The new Labcor-Santiago pericardial bioprosthesis

The Labcor-Santiago pericardial valve has been designed to minimize mechanical stress and to avoid abrasion wear, at the same time preserving the concept of mounting the pericardium outside the posts for full orifice opening. The new design has preserved the traditional superior hemodynamic performance of pericardial valves, avoiding abrasion by careful padding of the stents and introducing a new concept of cusp attachment in order to increase mechanical durability. Since June 1990, 40 patients received 46 Labcor-Santiago valves: 29 in the aortic position and 17 in the mitral position. Mean age was 65.6 years. Eighty percent of the patients were women. New York Heart Association Functional Class III-IV was present in 76% of patients. Hospital mortality has been 12.5%, with 31% undergoing concomitant procedures. No anticoagulation was administered and there has been one thromboembolic event. Echo-Doppler assessment yielded the following in the aortic position: effective orifice area for 19-mm size = 1 cm2; for 21-mm size = 1.2 cm2. Mean systolic gradient for 19-mm size = 14.7 mmHg; for 21-mm size = 11.2 mmHg. In the mitral position: effective orifice area for 27-mm size = 2 cm2; for 29-mm size = 2.3 cm2. Mean diastolic gradients for 27-mm size = 4.6 mmHg; for 29-mm size = 3.3 mmHg. The low-profile flexible stent, the streamlined shape without outside prosthetic material, and the anatomical sewing rim allow a comfortable implantation of the Labcor-Santiago valve, particularly in the small aortic annulus. It is hoped that this new design will contribute to an increase in in vivo mechanical durability.

Stentless valves treated by the L-hydro process in the aortic position in sheep

Calcification of glutaraldehyde-treated bioprosthetic heart valves is a major cause of long-term failure. We studied porcine aortic valves treated by the L-Hydro process and implanted into 14 juvenile sheep (group 1). Another 10 sheep were implanted with glutaraldehyde-treated porcine bioprostheses (group 2). The animals were sacrificed after 150 days and the explanted valves were analyzed for calcification. Hemodynamic measurements by echocardiography and angiography were carried out prior to sacrifice. Macroscopic analysis showed calcification and loss of mobility of the leaflets in all group 2 implants and in one group 1 implant. Light microscopy showed foci of calcification in all group 2 implants and in 3 valves from group 1. A significant reduction in the level of calcification was found in porcine bioprostheses treated by the L-Hydro process and implanted into the juvenile sheep model.

A juvenile sheep model for the long-term evaluation of stentless bioprostheses implanted as aortic root replacements

BACKGROUND AND AIM OF THE STUDY

Orthotopic valve replacement in large animals is an important component of the preclinical assessment of bioprosthetic valves. To provide the most useful preclinical information, the development of models that parallel clinical practice patterns is essential. Therefore, we sought to develop a technically feasible and reproducible model for chronic evaluation of stentless bioprosthetic aortic valves implanted as aortic root replacements in juvenile sheep.

METHODS

Juvenile domestic sheep (mean age 21+/-2.28 weeks; range: 17-26 weeks) underwent aortic root replacement using standard cardiopulmonary bypass (CPB) and surgical techniques. Animals were implanted with 19 mm (n = 21), 21 mm (n = 18) or 23 mm (n = 4) bioprostheses from two different manufacturers, and followed for 150 days. Animals surviving at least 150 days were considered long-term survivors; those which died prior to postoperative day (POD) 31 were considered operative deaths.

RESULTS

Forty-three animals underwent aortic root replacement. The mean CPB time was 91+/-20 min (range: 62-149 min); mean cross-clamp time was 63+/-13 min (range: 39-95 min). Thirty-five animals (81%) survived the first 30 days of the study period. Five deaths occurred at POD 0 due to anastomotic complications. One death occurred each on POD 3, 6, and 26 as a result of prosthesis size mismatching, thromboembolic complications, and endocarditis, respectively. There were five late deaths. Twenty animals survived the minimum 150-day study period, and 12 were sacrificed at 183+/-17 days. Six animals remain alive at 151+/-0.98 days, and one animal died each on POD 184 and 190. The remaining 10 animals are not yet 150 days from their operation. Currently, all are well at 102+/-34 days (range: 33-140) days.

CONCLUSION

These data suggest that long-term evaluation of stentless aortic bioprostheses implanted as aortic root replacements can be accomplished using juvenile sheep.