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Dittfeld C, Bähring S, Welzel C, Jannasch A, Matschke K, Tugtekin SM, Alexiou K. Tissue requirements for the application of aortic valve neocuspidization - appropriate pericardium properties and homogeneity? JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2024; 35:26. [PMID: 38683259 PMCID: PMC11058761 DOI: 10.1007/s10856-024-06790-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 03/05/2024] [Indexed: 05/01/2024]
Abstract
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.
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Affiliation(s)
- Claudia Dittfeld
- Department of Cardiac Surgery, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Heart Centre Dresden, Dresden, Germany.
| | - Sophia Bähring
- Department of Cardiac Surgery, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Heart Centre Dresden, Dresden, Germany
| | - Cindy Welzel
- Department of Cardiac Surgery, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Heart Centre Dresden, Dresden, Germany
| | - Anett Jannasch
- Department of Cardiac Surgery, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Heart Centre Dresden, Dresden, Germany
| | - Klaus Matschke
- Department of Cardiac Surgery, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Heart Centre Dresden, Dresden, Germany
| | - Sems-Malte Tugtekin
- Department of Cardiac Surgery, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Heart Centre Dresden, Dresden, Germany
| | - Konstantin Alexiou
- Department of Cardiac Surgery, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Heart Centre Dresden, Dresden, Germany
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Ciobotaru V, Batistella M, De Oliveira Emmer E, Clari L, Masson A, Decante B, Le Bret E, Lopez-Cuesta JM, Hascoet S. Aortic Valve Engineering Advancements: Precision Tuning with Laser Sintering Additive Manufacturing of TPU/TPE Submillimeter Membranes. Polymers (Basel) 2024; 16:900. [PMID: 38611158 PMCID: PMC11013727 DOI: 10.3390/polym16070900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/12/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
Synthetic biomaterials play a crucial role in developing tissue-engineered heart valves (TEHVs) due to their versatile mechanical properties. Achieving the right balance between mechanical strength and manufacturability is essential. Thermoplastic polyurethanes (TPUs) and elastomers (TPEs) garner significant attention for TEHV applications due to their notable stability, fatigue resistance, and customizable properties such as shear strength and elasticity. This study explores the additive manufacturing technique of selective laser sintering (SLS) for TPUs and TPEs to optimize process parameters to balance flexibility and strength, mimicking aortic valve tissue properties. Additionally, it aims to assess the feasibility of printing aortic valve models with submillimeter membranes. The results demonstrate that the SLS-TPU/TPE technique can produce micrometric valve structures with soft shape memory properties, resembling aortic tissue in strength, flexibility, and fineness. These models show promise for surgical training and manipulation, display intriguing echogenicity properties, and can potentially be personalized to shape biocompatible valve substitutes.
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Affiliation(s)
- Vlad Ciobotaru
- Centre Hospitalier Universitaire de Nîmes, Service de Radiologie, Imagerie Cardiovasculaire, 4 Rue du Professeur Robert Debré, 30900 Nîmes, France
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Inserm UMR-S 999, BME Lab, 133 Avenue de la Résistance, 92350 Le Plessis Robinson, France; (B.D.); (E.L.B.); (S.H.)
- 3DHeartModeling, 30132 Caissargues, France
| | - Marcos Batistella
- Polymers Composites and Hybrids Department, IMT Mines Alès, 30319 Ales, France; (M.B.); (E.D.O.E.); (L.C.); (A.M.); (J.-M.L.-C.)
| | - Emily De Oliveira Emmer
- Polymers Composites and Hybrids Department, IMT Mines Alès, 30319 Ales, France; (M.B.); (E.D.O.E.); (L.C.); (A.M.); (J.-M.L.-C.)
| | - Louis Clari
- Polymers Composites and Hybrids Department, IMT Mines Alès, 30319 Ales, France; (M.B.); (E.D.O.E.); (L.C.); (A.M.); (J.-M.L.-C.)
| | - Arthur Masson
- Polymers Composites and Hybrids Department, IMT Mines Alès, 30319 Ales, France; (M.B.); (E.D.O.E.); (L.C.); (A.M.); (J.-M.L.-C.)
| | - Benoit Decante
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Inserm UMR-S 999, BME Lab, 133 Avenue de la Résistance, 92350 Le Plessis Robinson, France; (B.D.); (E.L.B.); (S.H.)
| | - Emmanuel Le Bret
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Inserm UMR-S 999, BME Lab, 133 Avenue de la Résistance, 92350 Le Plessis Robinson, France; (B.D.); (E.L.B.); (S.H.)
| | - José-Marie Lopez-Cuesta
- Polymers Composites and Hybrids Department, IMT Mines Alès, 30319 Ales, France; (M.B.); (E.D.O.E.); (L.C.); (A.M.); (J.-M.L.-C.)
| | - Sebastien Hascoet
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Inserm UMR-S 999, BME Lab, 133 Avenue de la Résistance, 92350 Le Plessis Robinson, France; (B.D.); (E.L.B.); (S.H.)
