Document Detail


Aortic valve replacement with autologous pericardium: long-term follow-up of 15 patients and in vivo histopathological changes of autologous pericardium.
MedLine Citation:
PMID:  23143205     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The study aimed to assess the long-term follow-up of patients with an autologous pericardial aortic valve (APAV) replacement and to analyse in vivo histopathological changes in implanted APAVs.
METHODS: From 1996 to 1997, 15 patients (mean age, 34 years) underwent aortic valve replacement with the glutaraldehyde-treated autologous pericardium. All patients were followed up after discharge. The excised APAVs were processed for haematoxylin-eosin, Victoria blue-van Gieson and immunohistochemical staining.
RESULTS: The mean clinical follow-up was 11.43 ± 4.50 years. APAV-related in-hospital and late mortalities were both 0%. Five (33%) patients required reoperation because of a prolapse of the right coronary cusp (n = 1), infective endocarditis (n = 1) or fibrocalcific degeneration (n = 3). Freedom from endocarditis, fibrocalcific degeneration and reoperation at the end of follow-up was 93, 80 and 67%, respectively. The remaining 10 patients were alive and well with a mean New York Heart Association class of 1.10 ± 0.32 and normally functioning aortic valves (peak pressure gradient: 7.70 ± 3.41 mmHg; mean pressure gradient: 1.79 ± 0.64 mmHg). Histopathology revealed that (i) a thin factor VIII-positive layer (endothelialization) was found on all non-endocarditis APAVs; (ii) pericardial cells in all APAVs were positive for α-smooth muscle actin (myofibroblast phenotype) and some cells in the fibrocalcific APAVs were positive for alkaline phosphatase (osteoblast phenotype) and (iii) an elastic band was found in 3 cases (in vivo >9 years).
CONCLUSIONS: APAV replacement is a procedure with a low mortality. APAVs adapt to new environmental demands by producing an elastic band and by endothelialization, whereas myofibroblast/osteoblast transdifferentiation seems to be responsible for the fibrocalcification of APAVs.
Authors:
Xiaohong Liu; Lin Han; Zhigang Song; Mengwei Tan; Dejun Gong; Zhiyun Xu
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-11-08
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  16     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-21     Completed Date:  2013-09-13     Revised Date:  2014-02-04    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  123-8     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Actins / metabolism
Adult
Alkaline Phosphatase / metabolism
Aortic Valve / metabolism,  pathology,  surgery*
Biological Markers / metabolism
Bioprosthesis*
Calcinosis
Cell Transdifferentiation
Elastic Tissue / pathology
Endothelial Cells / metabolism,  pathology
Factor VIII / metabolism
Female
Fibrosis
Follow-Up Studies
Heart Valve Prosthesis*
Heart Valve Prosthesis Implantation / adverse effects,  instrumentation*
Humans
Immunohistochemistry
Male
Middle Aged
Myofibroblasts / metabolism,  pathology
Osteoblasts / metabolism,  pathology
Pericardium / metabolism,  pathology,  transplantation*
Phenotype
Prospective Studies
Prosthesis Design
Reoperation
Staining and Labeling
Time Factors
Transplantation, Autologous
Treatment Outcome
Young Adult
Chemical
Reg. No./Substance:
0/ACTA2 protein, human; 0/Actins; 0/Biological Markers; 0/F8 protein, human; 9001-27-8/Factor VIII; EC 3.1.3.1/Alkaline Phosphatase
Comments/Corrections
Comment In:
Interact Cardiovasc Thorac Surg. 2013 Feb;16(2):128   [PMID:  23334734 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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