|Aortic valve replacement with autologous pericardium: long-term follow-up of 15 patients and in vivo histopathological changes of autologous pericardium.|
|PMID: 23143205 Owner: NLM Status: MEDLINE|
|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.
|Xiaohong Liu; Lin Han; Zhigang Song; Mengwei Tan; Dejun Gong; Zhiyun Xu|
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|Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2012-11-08|
|Title: Interactive cardiovascular and thoracic surgery Volume: 16 ISSN: 1569-9285 ISO Abbreviation: Interact Cardiovasc Thorac Surg Publication Date: 2013 Feb|
|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|
|Languages: eng Pagination: 123-8 Citation Subset: IM|
|APA/MLA Format Download EndNote Download BibTex|
Alkaline Phosphatase / metabolism
Aortic Valve / metabolism, pathology, surgery*
Biological Markers / metabolism
Elastic Tissue / pathology
Endothelial Cells / metabolism, pathology
Factor VIII / metabolism
Heart Valve Prosthesis*
Heart Valve Prosthesis Implantation / adverse effects, instrumentation*
Myofibroblasts / metabolism, pathology
Osteoblasts / metabolism, pathology
Pericardium / metabolism, pathology, transplantation*
Staining and Labeling
|0/ACTA2 protein, human; 0/Actins; 0/Biological Markers; 0/F8 protein, human; 9001-27-8/Factor VIII; EC 220.127.116.11/Alkaline Phosphatase|
|Interact Cardiovasc Thorac Surg. 2013 Feb;16(2):128
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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