas G Gleason
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA
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Transplantation of cryopreserved human heart valves in Europe: 30 years of banking in Brussels and future perspectives. Cell Tissue Bank 2021; 22:519-537. [PMID: 33532987 PMCID: PMC7853167 DOI: 10.1007/s10561-021-09902-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/20/2021] [Indexed: 11/27/2022]
Abstract
For over 30 years, our TE has processed, controlled for quality and distributed cryopreserved allograft valves for human application. We present a review of this activity and future perspectives of cardiovascular tissue banking. The donor age and medical/behavioral history are in compliance with the regulations of the EUMS. Allograft morphology and function are evaluated in a class A cleanroom. Tests for viral/bacterial infection, histological control of structure/infection/malignancy and control-rate cryopreservation are performed. A total of 7562 hearts were sent to our TE, whereas 7290 valves (pulmonary, aortic and mitral) were transplanted. The donations increased over time: 1934, 2566 and 3062 hearts were donated during the first, second and third decades (increases of 32.7 and 19.3% during the second and third decades). Likewise, there was a significant increase in transplantations with 2050, 2550 and 2690 valves implanted during the first, second and third decades (24.4 and 5.5% increase during the second and third decades). A total of 4475 pulmonary (61.4%), 2760 aortic (37.9%) and 55 mitral valves (0.7%) were transplanted. Outstanding long-term results in adults and evidence of immune-related deterioration of allografts in neonates and infants were demonstrated. Decellularization was suggested as a solution. One hundred pulmonary and 180 aortic valves were sent for transplantation after decellularization for the ESPOIR and ARISE clinical trials and beyond. The donation and transplantation activity increased progressively. Although cryopreserved valves represent the best substitute for diseased valves, accelerated failure appears after implantation in neonates and infants. The implementation of new technologies, such as decellularization, as a standard procedure for treatment of allograft valves will offer further improvements in allograft quality and increase of durability.
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Willetts RG, Stickley J, Drury NE, Mehta C, Stumper O, Khan NE, Jones TJ, Barron DJ, Brawn WJ, Botha P. Four right ventricle to pulmonary artery conduit types. J Thorac Cardiovasc Surg 2021; 162:1324-1333.e3. [PMID: 33640135 DOI: 10.1016/j.jtcvs.2020.12.144] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The most durable valved right ventricle to pulmonary artery conduit for the repair of congenital heart defects in patients of different ages, sizes, and anatomic substrate remains uncertain. METHODS We performed a retrospective analysis of 4 common right ventricle to pulmonary artery conduits used in a single institution over 30 years, using univariable and multivariable models of time-to-failure to analyse freedom from conduit dysfunction, reintervention, and replacement. RESULTS Between 1988 and 2018, 959 right ventricle to pulmonary artery conduits were implanted: 333 aortic homografts, 227 pulmonary homografts, 227 composite porcine valve conduits, and 172 bovine jugular vein conduits. Patients weighed 1.6 to 98.3 kg (median 15.3 kg), and median duration of follow-up was 11.4 years, with 505 (52.2%) conduits developing dysfunction, 165 (17.2%) requiring catheter intervention, and 415 (43.2%) being replaced. Greater patient weight, conduit z-score, type and position, as well as catheter intervention were predictors of freedom from replacement. Multivariable analysis demonstrated inferior durability for smaller composite porcine valve conduits, with excellent durability for larger diameter conduits of the same type. Bovine jugular vein conduit longevity was inferior to that of homografts in all but the smallest patients. Freedom from dysfunction at 8 years was 60.7% for aortic homografts, 72% for pulmonary homografts, 51.2% for composite porcine valve conduits, and 41.3% for bovine jugular vein conduits. Judicious oversizing of the conduit improved conduit durability in all patients, but to the greatest extent in patients weighing 5 to 20 kg. CONCLUSIONS Pulmonary and aortic homografts had greater durability than xenograft conduits, particularly in patients weighing 5 to 20 kg. Judicious oversizing was the most significant surgeon-modifiable factor affecting conduit longevity.
