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Sadat N, Scharfschwerdt M, Tim S, Aboud A, Saisho H, Ensminger S, Fujita B. Functional performance of eight small surgical aortic valve bioprostheses: An in vitro study. Eur J Cardiothorac Surg 2022; 62:6673140. [PMID: 35993864 DOI: 10.1093/ejcts/ezac426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/31/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Selection of a surgical aortic valve bioprosthesis (SAV) model for treatment of aortic valve disease remains controversial. The aim of this study was to characterize the functional performance of eight SAV models in a standardized in vitro setting. METHODS The hydrodynamic performance of eight SAVs with labelled size 21 mm (Avalus™, Hancock® II, Mosaic® UltraTM, Perimount®, Perimount® Magna Ease, EpicTM Supra, Trifecta™ GT; Freestyle®) was investigated in a pulse duplicator. Transvalvular pressure gradients and effective orifice area (EOA) were recorded. The geometrical orifice area (GOA) and physical dimensions of the valves were determined, and new functional dimensions were introduced. RESULTS Mean pressure gradient (MPG) and EOA differed significantly between the analyzed SAVs. The Epic presented with the lowest EOA and highest MPG, while the Trifecta showed the highest EOA and the lowest MPG. We introduce a useful way to determine the minimal internal diameter and a new measure termed 'relative orifice area' to characterize a valve's performance. CONCLUSIONS SAVs showed significant differences in their hydrodynamic performance despite the same label size. This finding was related to the construction of the valves. We introduce a new measure that characterizes the functional performance of a valve model and size for treatment of an aortic annulus of a specific size. Our data emphasize that SAV selection should carefully be done using an individual patient approach and that future research is necessary to improve the current generation of SAVs.
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Affiliation(s)
- Najla Sadat
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Lübeck Campus, Germany
| | - Michael Scharfschwerdt
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Lübeck Campus, Germany
| | - Schaller Tim
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Lübeck Campus, Germany
| | - Anas Aboud
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Lübeck Campus, Germany
| | - Hiroyuki Saisho
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Lübeck Campus, Germany
| | - Stephan Ensminger
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Lübeck Campus, Germany
| | - Buntaro Fujita
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Lübeck Campus, Germany
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Ren K, Duan W, Liang Z, Yu B, Li B, Jin Z, Zhao Y, Xue C, Yu S, Liu J, Wei X. Glutaraldehyde and 2,3-butanediol treatment of bovine pericardium for aortic valve bioprosthesis in sheep: a preliminary study. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1668. [PMID: 33490180 PMCID: PMC7812161 DOI: 10.21037/atm-20-7803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Bovine pericardium can be used for cardiovascular repair surgeries, but challenges involving biocompatibility and durability remain. This study aimed to carry out pre-clinical testing of aortic valve replacement using an aortic valve prosthesis made of bovine pericardium modified with glutaraldehyde (GA) and 2,3-butanediol (BD). Methods The mechanical, plasma protein adsorption, platelet adhesion, collagenase digestion, and ninhydrin properties of the material (control vs. GA vs. GA + BD) were tested. All 3 tissues were implanted in rats and observed after 8 weeks under microscopy with alizarin red staining for calcification. Aortic valves made from the fully-treated material were implanted in sheep. A commercial bioprosthesis was used as control. Effectiveness and safety indicators were observed at 180 days after implantation. Results Compared with the control group, the GA + BD material showed higher elongation at breaking and tensile load (both P<0.05), lower plasma protein adsorption, lower platelet adhesion, lower collagenase digestion, lower ninhydrin value, and higher cross-linking (all P<0.05). After implantation in rat models, the GA + BD material showed little or no dissolution; there was no obvious calcification; and it was surrounded by a small amount of fibrosis, with peripheral capillary proliferation. After implantation in sheep models, the aortic valve leaflets of the experimental animals freely opened and closed, their surface was smooth, and no abnormal echo was observed. The echocardiographic results and hemodynamic were comparable between the two groups. All safety parameters were normal. Conclusions Modification of bovine pericardium with GA and BD results in a biomaterial with favorable properties for use as an aortic valve prosthesis.