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Eildermann K, Durashov M, Kuschnerus K, Poppe A, Weixler V, Photiadis J, Sigler M, Murin P. Tissue-engineered and autologous pericardium in congenital heart surgery: comparative histopathological study of human vascular explants. Eur J Cardiothorac Surg 2024; 65:ezae027. [PMID: 38290761 PMCID: PMC10924714 DOI: 10.1093/ejcts/ezae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/06/2024] [Accepted: 01/26/2024] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVES The goal of this histological study was to assess the biocompatibility of vascular patches used in the repair of congenital heart defects. METHODS We examined tissue-engineered bovine (n = 7) and equine (n = 7) patches and autologous human pericardium (n = 7), all explanted due to functional issues or follow-up procedures. Techniques like Movat-Verhoeff, von Kossa and immunohistochemical staining were used to analyse tissue composition, detect calcifications and identify immune cells. A semi-quantitative scoring system was implemented to evaluate the biocompatibility aspects, thrombus formation, extent of pannus, inflammation of pannus, cellular response to patch material, patch degradation, calcification and neoadventitial inflammation. RESULTS We observed distinct material degradation patterns among types of patches. Bovine patches showed collagen disintegration and exudate accumulation, whereas equine patches displayed edematous swelling and material dissolution. Biocompatibility scores were lower in terms of cellular response, degradation and overall score for human autologous pericardial patches compared to tissue-engineered types. The extent of pannus formation was not influenced by the type of patch. Bovine patches had notable calcifications causing tissue hardening, and foreign body giant cells were more frequently seen in equine patches. Plasma cells were frequently detected in the neointimal tissue of engineered patches. CONCLUSIONS Our results confirm the superior biocompatibility of human autologous patches and highlight discernible variations in the changes of patch material and the cellular response to patch material between bovine and equine patches. Our approach implements the semi-quantitative scoring of various aspects of biocompatibility, facilitating a comparative quantitative analysis across all types of patches, despite their inherent differences.
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Affiliation(s)
- Katja Eildermann
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August University Göttingen, Göttingen, Germany
| | - Maksim Durashov
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August University Göttingen, Göttingen, Germany
| | - Kira Kuschnerus
- Department of Congenital Heart Surgery—Pediatric Heart Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
| | - Andrea Poppe
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August University Göttingen, Göttingen, Germany
| | - Viktoria Weixler
- Department of Congenital Heart Surgery—Pediatric Heart Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
| | - Joachim Photiadis
- Department of Congenital Heart Surgery—Pediatric Heart Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
| | - Matthias Sigler
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August University Göttingen, Göttingen, Germany
| | - Peter Murin
- Department of Congenital Heart Surgery—Pediatric Heart Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
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Kiekenap J, Sun X, Hao Y, Steitz M, Breitenstein-Attach A, Emeis J, Berger F, Schmitt B. Long-term function of a novel autologous transcatheter pulmonary heart valve implant in an adult animal model. Catheter Cardiovasc Interv 2024; 103:597-606. [PMID: 38440908 DOI: 10.1002/ccd.30992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 02/15/2024] [Accepted: 02/17/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Current heart valve implants entail major disadvantages in the treatment for younger patients or those with congenital heart defects. AIM Evaluation of novel transcatheter pulmonary valve implant made from autologous pericardium with natural crosslinking agent in an in vitro setup and in vivo animal model METHODS: Valves were tested in a pulse duplicator according to ISO-standard 5840. For in vivo studies computer tomography was performed to measure sheep's native pulmonary valve dimensions. Pericardium was harvested by thoracotomy, personalized implants were manufactured and deployed in pulmonary valve position of the same sheep. Every 3 months implant functionality was evaluated by intracardiac echocardiography, intracardiac pressure measurements and cardiac magnetic resonance imaging (cMRI). Implants were explanted for macroscopic and histological examination. RESULTS In vitro experiments showed compliance with regulatory requirements in terms of valve opening and insufficiency. Five sheep successfully received an autologous valve implant. Two animals had to be euthanized due to trauma sustained in the stable. Long-term valve function was excellent in three out of four animals with median implant cMRI regurgitation fraction of 9% (n = 4) at 3 months, 8% (n = 3) at 6, 8% (n = 3) at 9, 12% (n = 3) at 13, 8% (n = 2) at 17% and 8% (n = 2) at 20.5 months after implantation. Despite good adherence to neighboring tissue and endothelization, histological assessment revealed some signs of degeneration. CONCLUSION Transcatheter pulmonary valve implants showed promising function for up to 20.5 months encouraging research to further improve this approach.
