Microstructural alterations owing to handling of bovine pericardium to manufacture bioprosthetic heart valves: A potential risk for cusp dehiscence

Morphologie ◽  
2017 ◽  
Vol 101 (333) ◽  
pp. 77-87 ◽  
Author(s):  
J. Mao ◽  
Y. Wang ◽  
E. Philippe ◽  
T. Cianciulli ◽  
I. Vesely ◽  
...  
Keyword(s):  
Potential Risk ◽  
Heart Valves ◽  
Bovine Pericardium ◽  
Bioprosthetic Heart Valves ◽  
Microstructural Alterations

scholarly journals Retardation of calcification of bovine pericardium used in bioprosthetic heart valves by phosphocitrate and a synthetic analogue

Biomaterials ◽  
1988 ◽  
Vol 9 (5) ◽  
pp. 393-397 ◽  
Author(s):  
Jack W. Tsao ◽  
Frederick J. Schoen ◽  
Ravi Shankar ◽  
John D. Sallis ◽  
Robert J. Levy
Keyword(s):  
Heart Valves ◽  
Bovine Pericardium ◽  
Synthetic Analogue ◽  
Bioprosthetic Heart Valves

scholarly journals Collagen fibre-mediated mechanical damage increases calcification of bovine pericardium for use in bioprosthetic heart valves

2021 ◽  
Author(s):  
Alix Whelan ◽  
Elizabeth Williams ◽  
Emma Fitzpatrick ◽  
Bruce Murphy ◽  
Paul S. Gunning ◽  
...  
Keyword(s):  
Heart Valves ◽  
Mechanical Damage ◽  
Collagen Fibre ◽  
Bovine Pericardium ◽  
Bioprosthetic Heart Valves

scholarly journals Collagen fibre-mediated mechanical damage increases calcification of bovine pericardium for use in bioprosthetic heart valves

2020 ◽  
Author(s):  
Alix Whelan ◽  
Elizabeth Williams ◽  
Emma Fitzpatrick ◽  
Bruce Murphy ◽  
Paul S. Gunning ◽  
...  
Keyword(s):  
Fatigue Damage ◽  
Heart Valves ◽  
Failure Modes ◽  
Mechanical Damage ◽  
Collagen Fibre ◽  
Bovine Pericardium ◽  
Bioprosthetic Heart Valves ◽  
High Fatigue ◽  
Primary Leaflet

AbstractIn cases of aortic stenosis, bioprosthetic heart valves (BHVs), with leaflets made from glutaraldehyde fixed bovine pericardium (GLBP), are often implanted to replace the native diseased valve. Widespread use of these devices, however, is restricted due to inadequate long-term durability owing specifically to premature leaflet failure. Mechanical fatigue damage and calcification remain the primary leaflet failure modes, where glutaraldehyde treatment is known to accelerate calcification. The literature in this area is limited, with some studies suggesting mechanical damage increases calcification and others that they are independent degenerative mechanisms. In this study, specimens which were non-destructively pre-sorted according to collagen fibre architecture and then uniaxially cyclically loaded until failure or 1 million cycles, were placed in an in-vitro calcification solution. Measurements of percentage volume calcification demonstrated that the weakest specimen group (those with fibres aligned perpendicular to the load) had statistically significantly higher volumes of calcification when compared to those with a high fatigue life. Moreover, SEM imaging revealed that ruptured and damaged fibres presented binding sites for calcium to attach; resulting in more than 4 times the volume of calcification in fractured samples when compared to those which did not fail by fatigue. To the authors’ knowledge, this study quantifies for the first time, that mechanical damage drives calcification in commercial-grade GLBP and that this calcification varies spatially according to localised levels of damage. These findings illustrate that not only is calcification potential in GLBP exacerbated by fatigue damage, but that both failure phenomena are underpinned by the unloaded collagen fibre organisation. Consequently, controlling for GLBP collagen fibre architecture in leaflets could minimise the progression of these prevalent primary failure modes in patient BHVs.

Thrombosis of Surgical Bioprosthetic Heart Valves-Insights from Reports to International Medical Device Vigilance Systems

2017 ◽  
Vol 65 (S 01) ◽  
pp. S1-S110
Author(s):  
C. Gestrich ◽  
J.E. Klein ◽  
B. Toctam ◽  
G.D. Dürr ◽  
J.M. Sinning ◽  
...  
Keyword(s):  
Medical Device ◽  
Heart Valves ◽  
International Medical ◽  
Bioprosthetic Heart Valves

scholarly journals In Situ “Humanization” of Porcine Bioprostheses: Demonstration of Tendon Bioprostheses Conversion into Human ACL and Possible Implications for Heart Valve Bioprostheses

2021 ◽  
Vol 8 (1) ◽  
pp. 10
Author(s):  
Uri Galili ◽  
Kevin R. Stone
Keyword(s):  
Extracellular Matrix ◽  
Heart Valves ◽  
Cruciate Ligament ◽  
Anticoagulation Therapy ◽  
Young Patients ◽  
Collagen Fibers ◽  
Reconstruction Process ◽  
Bioprosthetic Heart Valves ◽  
Porcine Tissue ◽  
Anterior Cruciate

This review describes the first studies on successful conversion of porcine soft-tissue bioprostheses into viable permanently functional tissue in humans. This process includes gradual degradation of the porcine tissue, with concomitant neo-vascularization and reconstruction of the implanted bioprosthesis with human cells and extracellular matrix. Such a reconstruction process is referred to in this review as “humanization”. Humanization was achieved with porcine bone-patellar-tendon-bone (BTB), replacing torn anterior-cruciate-ligament (ACL) in patients. In addition to its possible use in orthopedic surgery, it is suggested that this humanization method should be studied as a possible mechanism for converting implanted porcine bioprosthetic heart-valves (BHV) into viable tissue valves in young patients. Presently, these patients are only implanted with mechanical heart-valves, which require constant anticoagulation therapy. The processing of porcine bioprostheses, which enables humanization, includes elimination of α-gal epitopes and partial (incomplete) crosslinking with glutaraldehyde. Studies on implantation of porcine BTB bioprostheses indicated that enzymatic elimination of α-gal epitopes prevents subsequent accelerated destruction of implanted tissues by the natural anti-Gal antibody, whereas the partial crosslinking by glutaraldehyde molecules results in their function as “speed bumps” that slow the infiltration of macrophages. Anti-non gal antibodies produced against porcine antigens in implanted bioprostheses recruit macrophages, which infiltrate at a pace that enables slow degradation of the porcine tissue, neo-vascularization, and infiltration of fibroblasts. These fibroblasts align with the porcine collagen-fibers scaffold, secrete their collagen-fibers and other extracellular-matrix (ECM) components, and gradually replace porcine tissues degraded by macrophages with autologous functional viable tissue. Porcine BTB implanted in patients completes humanization into autologous ACL within ~2 years. The similarities in cells and ECM comprising heart-valves and tendons, raises the possibility that porcine BHV undergoing a similar processing, may also undergo humanization, resulting in formation of an autologous, viable, permanently functional, non-calcifying heart-valves.

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