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Early failure of xenogenous de-cellularised pulmonary valve conduits--a word of caution!
MedLine Citation:
PMID:  20219384     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
OBJECTIVE: The longevity of valved right ventricle to pulmonary artery (RV-PA) conduits is limited due to calcification and degeneration of non-viable structures. Xenografts are commonly used because of the restricted availability of cryopreserved homografts. Tissue-engineered (de-cellularised) pulmonary valves (TEPVs) were thought to be a valuable alternative to cryopreserved pulmonary homografts due to postoperative seeding with viable autologous vascular endothelial cells.
METHODS: From July 2007 to December 2008, xenogenous TEPV (Matrix P plus) were implanted in 16 patients in the right ventricular outflow tract for different indications, related to congenital heart disease. Mean age at operation was 14+/-11 years, including three patients younger than 1 year. The median conduit size was 22 mm (range: 13-26 mm).
RESULTS: The early and late survival rates were 100%. At a median follow-up of 10 months (range: 2-17 months), six patients (38%) had to be re-operated upon due to obstructed grafts. Five of these patients were older than 13 years (range: 13-26 years); one patient was younger than 1 year. On echocardiography before re-operation, mean systolic gradient in the main PA was 66+/-18 mmHg. In explanted conduits, we found a predominantly peripheral conduit narrowing without leaflet calcification. Histological examination revealed stenosis formation, due to inflammatory infiltration and severely fibrogenic pseudo-intimal reaction.
CONCLUSIONS: On the basis of our short-term results, the Matrix P plus de-cellularised tissue-engineered pulmonary valve cannot be regarded as an ideal conduit for right ventricular outflow tract reconstruction, as the widespread use of these grafts may increase the possibility of frequent early conduit failures.
Authors:
André Rüffer; Ariawan Purbojo; Iwona Cicha; Martin Glöckler; Sergej Potapov; Sven Dittrich; Robert Anton Cesnjevar
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Publication Detail:
Type:  Journal Article     Date:  2010-03-12
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  38     ISSN:  1873-734X     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-06-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  78-85     Citation Subset:  IM    
Copyright Information:
Copyright 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
Affiliation:
Department for Pediatric Cardiac Surgery, University Hospital Erlangen, Erlangen, Germany. andre.rueffer@uk-erlangen.de
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