HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Vesely, I. Articles by Song, T. Search for Related Content PubMed PubMed Citation Articles by Vesely, I. Articles by Song, T.

The Annals of Thoracic Surgery, Vol 46, 302-308, Copyright © 1988 by The Society of Thoracic Surgeons

ARTICLES

Tissue buckling as a mechanism of bioprosthetic valve failure

I Vesely, D Boughner and T Song
John P. Robarts Research Institute, London, Ont, Canada.

Current reports indicate that collagen fiber disruption resulting from cyclic leaflet bending is a factor determining long-term durability of bioprosthetic heart valves. Examination of the opening characteristics of porcine xenografts has shown two areas of high bending curvature that correlate well with sites of leaflet tearing. These are at the free edge and near the attachment of the leaflets to the aortic root. To determine the potential effects of sharp bends in leaflet material, we examined 15 strips each of fresh and glutaraldehyde-treated porcine aortic valve tissue. Leaflet strips were bent to curvatures of 0.18 mm- 1 to 6.67 mm-1, histologically processed, sectioned, and examined under a light microscope. We observed severe compressive buckling in the samples taken from bioprosthetic valves but little in the fresh-tissue samples. At physiological curvatures (less than 0.28 mm-1), no buckling occurred in the fresh tissue; at high bending curvatures (2.0 mm-1), the depth of buckling observed in the treated tissue was 100% greater than that in the fresh. We believe that porcine xenograft failure is related to compressive buckling of the aldehyde-treated tissue and is mediated by the systematic breaking of collagen fibers at the site of buckling. We suggest that alternative valve designs and preservation techniques be employed to prevent such abnormal leaflet deformations.

This article has been cited by other articles:

				F. J. Schoen Evolving Concepts of Cardiac Valve Dynamics: The Continuum of Development, Functional Structure, Pathobiology, and Tissue Engineering Circulation, October 28, 2008; 118(18): 1864 - 1880. [Abstract] [Full Text] [PDF]

				P. P. Urbanski, A. Diegeler, A. Siebel, M. Zacher, and R. W. Hacker Valved stentless composite graft: clinical outcomes and hemodynamic characteristics Ann. Thorac. Surg., February 1, 2003; 75(2): 467 - 471. [Abstract] [Full Text] [PDF]

				S. Gelsomino, G. Morocutti, R. Frassani, P. Da Col, R. Carella, and U. Livi Usefulness of the cryolife o'brien stentless suprannular aortic valve to prevent prosthesis-patient mismatch in the small aortic root J. Am. Coll. Cardiol., June 5, 2002; 39(11): 1845 - 1851. [Abstract] [Full Text] [PDF]

				A. Kalangos Stentless bioprostheses should be properly adjusted according to the disposition of patient coronary ostia at both the inflow and outflow insertion levels J. Thorac. Cardiovasc. Surg., April 1, 2001; 121(4): 818 - 819. [Full Text] [PDF]

				A. Kalangos How to avoid problems with freestyle valve implantation Ann. Thorac. Surg., September 1, 2000; 70(3): 1004 - 1004. [Full Text] [PDF]

				A. Kalangos, P. Trigo-Trindade, D. Vala, A. Panos, and B. Faidutti AORTIC VALVE REPLACEMENT WITH THE FREESTYLE STENTLESS BIOPROSTHESIS WITH RESPECT TO SPACIAL ORIENTATION OF PATIENT CORONARY OSTIA J. Thorac. Cardiovasc. Surg., June 1, 2000; 119(6): 1185 - 1192. [Abstract] [Full Text] [PDF]

				Z. L. Nagy, J. Fisher, P. G. Walker, and K. G. Watterson The effect of sizing on the hydrodynamic parameters of the medtronic freestyle valve in vitro Ann. Thorac. Surg., May 1, 2000; 69(5): 1408 - 1413. [Abstract] [Full Text] [PDF]

				J. M. G. Paez and E. Jorge-Herrero Assessment of Pericardium in Cardiac Bioprostheses: A Review J Biomater Appl, April 1, 1999; 13(4): 351 - 388. [Abstract] [PDF]

				G. Van Nooten, F. Caes, K. Francois, Y. Van Belleghem, and Y. Taeymans Stentless or stented aortic valve implants in elderly patients? Eur. J. Cardiothorac. Surg., January 1, 1999; 15(1): 31 - 36. [Abstract] [Full Text] [PDF]

				S. Westaby, H. A. Huysmans, and T. E. David Stentless Aortic Bioprostheses: Compelling Data From the Second International Symposium Ann. Thorac. Surg., January 1, 1998; 65(1): 235 - 235. [Abstract] [Full Text] [PDF]