Decellularized mitral valve in a long-term sheep model. / Iablonskii, Pavel; Cebotari, Serghei; Ciubotaru, Anatol; Sarikouch, Samir; Hoeffler, Klaus; Hilfiker, Andres; Haverich, Axel; Tudorache, Igor.
In: European Journal of Cardio-thoracic Surgery, Vol. 53, No. 6, 01.06.2018, p. 1165-1172.Research output: Contribution to journal › Article › peer-review
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TY - JOUR
T1 - Decellularized mitral valve in a long-term sheep model
AU - Iablonskii, Pavel
AU - Cebotari, Serghei
AU - Ciubotaru, Anatol
AU - Sarikouch, Samir
AU - Hoeffler, Klaus
AU - Hilfiker, Andres
AU - Haverich, Axel
AU - Tudorache, Igor
N1 - Funding Information: This work was supported by CORTISS Hannover, Herz-und Gewebeforschungs GmbH. Publisher Copyright: © The Author(s) 2017/2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. Copyright: Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2018/6/1
Y1 - 2018/6/1
N2 - OBJECTIVES: The objective of this study was to evaluate surgical handling, in vivo hemodynamic performance and morphological characteristics of decellularized mitral valves (DMVs) in a long-term sheep model. METHODS: Ovine mitral valves were decellularized using detergents and β-mercaptoethanol. Orthotopic implantations were performed in 6-month-old sheep (41.3 ± 1.2 kg, n = 11) without annulus reinforcement. Commercially available stented porcine aortic valves [biological mitral valve (BMV), n = 3] were implanted conventionally and used as controls. Valve function was evaluated by transoesophageal echocardiography and explants were investigated by a routine bright field microscopy and immunofluorescent histology. RESULTS: During implantation, 2 DMVs required cleft closure of the anterior leaflet. All valves were competent on water test and early postoperative transoesophageal echocardiography. Six animals (DMV, n = 4; BMV, n = 2) survived 12 months. Six animals died within the first 4 months due to valve-related complications. At 12 months, transoesophageal echocardiography revealed severe degeneration in all BMVs. Macroscopically, BMV revealed calcification at the commissures and leaflet insertion area. Histological examination showed sporadic cells negative for endothelial nitric oxide synthase, von Willebrand factor and CD45 on their surface. In contrast, DMV showed no calcification or stenosis, and the regurgitation was trivial to moderate in all animals. Fibrotic hardening occurred only along the suture line of the valve annulus, immunostaining revealed collagen IV covering the entire leaflet surface and a repopulation with endothelial cells. CONCLUSIONS: Surgical implantation of DMV is feasible and results in good early graft function. Additional in vivo investigations are required to minimize the procedure-related complications and to increase the reproducibility of surgical implantation. Degenerative profile of allogeneic DMV is superior to commercially available porcine aortic prosthesis.
AB - OBJECTIVES: The objective of this study was to evaluate surgical handling, in vivo hemodynamic performance and morphological characteristics of decellularized mitral valves (DMVs) in a long-term sheep model. METHODS: Ovine mitral valves were decellularized using detergents and β-mercaptoethanol. Orthotopic implantations were performed in 6-month-old sheep (41.3 ± 1.2 kg, n = 11) without annulus reinforcement. Commercially available stented porcine aortic valves [biological mitral valve (BMV), n = 3] were implanted conventionally and used as controls. Valve function was evaluated by transoesophageal echocardiography and explants were investigated by a routine bright field microscopy and immunofluorescent histology. RESULTS: During implantation, 2 DMVs required cleft closure of the anterior leaflet. All valves were competent on water test and early postoperative transoesophageal echocardiography. Six animals (DMV, n = 4; BMV, n = 2) survived 12 months. Six animals died within the first 4 months due to valve-related complications. At 12 months, transoesophageal echocardiography revealed severe degeneration in all BMVs. Macroscopically, BMV revealed calcification at the commissures and leaflet insertion area. Histological examination showed sporadic cells negative for endothelial nitric oxide synthase, von Willebrand factor and CD45 on their surface. In contrast, DMV showed no calcification or stenosis, and the regurgitation was trivial to moderate in all animals. Fibrotic hardening occurred only along the suture line of the valve annulus, immunostaining revealed collagen IV covering the entire leaflet surface and a repopulation with endothelial cells. CONCLUSIONS: Surgical implantation of DMV is feasible and results in good early graft function. Additional in vivo investigations are required to minimize the procedure-related complications and to increase the reproducibility of surgical implantation. Degenerative profile of allogeneic DMV is superior to commercially available porcine aortic prosthesis.
KW - Decellularization
KW - Mitral valve replacement
KW - Tissue engineering
UR - http://www.scopus.com/inward/record.url?scp=85048093720&partnerID=8YFLogxK
U2 - 10.1093/ejcts/ezx485
DO - 10.1093/ejcts/ezx485
M3 - Article
C2 - 29385428
AN - SCOPUS:85048093720
VL - 53
SP - 1165
EP - 1172
JO - European Journal of Cardio-thoracic Surgery
JF - European Journal of Cardio-thoracic Surgery
SN - 1010-7940
IS - 6
ER -
ID: 74299400