Long term outcome of mechanical valve prosthesis in the pulmonary position

Dos, Laura; Muñoz-Guijosa, Christian; Méndez, A.; Ginel, Antonino; Montiel, José; Padró, Josep M.; Subirana, María Teresa

doi:10.1016/j.ijcard.2010.04.004

Cited by 33 publications

(21 citation statements)

References 16 publications

(21 reference statements)

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“…Several materials have been tested clinically for reconstructing the RVOT, [22][23][24][25][26][27][28][29] but their common limitation is the lack of a growth potential that leads to reoperations, with their attendant risk of increased morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

Polymer-Based Reconstruction of the Inferior Vena Cava in Rat: Stem Cells or RGD Peptide?

Pontailler

Illangakoon

Williams

et al. 2015

Tissue Engineering Part A

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As part of a program targeted at developing a resorbable valved tube for replacement of the right ventricular outflow tract, we compared three biopolymers (polyurethane [PU], polyhydroxyalkanoate (the poly(3-hydroxybutyrate-co-3-hydroxyvalerate-co-4-hydroxyvalerate) [PHBVV]), and polydioxanone [PDO]) and two biofunctionalization techniques (using adipose-derived stem cells [ADSCs] or the arginine-glycine-aspartate [RGD] peptide) in a rat model of partial inferior vena cava (IVC) replacement. Fifty-three Wistar rats first underwent partial replacement of the IVC with an acellular electrospun PDO, PU, or PHBVV patch, and 31 nude rats subsequently underwent the same procedure using a PDO patch biofunctionalized either by ADSC or RGD. Results were assessed both in vitro (proliferation and survival of ADSC seeded onto the different materials) and in vivo by magnetic resonance imaging ( MRI), histology, immunohistochemistry [against markers of vascular cells (von Willebrand factor [vWF], smooth muscle actin [SMA]), and macrophages ([ED1 and ED2] immunostaining)], and enzyme-linked immunosorbent assay (ELISA; for the expression of various cytokines and inducible NO synthase). PDO showed the best in vitro properties. Six weeks after implantation, MRI did not detect significant luminal changes in any group. All biopolymers were evenly lined by vWF-positive cells, but only PDO and PHBVV showed a continuous layer of SMA-positive cells at 3 months. PU patches resulted in a marked granulomatous inflammatory reaction. The ADSC and RGD biofunctionalization yielded similar outcomes. These data confirm the good biocompatibility of PDO and support the concept that appropriately peptide-functionalized polymers may be successfully substituted for cell-loaded materials.

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Section: Discussionmentioning

confidence: 99%

Polymer-Based Reconstruction of the Inferior Vena Cava in Rat: Stem Cells or RGD Peptide?

Pontailler

Illangakoon

Williams

et al. 2015

Tissue Engineering Part A

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“…8 More specifically, data on the treatment of mechanical pulmonary valve (PV) thrombosis are virtually nonexistent. A small study of 22 patients reported the incidence of mechanical PV thrombosis to be 12%, 9 but failed to mention any treatment response. The largest case series in the literature on thrombolytic therapy of mechanical PV thrombosis included only 3 patients, with a failure rate of 33%.…”

mentioning

confidence: 99%

Thrombolytic Therapy for Right-Sided Mechanical Pulmonic and Tricuspid Valves: The Largest Survival Analysis to Date

Taherkhani¹,

Hashemi²,

Hekmat³

et al. 2015

Texas Heart Institute Journal

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Data regarding thrombolytic treatment of right-sided mechanical valve thrombosis are almost nonexistent, and all current guidelines arise from very small case series. We retrospectively studied the in-hospital and long-term outcome data of a larger series of patients who had received, from September 2005 through June 2012, thrombolytic therapy for right-sided mechanical pulmonary valve or tricuspid valve thrombosis. We identified 16 patients aged 8–67 years who had undergone thrombolytic therapy for definite thrombotic mechanical valve obstruction in the tricuspid or pulmonary valve position (8 in each position). All study patients except one had subtherapeutic international normalized ratios. The 8 patients with pulmonary mechanical valve thrombosis had a 100% response rate to thrombolytic therapy, and their in-hospital survival rate was also 100%. The 8 patients with tricuspid mechanical valve thrombosis had a 75% response rate to thrombolytic therapy, with an in-hospital survival rate of 87.5%. The one-year survival rate for mechanical valve thrombosis treated with thrombolytic therapy (whether pulmonary or tricuspid) was 87.5%. On the basis of our data, we recommend that thrombolytic therapy remain the first-line therapy for right-sided mechanical valve thrombosis in adults or children—including children with complex congenital heart disease and patients with mechanical pulmonary valve thrombosis. Surgery should be reserved for patients in whom this treatment fails.

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“…Risk of thrombosis may be higher in patients with rightventricular dysfunction. 30 Several small series have reported acceptable durability of the mechanical prosthesis in the pulmonary position, with mode of failure being growth of fibrosis rather than mechanical failure or thrombosis events. 31,32 Use of mechanical valves may be justified in patients requiring anticoagulation for other reasons, in patients likely to be compliant with long-term anticoagulation, and those in whom risk of reoperation is deemed to be unusually high.…”

Section: Mechanical Valvesmentioning

confidence: 99%