Trans-apical versus surgical implantation of autologous ovine tissue-engineered heart valves

P.E. Dijkman, A. Driessen-Mol, L.M. de Heer, J. Kluin, L.A. van Herwerden, B. Odermatt, F.P.T. Baaijens, S.P. Hoerstrup

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Background and aim of the study: Living tissue-engineered heart valves (TEHVs) based on rapidly degrading scaffolds and autologous cells might overcome the limitations of today's valve substitutes. Following minimally invasive trans-apical implantation into an ovine model, TEHVs showed adequate in-vivo functionality, but a thickening of the leaflets was observed. In order to evaluate the impact of the substantial tissue deformations of TEHVs associated with the crimping procedure during minimally invasive delivery, trans-apical and conventional implantation technologies were compared in an ovine model. Methods: Trileaflet heart valves (n = 11) based on PGA/P4HB-scaffolds, integrated into selfexpandable stents, were engineered from autologous ovine vascular-derived cells. After in-vitro culture, the TEHVs were either implanted surgically (n = 5), replacing the native pulmonary valve, or delivered trans-apically (n = 6) into the orthotopic pulmonary valve position. In-vivo functionality was assessed by echocardiography and by angiography for up to eight weeks. The tissue compositions of the explanted TEHVs and corresponding control valves were analyzed. Results: TEHV implantations were successful in all cases. Independent of the implantation method, the explants demonstrated a comparable layered tissue formation with thickening and deposited fibrous layers. Active remodeling of these layers was evident in the explants, as indicated by vascularization of the walls, invasion of the host cells, and the formation of a luminal endothelial layer on the TEHV leaflets. Conclusion: This direct comparison of trans-apical and conventional surgical implantation techniques showed that crimping had no adverse effect on the integrity or functional outcome of TEHVs. This suggests that a thickening of TEHVs in vivo is neither caused by nor enhanced by the crimping procedure, but represents a functional tissue remodeling process.

Original languageEnglish
Pages (from-to)670-678
Number of pages9
JournalJournal of Heart Valve Disease
Issue number5
Publication statusPublished - Sept 2012


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