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Affiliation(s)
- Robert G Willetts
- Department of Cardiac Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - John Stickley
- Department of Cardiac Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Nigel E Drury
- Department of Cardiac Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Chetan Mehta
- Department of Cardiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Oliver Stumper
- Department of Cardiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Natasha E Khan
- Department of Cardiac Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Timothy J Jones
- Department of Cardiac Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - David J Barron
- Department of Cardiac Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - William J Brawn
- Department of Cardiac Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Phil Botha
- Department of Cardiac Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom.
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Sharifulin R, Bogachev-Prokophiev A, Demin I, Afanasyev A, Ovcharov M, Pivkin A, Sapegin A, Zhuravleva I, Karaskov A. Allografts and xenografts for right ventricular outflow tract reconstruction in Ross patients. Eur J Cardiothorac Surg 2021; 59:162-169. [PMID: 32864698 DOI: 10.1093/ejcts/ezaa244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 05/30/2020] [Accepted: 06/04/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Pulmonary allografts (AG) are the gold standard for right ventricular outflow tract (RVOT) reconstruction during the Ross procedure. However, there is limited availability of AG in some countries, and the use of alternative grafts for RVOT reconstruction remains controversial. This study aimed to compare the rates of freedom from RVOT graft dysfunction for AG and diepoxide-treated pericardial xenografts (DPXG). METHODS Between 1998 and 2015, 793 adult patients underwent the Ross procedure in our centre. Using propensity score matching, the clinical outcomes and echocardiographic results of AG and DPXG were compared. RESULTS Propensity score matching resulted in 2 groups (AG and DPXG) of 122 patients each. No difference was found in early mortality (2.5%) in both groups. The freedom from RVOT graft dysfunction curves were comparable between the AG and DPXG groups (P = 0.186) and the 8-year rates of freedom from graft dysfunction were 91.8% and 82.2%, respectively. The survival rates at 8 years were 90.5% and 90.1%, and the rates of freedom from RVOT reintervention at 8 years were 100% and 96.8% for the AG and DPXG groups, respectively. At discharge and follow-up, transprosthetic gradients were significantly higher in the DPXG group. The rate of the RVOT gradient progression was also higher in the DPXG group than in the AG group (1.80 ± 0.06 vs 1.39 ± 0.04 mmHg/year, P < 0.001). CONCLUSIONS There was no difference in freedom from RVOT graft dysfunction by 8 years when using AG and DPXG in adult Ross patients, nor in survival and freedom from RVOT conduit reintervention. Long-term results need further evaluation.
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Affiliation(s)
- Ravil Sharifulin
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | | | - Igor Demin
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Alexander Afanasyev
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Mikhail Ovcharov
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Alexey Pivkin
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Andrey Sapegin
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Irina Zhuravleva
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Alexander Karaskov
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
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Van den Eynde J, Sá MPBO, Callahan CP, Dimagli A, Vervoort D, Kampaktsis PN, Zhigalov K, Ruhparwar A, Weymann A. Right ventricular outflow tract reconstruction with Medtronic Freestyle valve in the Ross procedure: A systematic review with meta-analysis. Artif Organs 2020; 45:338-345. [PMID: 33001477 DOI: 10.1111/aor.13837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 12/01/2022]
Abstract
Cryopreserved pulmonary homografts (PH) are the current gold standard for right ventricular outflow tract (RVOT) reconstruction in the Ross procedure. Unfortunately, their use is limited by a relatively scarce availability and high cost. Porcine stentless xenografts (SX) such as the Medtronic Freestyle SX are increasingly being used, although it is unclear whether the hemodynamic performance and the long-term durability are satisfactory. The present systematic review followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis statement. The pooled treatment effects were calculated using a weighted DerSimonian-Laird random-effects model. We also evaluated the effect of time after RVOT reconstruction on valve gradients using meta-regression. Six studies with a total of 156 patients met the inclusion criteria. The pooled estimates for the pooled follow-up of 37 months were: 1.3% operative mortality, 94.8% overall survival, 7.5% structural valve deterioration, 5.2% reintervention, 73.3% asymptomatic, and 1.5% moderate or severe pulmonary insufficiency. Peak valve gradients were significantly correlated with time after RVOT, increasing during follow-up. Three studies compared PH with SX, one concluded that the SX is an acceptable alternative for RVOT reconstruction, whereas two concluded that this valvular substitute had inferior performance. The Freestyle SX can be considered as an alternative to PH, although it might be associated with more reinterventions, higher peak valve pressure gradients, and pulmonary valve dysfunction.