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Affiliation(s)
- Jonathan Kiekenap
- DHZC (Deutsches Herzzentrum der Charité), Charité - University Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Xiaolin Sun
- DHZC (Deutsches Herzzentrum der Charité), Charité - University Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Yimeng Hao
- DHZC (Deutsches Herzzentrum der Charité), Charité - University Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Marvin Steitz
- DHZC (Deutsches Herzzentrum der Charité), Charité - University Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Alexander Breitenstein-Attach
- DHZC (Deutsches Herzzentrum der Charité), Charité - University Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Jasper Emeis
- DHZC (Deutsches Herzzentrum der Charité), Charité - University Medicine, Berlin, Germany
| | - Felix Berger
- DHZC (Deutsches Herzzentrum der Charité), Charité - University Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Boris Schmitt
- DHZC (Deutsches Herzzentrum der Charité), Charité - University Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
- BIH (Berlin Institute of Health), Berlin, Germany
- BCRT (BIH Center of Regenerative Therapies), Berlin, Germany
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Huang J, Zhang W, Jia B, Chen G, Mi Y, Shi Q, Shan Y, Zhang H. A midterm follow-up study of the application of a confluent aortic valve neocuspidization technique with pericardium in children. Transl Pediatr 2023; 12:1981-1991. [PMID: 38130583 PMCID: PMC10730963 DOI: 10.21037/tp-23-289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 10/22/2023] [Indexed: 12/23/2023] Open
Abstract
Background The treatment of aortic valve diseases in children remains a great challenge. We aim to report outcomes and midterm follow-up data of our confluent neocuspidization technique with pericardium for aortic valve replacement (AVR) in children. Methods A retrospective analysis was performed on all 20 children who underwent the confluent neocuspidization technique with pericardium at Children's Hospital of Fudan University from March 2017 to May 2022. Outcome measures included echocardiographic measurements, surgical intervention, and mortality. Results A total of 20 patients (17 males vs. 3 females), with a median age of 7.5 years [min-max, 0.3-12 years; interquartile range (IQR), 4.4-9.7 years], a median body weight of 24.0 kg (min-max, 6.0-52.3 kg; IQR, 15.6-31.0 kg), and median aortic valve annulus size before surgery of 19.0 mm (min-max, 11.0-25.0 mm; IQR, 17.1-21.5 mm), underwent the neocuspidization technique with pericardium (17 autologous pericardia and 3 bovine patch). With 50% of bicuspid aortic valve and 50% of tricuspid, they were respectively diagnosed as aortic stenosis (AS) (7/20, 35%), aortic regurgitation (AR) (8/20, 40%) and mixed AS and AR (AS & AR) (5/20, 25%). The median postoperative follow-up time was 19 months (min-max, 5-61 months; IQR, 16.3-35 months). The peak pressure gradient across the aortic valve decreased from 81.0±37.0 mmHg in AS group and AS & AR group before surgery to 25.9±15.8 mmHg within 24 hours after surgery (P<0.001) and was mostly around 25 mmHg during follow-up. All patients presented mild or less than mild regurgitation within 24 hours after surgery. There were no hospital mortalities. Three patients needed reintervention during follow-up. There was one late death related to mitral valve stenosis. Conclusions Though the confluent neocuspidization technique with pericardium provided immediate relief of significant AS or regurgitation, the midterm outcome was suboptimal. More research is needed to find the optimal material for AVR.
