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Repair of Mitral and Tricuspid Valves Using Bioresorbable Acellular Xenograft
Objective:
A limitation to valve tissue replacement is lack of synthetic or xenograft material that will not induce inflammation. Pericardial xenografts offer early performance but immunologic rejection leads to calcification, shrinkage and degeneration. Use of bio-resorbable extracellular matrix (ECM) with resultant growth of site-specific tissue provides repair of cardiac structures with no residual foreign body. This study investigates the durability and mid-term function of ECM mitral and tricuspid reconstructions.
Methods:
We have used ECM to perform 98 intra-cardiac repairs. These cases include the first known repairs and follow-up of mitral and tricuspid valves, using ECM. From September 2008 to November 2012, 17 mitral and 3 tricuspid valves were repaired using ECM. These consisted of acute and chronic endocarditis, subtotal and partial leaflet replacement, leaflet extension and reconstruction of atrio-ventricular continuity following annular decalcification. 17 cases required replacement of a portion of leaflet. Following debridement as necessary, ECM was tailored and sewn to native tissue, edge to edge with running 5-0 poly-propylene. Detailed intra-operative photography and follow-up echocardiography were used for evaluation.
Results:
Intra-operative photography demonstrates excellent achievement of architectural reconstruction. 2 patients returned with mitral regurgitation at 3 and 14 months post-op. Both had a history of cancer and high dose chemotherapy. All other repairs remain functional on echo-cardiographic follow-up between 1 and 36 months. Operating room photography and serial echo images are reviewed.
Conclusion:
The commercial availability of ECM for intra-cardiac reconstruction introduces the opportunity to re-grow portions of valve architecture. The acellular ECM provides support and function, while newly created tissue replaces the matrix. As a result, calcification of xenograft implants is avoided and valves are preserved, that might otherwise be replaced. The patients’ ability to provide progenitor cells to populate the matrix may need consideration. Ease of implantation makes ECM an excellent tool at surgery. Its bioresorbtion and replacement by site-specific recipient tissue, makes it a unique and potentially superior implant.