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Affiliation(s)
- Jef Van den Eynde
- Department of Cardiovascular Diseases, Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Michel Pompeu B O Sá
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco, PROCAPE, University of Pernambuco, Recife, Brazil
| | - Connor P Callahan
- Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Arnaldo Dimagli
- School of Clinical Sciences, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Dominique Vervoort
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
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Szczechowicz M, Weymann A, Mkalaluh S, Mashhour A, Zhigalov K, Easo J. Surgical Options for Aortic Root Replacement in Destructive Endocarditis. Braz J Cardiovasc Surg 2020; 35:265-273. [PMID: 32549097 PMCID: PMC7299601 DOI: 10.21470/1678-9741-2020-0020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To analyze patients’ preoperative characteristics, surgical data, postoperative courses, and short- and long-term outcomes after implantation of different full-root prostheses for destructive aortic valve endocarditis. Methods Between 1999 and 2018, 80 patients underwent aortic root replacement due to infective endocarditis in our institution. We analyzed the abovementioned data with standard statistical methods. Results The Freestyle stentless porcine prostheses were implanted in 53 (66.25%) patients, biological valve conduits in 13 (16.25%), aortic root homografts in nine (11.25%), and mechanical valve conduits in five (6.25%). There were no significant preoperative differences between the groups. The incidence of postoperative complications and intensive care unit length of stay did not differ significantly between the groups. The 30-day mortality rate was low among Freestyle patients (n=8, 15.1%) and high in the mechanical conduit cohort (n=3, 60%), though with borderline statistical significance (P=0.055). The best mean survival rates were observed after homograft (13.7 years) and stentless prosthesis (8.1 years) implantation, followed by biological (2.8 years) and mechanical (1.4 years) conduits (P=0.014). The incidence of reoperations was low in the mechanical conduit group (0) and stentless bioroot group (n=1, 1.9%), but two (15.4%) patients with biological conduits and three (33.3%) patients with homografts required reoperations in the investigated follow-up period (P=0.005). Conclusion In patients with the destructive form of aortic valve endocarditis, homografts and stentless porcine xenografts offer better survival rates than stented valve conduits; however, the reoperation rate among patients who received homograft valves is high.
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Affiliation(s)
- Marcin Szczechowicz
- Oldenburg University Hospital Department of Cardiac Surgery Oldenburg Germany Department of Cardiac Surgery, Oldenburg University Hospital, Oldenburg, Germany
| | - Alexander Weymann
- Oldenburg University Hospital Department of Cardiac Surgery Oldenburg Germany Department of Cardiac Surgery, Oldenburg University Hospital, Oldenburg, Germany
| | - Sabreen Mkalaluh
- Oldenburg University Hospital Department of Cardiac Surgery Oldenburg Germany Department of Cardiac Surgery, Oldenburg University Hospital, Oldenburg, Germany
| | - Ahmed Mashhour
- Oldenburg University Hospital Department of Cardiac Surgery Oldenburg Germany Department of Cardiac Surgery, Oldenburg University Hospital, Oldenburg, Germany
| | - Konstantin Zhigalov
- Oldenburg University Hospital Department of Cardiac Surgery Oldenburg Germany Department of Cardiac Surgery, Oldenburg University Hospital, Oldenburg, Germany
| | - Jerry Easo
- Oldenburg University Hospital Department of Cardiac Surgery Oldenburg Germany Department of Cardiac Surgery, Oldenburg University Hospital, Oldenburg, Germany
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Marathe SP, Bell D, Betts K, Sayed S, Dunne B, Ward C, Whight C, Jalali H, Venugopal P, Andrews D, Alphonso N. Homografts versus stentless bioprosthetic valves in the pulmonary position: a multicentre propensity-matched comparison in patients younger than 20 years. Eur J Cardiothorac Surg 2019; 56:5309049. [PMID: 30753373 DOI: 10.1093/ejcts/ezz021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/10/2019] [Indexed: 02/28/2024] Open
Abstract
