The Autogenous Tissue Heart Valve: Current Status

Abstract

Residual antigenicity of xenograft tissue after glutaraldehyde tanning may be a factor that determines calcification and durability of bioprostheses. We have pursued the concept of a nonantigenic, noncalcifying, more durable bioprosthesis. We previously described a technique for rapid intraoperative fabrication of an autogenous tissue heart valve (ATHV). That technique has been modified to improve reliability and ease of learning. With the modified technique, a geometrically perfect trileaflet valve can be made in 5 minutes. Although any suitable tissue can be used, the pericardial ATHV is the subject of this report. Autogenous pericardium immersed for 5 minutes in glutaraldehyde has proven satisfactory for valve construction. In vitro testing in the pulse duplicator and accelerated life tester has shown that the stent assembly is capable of function beyond 800,000,000 cycles without failure. In vivo testing has been performed in the juvenile sheep model as described by the National Institutes of Health group. Five sheep were maintained for 5 months postimplant before sacrifice. Explanted valves showed no tissue thickening or shrinkage, problems seen with earlier valves made with untreated autogenous tissue, and the leaflets remained pliable, free of the degenerative changes usually seen in the sheep model.

Polypeptide resurfacing method improves fibroblast's adhesion to hyaluronan strands

“…In order for the HyA strands to maintain a consistent shape, fabricated strands were incubated in highconcentration Glut, a widely used crosslinking agent of many biomaterials. [15][16][17] Previous studies on collagen demonstrated that increased Glut concentration increased collagen insolubility, implicating the formation of intermolecular crosslinks in addition to intramolecular links. 14 In the present study, results demonstrate that high-concentration Glut effectively crosslinks HyA.…”

“…As one of the most widely used linking agents for biomaterials, Glut also has been used to stabilize tissue heterografts, to strengthen and develop tissue bioprostheses, such as heart valves, blood vessels, and tendons, during the past twenty years, and, recently, in the crosslinking of collagen. [13][14][15][16][17] Although there are some concerns about the cytotoxicity of aldehyde, [18][19][20] renewed interest in the use of short-term Glut-treated autologous graft was encouraged by the observation that Glutcrosslinked pericardium appears not to calcify or shrink after implantation. 21,22 Cell-surface adhesion receptors are a newly identified mechanism associated with the secretion of certain polypeptide growth factors and cytokines.…”

The Ozaki Procedure: Standardized Protocol Adoption of a Complex Innovative Procedure

“…Various methods to repair and reconstruct aortic valves using autologous pericardium have been reported since the 1960s. 11 In 1986, Love and Love 12 introduced tanning the pericardium with 0.6% glutaraldehyde to prevent retraction and scarring. Al Halees and colleagues applied this treatment of autologous pericardium to reconstruct aortic valves, reporting 16-year results in 2005, followed by Chan and colleagues in 2011.…”

History of the use of autologous materials in aortic valve surgery

“…Love и J.W. Love совершили ключевое открытие, описав интраоперационное создание клапана из аутоперикарда, обработанного глу-таральдегидом [25]. Свежевыделенный перикард освобождали от жира, замачивали в 0,6% растворе глутаральдегида в течение 5 мин и промывали физиологическим раствором.…”