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Related Experiment Videos

Pericardial heterografts: why do these valves fail?

E A Trowbridge1, P V Lawford, C E Crofts

  • 1Department of Medical Physics and Clinical Engineering, University of Sheffield, Royal Hallamshire Hospital, England.

The Journal of Thoracic and Cardiovascular Surgery
|April 1, 1988
PubMed
Summary

Pericardial heterografts, especially Ionescu-Shiley valves, showed structural failure due to stress and calcification. Leaflet thickening and sagging were linked to fiber changes and host environment interactions, impacting valve durability.

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Area of Science:

  • Biomaterials Science
  • Cardiovascular Surgery
  • Pathology

Background:

  • Pericardial heterografts are widely used in cardiac valve replacement.
  • Understanding the long-term durability and failure mechanisms of these grafts is crucial for improving patient outcomes.

Purpose of the Study:

  • To investigate the structural and material changes in explanted pericardial heterografts.
  • To identify factors contributing to the failure of these bioprosthetic valves, particularly the Ionescu-Shiley model.

Main Methods:

  • Analysis of 18 explanted pericardial heterografts (16 Ionescu-Shiley, 1 Hancock, 1 Mitroflow).
  • Macroscopic and microscopic examination, including electron microscopy.
  • Assessment of mechanical properties and comparison with unimplanted valves.

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  • Confirmation of findings using a subcutaneous implantation animal model.

    • Main Results:

    • All explanted Ionescu-Shiley valves failed due to regurgitation, exhibiting commissural tears and calcification (10/16).
    • Leaflet thickening, stiffness, and sagging were observed, linked to fiber separation and amorphous matrix infiltration.
    • Mechanical stresses, exacerbated by host environment and suture holes, contributed to early/midterm failure.
    • Long-term failure involved collagen disruption and secondary calcification.

    Conclusions:

    • Structural degradation and calcification are key failure modes for pericardial heterografts.
    • Host environment and mechanical stress significantly influence bioprosthetic valve durability.
    • Specific design features, like suture hole stress concentrations, can accelerate failure in certain valve models.