OBJECTIVES The aim of this study was to compare the performance of pulmonary homografts with stentless bioprosthetic valves [Medtronic Freestyle™ (Medtronic, Minneapolis, MN, USA)] in the pulmonary position in patients with congenital heart disease (CHD) younger than 20 years. METHODS Between January 2000 and December 2017, 215 patients were retrospectively identified from hospital databases in 3 congenital heart centres in Australia. Valve performance was evaluated using standard criteria. Propensity score matching was used to balance the 2 treatment groups. RESULTS Freedom from reintervention for patients who received a pulmonary homograft (n = 163) was 96%, 88% and 81% at 5, 10 and 15 years and for patients who received a Freestyle™ valve (n = 52) was 98%, 89% and 31% at 5, 10 and 15 years, respectively. Freedom from structural valve degeneration for patients with a homograft was 92%, 87% and 77% at 5, 10 and 15 years and for patients with a Freestyle valve was 96%, 80% and 14% at 5, 10 and 15 years, respectively. In the first 10 years, there was no difference in outcomes [reintervention hazard ratios (HR) = 0.69, 95% confidence intervals (CI) (0.20-2.42), P = 0.56; structural valve degeneration HR = 0.92 (0.34-2.51), P = 0.87]. After 10 years, the recipients of the Freestyle valves were at higher risk of both outcomes [reintervention HR = 7.89; 95% CI (2.79-22.34), P < 0.001; structural valve degeneration HR = 7.41 (2.77-19.84), P < 0.001]. The findings were similar when analysed by implantation in the orthotopic position and in the propensity-matched groups. CONCLUSIONS The Freestyle stentless bioprosthetic valve is a comparable alternative to cryopreserved pulmonary homografts up to 10 years after implantation when implanted in an orthotopic pulmonary position in patients younger than 20 years with CHD.
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Affiliation(s)
- Supreet P Marathe
- Queensland Paediatric Cardiac Services, Queensland Children's Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Douglas Bell
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- The Prince Charles Hospital, Brisbane, Australia
| | - Kim Betts
- Department of Epidemiology, Institute for Social Science Research, University of Queensland, Brisbane, Australia
| | - Sajid Sayed
- Department of Cardiothoracic Surgery, Child and Adolescent Health Service, Princess Margaret Hospital, Perth, Australia
| | - Benjamin Dunne
- Department of Cardiothoracic Surgery, Child and Adolescent Health Service, Princess Margaret Hospital, Perth, Australia
| | - Cameron Ward
- Queensland Paediatric Cardiac Services, Queensland Children's Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Chris Whight
- The Prince Charles Hospital, Brisbane, Australia
| | | | - Prem Venugopal
- Queensland Paediatric Cardiac Services, Queensland Children's Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - David Andrews
- Department of Cardiothoracic Surgery, Child and Adolescent Health Service, Princess Margaret Hospital, Perth, Australia
| | - Nelson Alphonso
- Queensland Paediatric Cardiac Services, Queensland Children's Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
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Bester D, Botes L, van den Heever JJ, Kotze H, Dohmen P, Pomar JL, Smit FE. Cadaver donation: structural integrity of pulmonary homografts harvested 48 h post mortem in the juvenile ovine model. Cell Tissue Bank 2018; 19:743-754. [PMID: 30311023 DOI: 10.1007/s10561-018-9729-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 10/05/2018] [Indexed: 12/01/2022]
Abstract
Cryopreserved pulmonary homograft (CPH) implantation remains the gold standard for reconstruction of the right ventricular outflow tract (RVOT). Harvesting homografts < 24-h post mortem is the international norm, thereby largely excluding cadaveric donors. This study examines the structural integrity and stability of ovine pulmonary homografts harvested after a 48-h post mortem period, cryopreserved and then implanted for up to 180 days. Fifteen ovine pulmonary homografts were harvested 48-h post mortem and cryopreserved. Five CPH served as a control group (group 1; n = 5). CPH were implanted in the RVOT of juvenile sheep and explanted after 14 days (group 2; n = 5) and 180 days (group 3; n = 5). Leaflet integrity was evaluated by strength analysis, using tensile strength (TS), Young's modulus (YM) and thermal denaturation temperature (Td), and morphology, including haematoxylin and eosin (H&E), Picrosirius red staining, scanning electron microscopy (SEM), transmission electron microscopy (TEM) and von Kossa stains. Echocardiography confirmed normal function in all implants. In explants, no reduction in TS, YM or Td could be demonstrated and H&E showed mostly acellular leaflet tissue with no difference on Picrosirius red. TEM demonstrated consistent collagen disruption after cryopreservation in all three groups, with no morphological deterioration during the study period. von Kossa stains showed mild calcification in group 3. No deterioration of structural integrity could be demonstrated using strength or morphological evaluations between the controls and implant groups over the study period. Extending the post mortem harvesting time of homografts beyond 24 h did not appear to negatively affect the long-term performance of such transplanted valves in this study.
