Experimental Reconstruction of the Tricuspid Valve With Autologous Fascia Lata

Gilbert, Joseph W.; Mansour, K.; Sanders, Steven W.; Gravanis, Michael B.

doi:10.1001/archsurg.1968.01340010179025

Cited by 13 publications

(4 citation statements)

References 11 publications

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“…These changes confirm the experimental work of Brea, Allen, and Muller (1965), Flege, Rossi, Auer, and Ehrenhaft (1967), Gilbert, Mansour, Sanders and Gravanis (1968), and Myers and Miller (1969), who demonstrated that fascia lata valves in the dog underwent thickening and cicatricial contraction and became incompetent in the long term. The disorganization of the collagen bundles, coupled with a significant decrease in the number of fibroblasts in fascia lata which has been implanted as a heart valve substitute, together with the clinical findings of contraction of the fascia lata in several patients, suggest that human fascia lata is not maintaining its in vivo characteristics.…”

Section: Resultssupporting

confidence: 87%

Viability of autologous fascia lata in heart valve replacements

Lincoln

Riley

Revignas

et al. 1971

Thorax

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A histological and radioautographic examination of 11 autologous fascia lata heart valves used in man is described. There was a significant decrease, exponential with time, in the number of fibroblasts per unit volume (P<0 001). The collagen bundles were grossly disorganized and separated, suggesting a breakdown of the cross-linkage in the tissue. Redundant connective tissue on the surface of the valve cusp became oedematous and contained many trapped cells. A pseudoendothelium was formed within 10 days. Incorporation of tritium-labelled thymidine in the nuclei of the fibroblasts showed a sixfold reduction over 9 to 12 weeks following implantation, suggesting a failure of metabolism in these cells. The suitability of fascia lata for human heart valve replacement is discussed.The construction of heart valve substitutes from autologous fascia lata using differing techniques has now become a well-established routine in many centres (Senning, 1967;Ionescu and Ross, 1969;Ionescu, Ross, Deac, Grimshaw, Taylor, Whitaker and Wooler, 1970). Probably the technique most commonly used is one where the fascia lata is sewn on to a supporting threepronged stent for ease of fabrication and insertion (Ionescu and Ross, 1969).In a recent review of 76 patients who had undergone mitral valve replacement with a framemounted fascia lata valve, concern was expressed at the finding of contraction of the cusps of three of these fascia lata valves, with ensuing incompetence (Lincoln, Balcon, Emanuel, McDonald, Muir, Ross, Somerville, and Taylor, 1970). Because of these findings, a study was carried out on frame-mounted fascia lata valves which, for a variety of reasons, had been removed from patients in whom they had been inserted. MATERIAL 1. Fascia lata taken from two patients, A and B, who were undergoing cardiac surgery was made into routine histological sections and stained with haematoxylin and eosin, and these were used as controls. From 11 patients, C to M, sections of valves which had been inserted for periods of time ranging from two days to 32 weeks were also made into histological sections and stained with haematoxylin and eosin.2. Fascia lata from patient B was divided into two parts. One part was immediately fixed in 10% formalin in 0-1 M phosphate buffer, and the other part was left unfixed. Parts of both were prepared for radioautography. Fascia lata from patient I, who had had a valve in situ for nine weeks, and from patient J, who had had a valve in situ for 12 weeks, was prepared for radioautography. The time lapse which occurred between removing the fascia lata from the patients and its special preparation for these studies never exceeded 30 minutes. METHODSRadioautography can give information regarding the growth rate of cells by their ability to incorporate tritium(H3)-labelled precursors of DNA.A modification of the radioautographic technique of Kopriwa and Leblond (1962) was used. This technique is as follows:1. Samples of fascia lata were incubated at 37°C for 48 hours in Eagles Minimum Essential Medium to which ...

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Section: Resultssupporting

confidence: 87%

Viability of autologous fascia lata in heart valve replacements

Lincoln

Riley

Revignas

et al. 1971

Thorax

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“…Few reports have described surgical strategies to approach the tricuspid valve in quadrupeds. Gilbert et al [3] described experimental reconstruction of the tricuspid valve with autologous fascia lata, but no full cardiopulmonary bypass was used. Kinney et al [6] described a trans-sternal bilateral thoracotomy in a canine model with acute, reversible tricuspid insufficiency.…”

Section: Discussionmentioning

confidence: 99%

Surgical access via right thoracotomy facilitates tricuspid valve surgery in sheep

et al. 2017

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In quadrupeds, the three-dimensional orientation of the heart with respect to the thorax is fundamentally different from that in humans. In this study, we assessed the best surgical approach to the tricuspid valve in sheep. Firstly, different surgical access sites to the tricuspid valve were tested in sheep cadavers, the anatomy was analyzed, and the optimal surgical approach to the tricuspid valve was determined. Secondly - along with cardiopulmonary bypass and cardioplegic arrest -the chosen approach was tested in six adult sheep in vivo. Anatomical analyses revealed that a left thoracotomy provided optimal access to the aorta and left heart. However, visualization of the right heart was significantly impaired. In contrast, a right thoracotomy provided good access to the right heart, but the ascending aorta was difficult to approach. Therefore, in the in vivo studies, arterial cannulation was performed through a carotid (n = 4) or femoral (n = 2) artery. In conclusion, a right-sided thoracotomy allows good visualization of all components of the tricuspid valve complex in sheep, but not of the ascending aorta. Consequently, peripheral vessels are preferred for arterial cannulation. This work may stimulate the investigation of pathomechanisms and/or novel treatment options for tricuspid valve pathologies.

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“…Gilbert, Mansour, Sanders, and Gravanis (1968) used patches and leaflet type grafts in the tricuspid position in dogs. Their results, too, were discouraging.…”

Section: Structure and Function Of Fascia Fascia Ismentioning

confidence: 99%