Bioprosthetic leaflet perforation due to repetitive trauma by overknotted sutures (original) (raw)
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Evidence of leaflet injury during percutaneous aortic valve deployment
European Journal of Cardio-Thoracic Surgery, 2011
It has been suggested that valved stent deployment during transcatheter aortic valve implantation may be responsible for traumatic injury to pericardial leaflets, especially with balloon expandable valved stents. However, such an injury has not been described nor reported so far. We here report the microscopic analysis of 4 Sapien-Edwards prostheses, 2 of which have been implanted in humans. There was no macroscopic evidence of traumatic injury to the pericardial leaflets of the percutaneous valves. However, pathological microscopic findings were observed in all of them. These mainly consisted of collagen fibers fragmentation and disruption. Areas of non-or mildly affected tissue were adjacent to areas of severely damaged tissue. The entire thickness of the leaflets might be involved. The severity of the lesions also differed among leaflets from a same prosthesis. Areas of plasmatic insudation were identified in one case. The disruption index was significantly higher in the Sapien group in comparison to the control group: 42.4% (14-63.5%) versus 17.5% (9.2-31%) (p < 0.001). Although of limited size sample, this study does prove that traumatic injury to leaflets occurs during percutaneous valves implantation. This should prompt physicians to wait for the long-term results of this new technology before extending the indications to low-risk patients.
European Journal of Cardio-Thoracic Surgery, 2012
OBJECTIVES: No comparison of balloon-or self-expandable valved stents (VSs) regarding tissue injury (if any) has been reported yet. The objective was to evaluate the occurrence and compare the severity of traumatic injury to leaflets from balloon-or self-expandable VSs. METHODS: Twelve homemade VSs were used for this experiment. These three-leaflet bovine pericardial bioprostheses had either a stainless steel (Group A) or a nitinol stent (Group B). After a 30-min period of compression (external diameter of VS reduced to 7 mm), the prostheses were deployed by balloon inflation (Group A) or by unsheathing (Group B). After H&E staining, pericardial leaflets were subsequently analyzed qualitatively and quantitatively for microscopic lesions. Non-crimped pericardial leaflets were used as a control group (Group C). RESULTS: All deployed VSs had microscopic lesions evocating traumatic injury to pericardial leaflets. Transverse fractures and longitudinal cleavages were the two main lesions encountered. Transverse fractures (no. per field) were significantly more frequent in the VS in comparison with the control group: 5 (range: 0-13), 4 (range: 0-9) and 0 (range: 0-1) in Groups A, B and C, respectively (P < 0.001). Cleavages (no. per field) were also more frequent with balloon-expandable VSs compared with self-expandable VSs [3 (range: 0-7) vs 1(range: 0-8); P = 0.03]. CONCLUSIONS: Traumatic injury to the pericardial leaflets does occur during crimping and deployment of balloon-or self-expandable VSs. Injury may be more severe with the balloon-expandable VSs. The impact of such an injury on prosthesis durability requires a further investigation.
European Journal of Cardio-Thoracic Surgery, 2006
Objective: This study aimed at calculating and comparing the long-term outcomes of patients after aortic valve replacement with the Carpentier-Edwards bovine pericardial and porcine supraannular bioprostheses using microsimulation. Methods: We conducted a meta-analysis of eight studies on the Carpentier-Edwards pericardial valves (2685 patients, 12,250 patient-years) and five studies on the supraannular valves (3796 patients, 20,127 patient-years) to estimate the occurrence rates of valve-related events. Eighteen-year follow-up data sets were used to construct age-dependent Weibull curves that described their structural valvular deterioration. The estimates were entered into a microsimulation model, which was used to calculate the outcomes of patients after aortic valve replacement. Results: The annual hazard rates for thromboembolism after aortic valve replacement were 1.35% and 1.76% for the pericardial and supraannular valves, respectively. For a 65-year-old male, median time to structural valvular deterioration was 20.1 and 22.2 years while the lifetime risk of reoperation due to structural valvular deterioration was 18.3% and 14.0%, respectively. The life expectancy of the patient was 10.8 and 10.9 years and event-free life expectancy 9.0 and 8.8 years, respectively. Conclusions: The microsimulation methodology provides insight into the prognosis of a patient after aortic valve replacement with any given valve type. Both the Carpentier-Edwards pericardial and supraannular valve types perform satisfactorily, especially in elderly patients, and show no appreciable difference in long-term outcomes when implanted in the aortic position. #
Late Tears in Leaflets of Porcine Bioprostheses in Adults
The Annals of Thoracic Surgery, 1984
Of 836 patients with a mitral or aortic bioprosthesis who were followed over an 8-year period, 32 required reoperation for prosthetic dysfunction. Of the 26 prostheses removed at operation, 18 (12 mitral and 6 aortic prostheses) showed tears in the valve leaflets. In 7 of the 12 patients with rupture of "mitral" leaflets and in 1 of the 6 patients with tom "aortic" leaflets, the onset of symptoms was sudden, requiring urgent reoperation. Two of the 18 patients died early after reoperation; both had progressive disability and underwent elective operation.
Early aortic dissection after aortic valve replacement with a Perceval sutureless bioprosthesis
Indian Journal of Thoracic and Cardiovascular Surgery, 2018
We report a patient who developed ascending aorta dissection after aortic valve replacement with a Perceval sutureless pericardial bioprosthesis, a previously not reported complication with this device. At reoperation, the intimal tear was located at the aortotomy suture line; the tips of the nitinol stent were far from the aortic lesion which therefore was not attributable to the presence of this specific prosthetic model. Nevertheless, a previous report of aortic dissection due to erosion of the aortic wall by the strut of a transcatheter prosthesis may raise the suspicion that such complication could also occur with sutureless prostheses of similar design.