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Affiliation(s)
- Dreyer Bester
- Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State (UFS), P.O. Box 339, (Internal Box G32), Bloemfontein, 9300, South Africa
| | - Lezelle Botes
- Department of Health Sciences, Central University of Technology, Free State (CUT), Private Bag X20539, Bloemfontein, 9300, South Africa.
| | - Johannes Jacobus van den Heever
- Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State (UFS), P.O. Box 339, (Internal Box G32), Bloemfontein, 9300, South Africa
| | - Harry Kotze
- Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State (UFS), P.O. Box 339, (Internal Box G32), Bloemfontein, 9300, South Africa
| | - Pascal Dohmen
- Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State (UFS), P.O. Box 339, (Internal Box G32), Bloemfontein, 9300, South Africa.,Department of Cardiac Surgery, Heart Centre Rostock, University of Rostock, 18107, Rostock, Germany
| | - Jose Luis Pomar
- Department of Cardiovascular Surgery, Hospital Clinico de Barcelona, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Francis Edwin Smit
- Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State (UFS), P.O. Box 339, (Internal Box G32), Bloemfontein, 9300, South Africa
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11
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Sharifulin R, Bogachev-Prokophiev A, Demin I, Zheleznev S, Pivkin A, Afanasyev A, Karaskov A. Right ventricular outflow tract reconstruction using a polytetrafluoroethylene conduit in Ross patients†. Eur J Cardiothorac Surg 2018; 54:427-433. [DOI: 10.1093/ejcts/ezy128] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 01/30/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ravil Sharifulin
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation
| | | | - Igor Demin
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation
| | - Sergey Zheleznev
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation
| | - Alexey Pivkin
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation
| | - Alexander Afanasyev
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation
| | - Alexander Karaskov
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation
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Right Ventricular Outflow Tract Replacement With Xenografts in Ross Patients Older Than 60 Years. Ann Thorac Surg 2016; 101:2252-9. [DOI: 10.1016/j.athoracsur.2015.12.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2015] [Indexed: 11/24/2022]
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Suchá D, Symersky P, Tanis W, Mali WP, Leiner T, van Herwerden LA, Budde RP. Multimodality Imaging Assessment of Prosthetic Heart Valves. Circ Cardiovasc Imaging 2015; 8:e003703. [DOI: 10.1161/circimaging.115.003703] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Echocardiography and fluoroscopy are the main techniques for prosthetic heart valve (PHV) evaluation, but because of specific limitations they may not identify the morphological substrate or the extent of PHV pathology. Cardiac computed tomography (CT) and magnetic resonance imaging (MRI) have emerged as new potential imaging modalities for valve prostheses. We present an overview of the possibilities and pitfalls of CT and MRI for PHV assessment based on a systematic literature review of all experimental and patient studies. For this, a comprehensive systematic search was performed in PubMed and Embase on March 24, 2015, containing CT/MRI and PHV synonyms. Our final selection yielded 82 articles on surgical valves. CT allowed adequate assessment of most modern PHVs and complemented echocardiography in detecting the obstruction cause (pannus or thrombus), bioprosthesis calcifications, and endocarditis extent (valve dehiscence and pseudoaneurysms). No clear advantage over echocardiography was found for the detection of vegetations or periprosthetic regurgitation. Whereas MRI metal artifacts may preclude direct prosthesis analysis, MRI provided information on PHV-related flow patterns and velocities. MRI demonstrated abnormal asymmetrical flow patterns in PHV obstruction and allowed prosthetic regurgitation assessment. Hence, CT shows great clinical relevance as a complementary imaging tool for the diagnostic work-up of patients with suspected PHV obstruction and endocarditis. MRI shows potential for functional PHV assessment although more studies are required to provide diagnostic reference values to allow discrimination of normal from pathological conditions.
