Document Detail

Oral everolimus inhibits neointimal proliferation in prosthetic pulmonary valved stents in pigs.
MedLine Citation:
PMID:  18751477     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND AIM OF THE STUDY: Growth factor-dependent cell proliferation can cause in-stent neointimal hyperplasia. The study aim was to evaluate whether oral everolimus inhibits the intimal proliferation associated with the implantation of prosthetic pulmonary valved stents. METHODS: Prosthetic pulmonary valves were implanted in 12 pigs (mean bodyweight 25 kg) using a transcatheter technique. Tricuspid valves were prepared from a titanium-coated polymer and sewn into a self-expanding nitinol stent (diameter 20 mm). Valved stents were implanted in the pulmonary position, where they remained for three months. In six animals, treatment with 2 mg/kg everolimus (Certican; Novartis) per day was started three days before implantation and continued throughout the course of the experiment. The other six pigs acted as controls. Adjuvant anticoagulation treatment consisted of acetylsalicylic acid and oral clopidogrel. After three months, hemodynamic valve function was investigated at catheterization and with MRI. At postmortem investigation the valved stents were explanted and subjected to macroscopic, histological and electron microscopic examination. RESULTS: There were no adverse side effects due to everolimus treatment. The overall mean everolimus plasma level during the study was 4.2 +/- 2.4 ng/ml. MRI revealed intact valve function with a regurgitation fraction of 7.3 +/- 4.2% in controls and 4.3 +/- 3.1% in the everolimus group (p <0.01). On macroscopic inspection and histological examination, the everolimus group showed only a thin tissue coverage of the stent struts. The valve cusps were free from intimal thickening, and electron microscopy showed a thin continuous cellular coating. In contrast, substantial neointimal formation was noted in controls. Tissue neogenesis was pronounced at the base of the valve, extended to the valve cusps, and caused valve thickening and foreshortening. CONCLUSION: The oral administration of everolimus effectively inhibits tissue neogenesis in pulmonary valved stents in pigs.
Titus Kuehne; Klaus Pietzner; Hans B Lehmkuhl; Dinah Gelernter; Björn Peters; Julia J Krueger; Carolin Meinus; Katrin Klimes; Florian Brinkert; Peter Ewert; Felix Berger
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of heart valve disease     Volume:  17     ISSN:  0966-8519     ISO Abbreviation:  J. Heart Valve Dis.     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-08-28     Completed Date:  2009-01-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9312096     Medline TA:  J Heart Valve Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  465-72     Citation Subset:  IM    
Department for Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
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MeSH Terms
Cell Proliferation / drug effects*
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation
Hyperplasia / etiology,  pathology,  prevention & control*
Immunosuppressive Agents / pharmacology,  therapeutic use*
Microscopy, Electron, Scanning
Pulmonary Valve
Sirolimus / analogs & derivatives*,  pharmacology,  therapeutic use
Stents / adverse effects*
Tunica Intima / cytology,  drug effects
Reg. No./Substance:
0/Immunosuppressive Agents; 159351-69-6/everolimus; 53123-88-9/Sirolimus

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

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