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Affiliation(s)
- Jiaxi Huang
- Department of Pediatric Cardiothoracic Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Wenbo Zhang
- Department of Pediatric Cardiothoracic Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Bing Jia
- Department of Pediatric Cardiothoracic Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Gang Chen
- Department of Pediatric Cardiothoracic Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Yaping Mi
- Department of Pediatric Cardiothoracic Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Qiqi Shi
- Department of Pediatric Cardiothoracic Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Yaping Shan
- Department of Pediatric Cardiothoracic Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Huifeng Zhang
- Department of Pediatric Cardiothoracic Surgery, Children's Hospital of Fudan University, Shanghai, China
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Bazylev V, Tungusov D, Mikulyak A. Predictors of Mid-Term AVNeo Insufficiency. Braz J Cardiovasc Surg 2023; 38:e20220370. [PMID: 37797236 PMCID: PMC10549767 DOI: 10.21470/1678-9741-2022-0370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/15/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION Aortic stenosis (AS) is the most common valvular heart disease and the most common indication for aortic valve replacement in adults. Aortic valve neocuspidization (AVNeo) with fixed autologous pericardium, also known as the Ozaki procedure, is a possible alternative treatment of AS. Autopericardial valves save the dynamics and physiological anatomy of the aortic root, however, the service life of autopericardial leaflets is limited. There is no data about factors that may influence the development of AVNeo insufficiency. Here, we assessed the effect of autopericardial leaflet symmetry on the development of aortic insufficiency after Ozaki procedure. METHODS This study included 381 patients with AS who underwent Ozaki procedure. Patients were divided into group 1 (171 patients with symmetric aortic root) and group 2 (210 patients with asymmetric aortic root). RESULTS The maximum observation period was up to 65 months. Sixteen cases of aortic insufficiency were detected in group 1, and 33 cases were detected in group 2. Based on the results of Cox regression, the predictors of aortic insufficiency in the late postoperative period are age and asymmetry of neocusps. According to results of Kaplan-Meier analysis, insufficiency of AVNeo in the maximum follow-up period after surgical correction of AS for group 1 patients was significantly lower than for group 2 patients (P=0.006). CONCLUSION Asymmetric neocusps increase the risk of aortic insufficiency in the mid-term period after Ozaki procedure. And the older the patients at the time of surgery, the less likely they develop AVNeo insufficiency.
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Affiliation(s)
- Vladlen Bazylev
- Federal Center for Cardiovascular Surgery (Penza), Ministry of
Health of the Russian Federation, Penza, Russian Federation
| | - Dmitry Tungusov
- Federal Center for Cardiovascular Surgery (Penza), Ministry of
Health of the Russian Federation, Penza, Russian Federation
| | - Artur Mikulyak
- Federal Center for Cardiovascular Surgery (Penza), Ministry of
Health of the Russian Federation, Penza, Russian Federation
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Rapid anticalcification treatment for glutaraldehyde-fixed autologous tissue in cardiovascular surgery. J Cardiothorac Surg 2022; 17:138. [PMID: 35642062 PMCID: PMC9158145 DOI: 10.1186/s13019-022-01895-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/19/2022] [Indexed: 01/16/2023] Open
Abstract
Background Glutaraldehyde (GA)-fixed autologous tissues, including the pericardium, are widely used as patches and valve substitutes in cardiovascular surgery. However, GA treatment causes tissue calcification. No rapid anticalcification method has been established for use during surgery. Here, we aimed to establish a rapid anticalcification method using ethanol, as has already been demonstrated for bioprosthetic valves. Methods Thoracic aorta tissues were first fixed with GA for 3 min and then treated with ethanol for 0 (group 2), 10 (group 3), 20 (group 4), and 30 (group 5) min; untreated tissues (group 1) served as the control. The treated tissues were subdermally implanted into 3-week-old male Wistar rats and kept in place for 28 days. The calcification in each explant was semiquantitatively evaluated by annotating and measuring the area using virtual slides, and the data obtained were statistically analyzed. Results Semiquantitative analysis revealed that calcification of the implants from the untreated group (group 1; P = 0.0014) and groups 4 (P = 0.0014) and 5 (P = 0.0031) was significantly lower than that of implants from group 2. Moreover, implants from group 3 showed a tendency toward decreased calcification, although it was not significant (P = 0.0503). Conclusions A rapid ethanol treatment prevents calcification of GA-fixed tissues in a rat model of subdermal implantation. This method may facilitate effective and rapid anticalcification of autologous tissues for use during cardiovascular surgery. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-022-01895-7.
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Shimoda T, Mathis BJ, Kato H, Matsubara M, Suzuki Y, Suetsugu F, Hiramatsu Y. Architecture matters: Tissue preservation strategies for tetralogy of Fallot repair. J Card Surg 2021; 36:2836-2849. [PMID: 33908656 DOI: 10.1111/jocs.15584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/11/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Great variability exists in repair strategies for the tetralogy of Fallot. While transannular patching, as introduced by Kirklin, was a breakthrough for primary repair, pulmonary regurgitation and a need for reoperation have led to the development of methods that preserve the natural morphology of the right ventricular outflow tract. METHODS State-of-the-art details of tetralogy of Fallot repair are explained from the standpoint of architectural preservation, especially with regard to sparing native tissue such as the annulus, valve, or infundibulum. Particular attention is given to the latest technical details of each approach, benefits and disadvantages, and any long-term data available. RESULTS The choice of procedure is complex and unique to each case as transannular patching alone may carry long-term pulmonary risks. Modifications that spare the annulus, valves, or infundibulum may thus be essential as preservation of natural morphology has resulted in excellent mid-term results. CONCLUSIONS The complexity of tetralogy of Fallot repair demands constant attention to clinical presentation and vigilance against long-term sequelae. Techniques will continue to improve over time as long-term data guides the refinement of these innovative surgical methods.