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Affiliation(s)
- Dominika Suchá
- From the Departments of Radiology (D.S., W.P.Th.M.M., T.L., R.P.J.B.) and Cardiothoracic Surgery (L.A.v.H.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Cardiothoracic Surgery, VU University Medical Center, Amsterdam, The Netherlands (P.S.); Department of Cardiology, HagaZiekenhuis, The Hague, The Netherlands (W.T.); and Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (R.P.J.B.)
| | - Petr Symersky
- From the Departments of Radiology (D.S., W.P.Th.M.M., T.L., R.P.J.B.) and Cardiothoracic Surgery (L.A.v.H.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Cardiothoracic Surgery, VU University Medical Center, Amsterdam, The Netherlands (P.S.); Department of Cardiology, HagaZiekenhuis, The Hague, The Netherlands (W.T.); and Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (R.P.J.B.)
| | - W. Tanis
- From the Departments of Radiology (D.S., W.P.Th.M.M., T.L., R.P.J.B.) and Cardiothoracic Surgery (L.A.v.H.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Cardiothoracic Surgery, VU University Medical Center, Amsterdam, The Netherlands (P.S.); Department of Cardiology, HagaZiekenhuis, The Hague, The Netherlands (W.T.); and Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (R.P.J.B.)
| | - Willem P.Th.M. Mali
- From the Departments of Radiology (D.S., W.P.Th.M.M., T.L., R.P.J.B.) and Cardiothoracic Surgery (L.A.v.H.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Cardiothoracic Surgery, VU University Medical Center, Amsterdam, The Netherlands (P.S.); Department of Cardiology, HagaZiekenhuis, The Hague, The Netherlands (W.T.); and Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (R.P.J.B.)
| | - Tim Leiner
- From the Departments of Radiology (D.S., W.P.Th.M.M., T.L., R.P.J.B.) and Cardiothoracic Surgery (L.A.v.H.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Cardiothoracic Surgery, VU University Medical Center, Amsterdam, The Netherlands (P.S.); Department of Cardiology, HagaZiekenhuis, The Hague, The Netherlands (W.T.); and Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (R.P.J.B.)
| | - Lex A. van Herwerden
- From the Departments of Radiology (D.S., W.P.Th.M.M., T.L., R.P.J.B.) and Cardiothoracic Surgery (L.A.v.H.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Cardiothoracic Surgery, VU University Medical Center, Amsterdam, The Netherlands (P.S.); Department of Cardiology, HagaZiekenhuis, The Hague, The Netherlands (W.T.); and Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (R.P.J.B.)
| | - Ricardo P.J. Budde
- From the Departments of Radiology (D.S., W.P.Th.M.M., T.L., R.P.J.B.) and Cardiothoracic Surgery (L.A.v.H.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Cardiothoracic Surgery, VU University Medical Center, Amsterdam, The Netherlands (P.S.); Department of Cardiology, HagaZiekenhuis, The Hague, The Netherlands (W.T.); and Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (R.P.J.B.)
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Pepper J. Do stentless valves make a difference? J Thorac Cardiovasc Surg 2014; 148:1911-2. [PMID: 25444185 DOI: 10.1016/j.jtcvs.2014.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 09/12/2014] [Indexed: 11/30/2022]
Affiliation(s)
- John Pepper
- Department of Surgery, Royal Brompton Hospital, London, United Kingdom.
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Abstract
In 1967, Donald Ross transferred the patient's own pulmonary valve into the aortic root. Although results of this technique were encouraging, the Ross procedure did not gain widespread popularity until the late 1980s when surgeons started to implant the pulmonary autograft as a freestanding full root replacement with reimplantation of the coronary arteries. However, frequent dilatation of the pulmonary autograft was observed using the freestanding full root replacement technique. In contrast, the original subcoronary implantation technique and aortic root inclusion technique prevented dilatation in the long-term. Through advancing know-how in aortic root surgery and confidence, the Ross procedure has also been used in combined procedures and complex clinical presentations with good long-term results, which encourage continual use. However, the Ross procedure is a complex operation; careful patient selection and experience of the surgeon are mandatory requirements to achieve satisfactory results.
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Affiliation(s)
- Alexander Weymann
- Department of Cardiac Surgery, Heart and Marfan Center - University of Heidelberg, INF 110, 69120 Heidelberg, Germany
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