Orthotopic replacement of the aortic valve with decellularized allograft in a sheep model

Baraki, Hassina; Tudorache, I.; Braun, Maike; Höffler, Klaus; Görler, Adelheid; Lichtenberg, Artur; Bara, C.; Calistru, Alex; Brandes, Gudrun; Hewicker‐Trautwein, M.; Hilfiker, Andres; Haverich, Axel; Cebotari, Serghei

doi:10.1016/j.biomaterials.2009.07.068

Cited by 106 publications

(80 citation statements)

References 19 publications

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“…Although a limitation of this study was the relatively small number of enrolled animals, statistical analysis indicated that both D and DC grafts did not show significant time-related increasing in PTGs after implantation. These results are in line with other reports regarding biological valvular scaffolds, for which the gradients remained constant during the entire period of followup [24][25][26][27]. However, PTGs were significantly higher than the preoperative gradients and the short-term nature of this event precludes the genesis of a pathological stenosis.…”

Section: Discussionsupporting

confidence: 91%

“…From our previous experience [19][20][21], spontaneous tissue-guided regeneration of acellular scaffolds from native heart valves proved to be an appealing technique for a straight-forward and functional clinical application. Previous studies utilize as animal model the juvenile sheep and more recently also the elderly sheep [24][25][26]. In this context, the allogeneic VP model has been shown to be a suitable experimental system for in vivo, long-term validation of valve prostheses, since it produces coagulation and inflammatory responses, as in transplanted patients.…”

Section: Discussionmentioning

confidence: 99%

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Decellularized aortic conduits: could their cryopreservation affect post-implantation outcomes? A morpho-functional study on porcine homografts

et al. 2016

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Explanted D grafts exhibited near-normal features, whereas the presence of calcification, inflammatory infiltrates, and disarray of elastic lamellae occurred in some DC grafts. In the unaltered regions of AVCs from both groups, almost complete re-endothelialization was observed for both valve cusps and aorta walls. In addition, side-by-side repopulation by recipient's fibroblasts, myofibroblasts, and smooth muscle cells was paralleled by ongoing tissue remodeling, as revealed by the ultrastructural identification of typical canals of collagen fibrillogenesis and elastogenesis-related features. Incipient neo-vascularization and re-innervation of medial and adventitial tunicae of grafted aortic walls were also detected for both D and DC groups. Cryopreservation did not affect post-implantation AVC hemodynamic behavior and was topically propensive to cell repopulation and tissue renewal, although graft deterioration including calcification was present in several areas. Thus, these preliminary data provide essential information on feasibility of decellularization and cryopreservation coupling in the perspective of treatment optimization and subsequent clinical Abstract Decellularized porcine aortic valve conduits (AVCs) implanted in a Vietnamese Pig (VP) experimental animal model were matched against decellularized and then cryopreserved AVCs to assess the effect of cryopreservation on graft hemodynamic performance and propensity to in vivo repopulation by host's cells. VPs (n = 12) underwent right ventricular outflow tract substitution using AVC allografts and were studied for 15-month follow-up. VPs were randomized into two groups, receiving AVCs treated with decellularization alone (D; n = 6) or decellularization/ cryopreservation (DC; n = 6), respectively. Serial echocardiography was carried out to follow up hemodynamic function. All explanted AVCs were processed for light and electron microscopy. No signs of dilatation, progressive stenosis, regurgitation, and macroscopic calcification were echocardiographically observed in both D and DC groups. Heart Vessels 1 3 trials using similarly treated human allografts as innovative heart valve substitutes.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Decellularized aortic conduits: could their cryopreservation affect post-implantation outcomes? A morpho-functional study on porcine homografts

et al. 2016

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“…18 Alternatively, our preclinical studies in the sheep model showed excellent hemodynamic performance of decellularized allograft valve scaffolds. 5,19 We report our clinical follow-up of decellularized homograft implantation in children and young adults. These results were compared retrospectively with mostly xenograft and allograft types of valves in pediatric cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, decellularized valve conduits become repopulated by endothelial and interstitial cells that positively responded to endothelial nitric oxide synthase, von Willebrand factor, and ␣-smooth muscle actin stainings. 19 In our previous study, we described clinical application of tissue-engineered heart valves using autologous progenitor cells, which were preseeded on trypsin-decellularized allograft valves. 3 In the present study, we used our new method of detergent treatment for decellularization.…”

Section: Discussionmentioning

confidence: 99%

Use of Fresh Decellularized Allografts for Pulmonary Valve Replacement May Reduce the Reoperation Rate in Children and Young Adults

et al. 2011

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Background-Degeneration of xenografts or homografts is a major cause for reoperation in young patients after pulmonary valve replacement. We present the early results of fresh decellularized pulmonary homografts (DPH) implantation compared with glutaraldehyde-fixed bovine jugular vein (BJV) and cryopreserved homografts (CH). Methods and Results-Thirty-eight patients with DPH in pulmonary position were consecutively evaluated during the follow-up (up to 5 years) including medical examination, echocardiography, and MRI. These patients were matched according to age and pathology and compared with BJV (nϭ38) and CH (nϭ38) recipients. In contrast to BJV and CH groups, echocardiography revealed no increase of transvalvular gradient, cusp thickening, or aneurysmatic dilatation in DPH patients. Over time, DPH valve annulus diameters converge toward normal z-values. Five-year freedom from explantation was 100% for DPH and 86Ϯ8% and 88Ϯ7% for BJV and CH conduits, respectively. Additionally, MRI investigations in 17 DPH patients with follow-up time Ͼ2 years were compared with MRI data of 20 BJV recipients. Both patient groups (DPH and BJV) were at comparable ages (mean, 12.7Ϯ6.1 versus 13.0Ϯ3.0 years) and have comparable follow-up time (3.7Ϯ1.0 versus 2.7Ϯ0.9 years). In DPH patients, the mean transvalvular gradient was significantly (Pϭ0.001) lower (11 mm Hg) compared with the BJV group (23.2 mm Hg). Regurgitation fraction was 14Ϯ3% and 4Ϯ5% in DPH and BJV groups, respectively. In 3 DPH recipients, moderate regurgitation was documented after surgery and remained unchanged in follow-up. Conclusions-In contrast to conventional homografts and xenografts, decellularized fresh allograft valves showed improved freedom from explantation, provided low gradients in follow-up, and exhibited adaptive growth. (Circulation. 2011; 124[suppl 1]:S115-S123.)

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“…However, in vitro endothelialization of grafts involves multiple additional procedures, for instance donation of patient specific tissue for isolation of endothelial cells. In vivo studies showed that implantation of nonendothelialized TEHV resulted in almost confluent endothelialization already after 4-8 weeks in vivo [16,48,50,51]. However, using ADSC for tissue engineering would enable the endothelialization after differentiation of the cells in the presence of vascular endothelial growth factor without requiring any surgical harvesting of additional patientspecific tissues.…”

Section: Discussionmentioning

confidence: 99%

Adipose Derived Tissue Engineered Heart Valve

Frese

Sanders

Beer³

et al. 2015

J Tissue Sci Eng

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Orthotopic replacement of the aortic valve with decellularized allograft in a sheep model

Cited by 106 publications

References 19 publications

Decellularized aortic conduits: could their cryopreservation affect post-implantation outcomes? A morpho-functional study on porcine homografts

Decellularized aortic conduits: could their cryopreservation affect post-implantation outcomes? A morpho-functional study on porcine homografts

Use of Fresh Decellularized Allografts for Pulmonary Valve Replacement May Reduce the Reoperation Rate in Children and Young Adults

Adipose Derived Tissue Engineered Heart Valve

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