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Affiliation(s)
- Kai Ren
- Department of Cardiovascular Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, China
| | - Weixun Duan
- Department of Cardiovascular Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, China
| | - Zhuowen Liang
- Medicine Institute of Orthopedics, Xijing Hospital, Air Force Military Medical University, Xi'an, China
| | - Bo Yu
- Department of Cardiovascular Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, China
| | - Buying Li
- Department of Cardiovascular Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, China
| | - Zhengxiao Jin
- Department of Cardiovascular Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, China
| | - Yimin Zhao
- Jiahe Zhongbang Biotechnology Co., Ltd., Hangzhou, China
| | - Chao Xue
- Department of Cardiovascular Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, China
| | - Shiqiang Yu
- Department of Cardiovascular Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, China
| | - Jincheng Liu
- Department of Cardiovascular Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, China
| | - Xufeng Wei
- Department of Cardiovascular Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, China
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Bollache E, Fedak PWM, van Ooij P, Rahman O, Malaisrie SC, McCarthy PM, Carr JC, Powell A, Collins JD, Markl M, Barker AJ. Perioperative evaluation of regional aortic wall shear stress patterns in patients undergoing aortic valve and/or proximal thoracic aortic replacement. J Thorac Cardiovasc Surg 2017; 155:2277-2286.e2. [PMID: 29248286 DOI: 10.1016/j.jtcvs.2017.11.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 10/11/2017] [Accepted: 11/06/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To assess in patients with aortopathy perioperative changes in thoracic aortic wall shear stress (WSS), which is known to affect arterial remodeling, and the effects of specific surgical interventions. METHODS Presurgical and postsurgical aortic 4D flow MRI were performed in 33 patients with aortopathy (54 ± 14 years; 5 women; sinus of Valsalva (d_SOV)/midascending aortic (d_MAA) diameters = 44 ± 5/45 ± 6 mm) scheduled for aortic valve (AVR) and/or root (ARR) replacement. Control patients with aortopathy who did not have surgery were matched for age, sex, body size, and d_MAA (n = 20: 52 ± 14 years; 3 women; d_SOV/d_MAA = 42 ± 4/42 ± 4 mm). Regional aortic 3D systolic peak WSS was calculated. An atlas of WSS normal values was used to quantify the percentage of at-risk tissue area with abnormally high WSS, excluding the area to be resected/graft. RESULTS Peak WSS and at-risk area showed low interobserver variability (≤0.09 [-0.3; 0.5] Pa and 1.1% [-7%; 9%], respectively). In control patients, WSS was stable over time (follow-up-baseline differences ≤0.02 Pa and 0.0%, respectively). Proximal aortic WSS decreased after AVR (n = 5; peak WSS difference ≤-0.41 Pa and at-risk area ≤-10%, P < .05 vs controls). WSS was increased after ARR in regions distal to the graft (peak WSS difference ≥0.16 Pa and at-risk area ≥4%, P < .05 vs AVR). Follow-up duration had no significant effects on these WSS changes, except when comparing ascending aortic peak WSS between ARR and AVR (P = .006). CONCLUSIONS Serial perioperative 4D flow MRI investigations showed distinct patterns of postsurgical changes in aortic WSS, which included both reductions and translocations. Larger longitudinal studies are warranted to validate these findings with clinical outcomes and prediction of risk of future aortic events.
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Affiliation(s)
- Emilie Bollache
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Paul W M Fedak
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Division of Surgery-Cardiac Surgery, Northwestern University, Chicago, Ill
| | - Pim van Ooij
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Ozair Rahman
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - S Chris Malaisrie
- Division of Surgery-Cardiac Surgery, Northwestern University, Chicago, Ill
| | - Patrick M McCarthy
- Division of Surgery-Cardiac Surgery, Northwestern University, Chicago, Ill
| | - James C Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Alex Powell
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Jeremy D Collins
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Ill; Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, Ill
| | - Alex J Barker
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Ill.
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Aguiari P, Iop L, Favaretto F, Fidalgo CML, Naso F, Milan G, Vindigni V, Spina M, Bassetto F, Bagno A, Vettor R, Gerosa G. In vitro
comparative assessment of decellularized bovine pericardial patches and commercial bioprosthetic heart valves. Biomed Mater 2017; 12:015021. [DOI: 10.1088/1748-605x/aa5644] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Pinho P. Comment on “Long-term durability of bioprosthetic aortic valves: implications from 12,569 implants”. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2015; 34:573-4. [PMID: 26618207 DOI: 10.1016/j.repce.2015.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Pinho P. Comentário a «Durabilidade a longo prazo de válvulas aórticas biológicas: implicações a partir de 12 569 implantes». Rev Port Cardiol 2015. [DOI: 10.1016/j.repc.2015.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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