Trileaflet Semilunar Valve Reconstruction: Acute Porcine in Vivo Evaluation

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Biomedical Engineering

Background:

• Surgical treatment of malformed semilunar valves in congenital heart defects presents challenges in achieving long-term function and accommodating growth.
• Existing techniques often struggle to provide both durability and the capacity for pediatric patients to grow.

Purpose of the Study:

• To investigate a new surgical technique, Trileaflet Semilunar Valve Reconstruction, in an acute porcine model.
• To assess the geometrical properties and hemodynamic function of the reconstructed valves, evaluating their potential for growth.

Main Methods:

• Utilized an acute 60-kg porcine model for pulmonary valve investigation.
• Performed Trileaflet Semilunar Valve Reconstruction using customized homograft-treated pericardial neo-leaflets on cardiopulmonary bypass.
• Assessed hemodynamics and valvular geometry via echocardiography before and after the procedure.

Main Results:

• The reconstructed neo-valves demonstrated sufficiency in 10 out of 12 animals, with minimal regurgitation in the remaining two.
• Observed a peak gradient of 3 ± 2 mm Hg and peak velocity of 0.8 ± 0.2 m/s.
• Reported a significant mean increase in neo-valve coaptation (4 ± 3 mm, P < .001) and characteristic windmill shape and billowed leaflets.

Conclusions:

• The Trileaflet Semilunar Valve Reconstruction in this acute porcine model resulted in neo-valves without clinically significant regurgitation or stenosis.
• The observed geometric features, including increased coaptation and specific leaflet morphology, suggest potential for sustained function and growth.
• Further long-term studies are warranted to fully evaluate the efficacy and growth potential of this novel surgical technique.