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Structural changes in Hancock porcine xenograft cardiac valve bioprostheses
Insights
Porcine bioprosthetic valves show tissue changes like fibrin deposits and inflammation after implantation. However, these bioprosthetic heart valves rarely fail within the studied periods.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Pathology
Background:
- Porcine heterograft bioprostheses are utilized in cardiac valve replacement surgery.
- Understanding the long-term biological response to these implanted devices is crucial.
Purpose of the Study:
- To investigate the gross and histologic changes in glutaraldehyde-preserved porcine bioprosthetic valves after human implantation.
- To assess the biological inertness and durability of these valves.
Main Methods:
- Examination of 51 explanted Hancock porcine bioprosthetic valves from 41 patients.
- Analysis of valves based on implantation duration: early (<2 months) and late (up to 75 months).
- Gross and histologic evaluation of valve tissues.
Main Results:
- Major gross findings included cuspal thrombosis and degeneration.
- Histologic examination revealed fibrin deposits, inflammatory cell infiltrates, histiocyte deposition, giant cell formation, and fibrocollagenous disruption.
- These changes indicate porcine bioprostheses are not biologically inert.
Conclusions:
- Porcine bioprosthetic valves elicit biological responses in the human circulation.
- Despite observed tissue alterations, valve failure was infrequent during the study's implantation periods.
Abstract:
Gross and histologic observations are described in 51 Hancock glutaraldehyde-preserved porcine heterograft bioprostheses from 41 patients: 33 valves from 25 patients had been in place for less than 2 months (early) and 18 valves from 17 patients were examined at later periods up to 75 months (late) after implantation. The major gross changes were cuspal thrombosis (5 bioprostheses) and cuspal degeneration (3 bioprostheses). Major histologic changes observed in 44 bioprostheses (26 early and 18 late) examined histologically were: (1) fibrin deposits on inflow and outflow surfaces of the cusps; (2) inflammatory cell infiltrates; (3) histiocyte deposition; (4) giant cell formation, and (5) focal disruption of the fibrocollagenous structure of the cusps. These observations indicate that porcine bioprostheses are not biologically inert in the human circulation. Valve failure, however, is rare at the implantation periods studied.