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Viability properties in autologous fascia lata heart valve grafts: a transmission electron microscopical study
Insights
Autologous fascia lata heart valve grafts showed both preserved and degenerated cells, including myofibroblasts, which may explain graft shrinkage and dysfunction after 10 years.
Area of Science:
- Cardiovascular surgery
- Biomaterials science
- Histopathology
Background:
- Autologous fascia lata grafts are used for heart valve repair.
- Long-term graft performance and cellular changes require further investigation.
Purpose of the Study:
- To examine the ultrastructural changes in autologous fascia lata heart valve grafts after implantation.
Main Methods:
- Transmission electron microscopy (TEM) was used to analyze fascia lata valve grafts.
- Grafts were retrieved after 18-41 months and one after 10 years.
Main Results:
- Areas of well-preserved and degenerated subcellular structures were observed in all grafts.
- Degeneration included fragmentation of nuclear and collagen fibers.
- Fibrocytes, fibroblasts, and myofibroblasts were identified within the grafts.
Conclusions:
- Myofibroblast presence may contribute to graft shrinkage and subsequent valve dysfunction.
- Fascial cells can survive within the bloodstream for up to 10 years post-implantation.
Abstract:
Four frame-mounted autologous fascia lata heart valve grafts in situ for 18 to 41 months as well as one free-mounted fascia cusp in situ for 10 years were examined by transmission electron microscopy (TEM). In all cusps, areas of well-preserved subcellular structures were found as well as areas with degeneration and fragmentation of both nuclear and collagen fibers. Fibrocytes, fibroblasts, and a special cell form, the myofibroblast, were encountered. The appearance of this last cell form may explain the shrinkage phenomenon encountered in these valves, all retrieved at reoperation because of valve dysfunction. Some of the fascial cells thus stayed alive within the bloodstream for up to 10 years.