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Affiliation(s)
- Tomonari Shimoda
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Bryan J Mathis
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hideyuki Kato
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Muneaki Matsubara
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yasuyuki Suzuki
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Fuminaga Suetsugu
- Department of Cardiovascular Surgery, Suetsugu Clinic , Kitakyushu, Fukuoka, Japan
| | - Yuji Hiramatsu
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Pirola S, Mastroiacovo G, Arlati F, Mostardini G, Bonomi A, Penza E, Polvani G. Single center 5-years' experience of Ozaki procedure: mid-term follow-up. Ann Thorac Surg 2020; 111:S0003-4975(20)31730-6. [PMID: 34756837 DOI: 10.1016/j.athoracsur.2020.08.039] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/11/2020] [Accepted: 08/24/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Ozaki procedure is an innovative surgical technique aiming at the reconstruction of the aortic valve with autologous pericardium to overcome the limitations of commercially available prostheses. METHODS We retrospectively analysed 71 patients who underwent Ozaki operation at our centre between October 2014 and February 2020. RESULTS No in-hospital death occurred. Freedom from major adverse valve-related events (MAVRE) was 97%. The aortic gradients and transvalvular velocity are significantly lower at the 3-months echocardiographic control than at the pre-discharged echocardiography (10.93 ± 5.38, p= 0,0003 vs 16.24 ± 7.67 p= 0,0004 respectively). The median follow-up period was 20.7 months (range 2 to 47 months). Four patients showed mild/moderate aortic insufficiency (5.6%) and none showed severe aortic valve insufficiency. No patients underwent reoperation. CONCLUSIONS Mid-term outcome follow-up of Ozaki procedure showed optimal results in term of mortality, transaortic valve gradients, freedom from MAVRE and recurrence of aortic valve insufficiency.
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Affiliation(s)
| | | | | | | | - Alice Bonomi
- Department of Statistics Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | - Gianluca Polvani
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Cardiovascular Sciences and Community Health, University of Milan, Italy
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Wang K, Zhang H, Jia B. Current surgical strategies and techniques of aortic valve diseases in children. Transl Pediatr 2018; 7:83-90. [PMID: 29770290 PMCID: PMC5938258 DOI: 10.21037/tp.2018.02.03] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
While the long-term outcome of surgical aortic valvotomy (SAV) appears to be better than that of balloon aortic valvuloplasty (BAV) as the primary procedure of aortic valve stenosis, the surgical strategies and techniques of treating aortic valve disease in children in other situations remain controversial. Valve repair should be first considered while replacement is still unavoidable in some cases, and new repair techniques developed by innovative surgeons are gradually becoming adopted. Some complex repair procedures such as cusp extension, leaflet replacement/reconstruction have provided satisfactory outcomes. The Ozaki technique replaces aortic valve leaflets with glutaraldehyde-treated autologous pericardium instead of replacing the valve entirely. Special instruments have been developed to make the Ozaki technique more reproducible and standardized. Neonates and infants undergoing aortic valve replacement (AVR) are a high-risk group, where repair should be the primary consideration rather than replacement. Several systematic reviews reveal that all currently available aortic valve substitutes such as pulmonary autograft, mechanical prosthesis, homograft and bioprosthesis are associated with suboptimal results in children, but pulmonary autograft appeared to be superior with high freedom from reintervention and better hemodynamic performance. The strategy for treatment of aortic valve disease should be specifically analyzed based on the brief of being beneficial for children.
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Affiliation(s)
- Kun Wang
- Department of Cardiovascular Surgery, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Huifeng Zhang
- Department of Cardiovascular Surgery, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Bing Jia
- Department of Cardiovascular Surgery, Children's Hospital of Fudan University, Shanghai 201102, China
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Velicki L, Rosic M, Susak S, Redzek A. eReply re: Atrial septal defect closure with a composite check-valved patch in pulmonary hypertensive patients. Interact Cardiovasc Thorac Surg 2016; 22:858-9. [DOI: 10.1093/icvts/ivw181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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