Decellularization reduces calcification while improving both durability and 1-year functional results of pulmonary homograft valves in juvenile sheep

被引:77
作者
Hopkins, Richard A. [1 ,3 ]
Jones, Alyce Linthurst [2 ]
Wolfinbarger, Lloyd [2 ]
Moore, Mark A. [2 ]
Bert, Arthur A. [1 ,3 ]
Lofland, Gary K. [1 ]
机构
[1] Childrens Mercy Hosp Clin, Kansas City, MO 64108 USA
[2] LifeNet Hlth, Virginia Beach, VA USA
[3] Brown Univ, Sch Med, Providence, RI 02912 USA
关键词
ALLOGRAFT HEART-VALVES; HUMAN CARDIAC VALVES; INFANTS; ANTIBODIES; SCAFFOLDS; CHILDREN; ADULTS;
D O I
10.1016/j.jtcvs.2008.12.009
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: The juvenile sheep functional valve chronic implant calcification model was used to compare long-term calcification rates, functional performance, and durability for 3 types of right ventricular outflow tract implants: classically cryopreserved homografts and 2 decellularized pulmonary valved conduits. Methods: Fifteen juvenile sheep were randomly assigned to one of 3 study arms and underwent pulmonary valve replacement. The arms included the following: (1) cryopreserved ovine pulmonary valves; (2) cryopreserved, decellularized, saline (1 degrees C-10 degrees C)-stored ovine pulmonary valves; and (3) cryopreserved, decellularized, glycerolized (-80 degrees C) stored ovine pulmonary valves. Animal growth, serial echocardiographic results (with valve performance assessment), dimensions, and tissue-specific calcification measurements were compared with pre-explant angiographic analysis and right ventricular outflow tract pressure measurements, cardiac magnetic resonance imaging, specimen radiographic analysis, gross explant pathology, and histopathology. Parametric and nonparametric statistical analysis were performed. Results: All but 2 study animals receiving implants thrived postoperatively, with similar growth rates, explant valve dimensions, ventricular functions, cardiac output, and indices during the study. As determined by means of echocardiographic analysis, 3 animals in arm 1 (and one in arm 2) had leaflet dysfunction. Valve regurgitation was recognized in 1 survivor each from both arms 1 and 2. Although 1 arm 1 animal died with calcified subacute bacterial endocarditis, and the other 4 had leaflet and conduit wall calcification by the time of death, no arm 2 or arm 3 animals demonstrated leaflet calcium, and no arm 3 and only 1 arm 2 animals had calcium in the conduit wall over the entire year, as determined with any measurement method. All cryopreserved conduit walls had calcium by 20 weeks, whereas only 1 of 10 decellularized conduits (arms 2 plus 3) had wall calcium. Conclusion: Cryopreserved-decellularized-glycerolized valves retained normal valve function, with absent leaflet and minimal wall calcifications 1 year postoperatively, as opposed to classically cryopreserved allografts. These results might be predictive of the prolonged durability and functionality of a cryopreserved-decellularized -glycerolized allograft valve.
引用
收藏
页码:907 / U142
页数:11
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