Transcatheter treatment of tricuspid regurgitation by caval valve implantation-experimental evaluation of decellularized tissue valves in central venous position

• Published in: Catheterization and cardiovascular interventions 2015-01, Vol.85 (1), p.150-160
• Main Authors: Lauten, Alexander, Laube, Adrian, Schubert, Harald, Bischoff, Sabine, Nietzsche, Sandor, Horstkötter, Kim, Poudel-Bochmann, Bhawana, Franz, Marcus, Lichtenberg, Artur, Figulla, Hans R., Akhyari, Payam
• Format: Article
• Language: English
• Subjects: Alloys; Animals; Bioprosthesis; Cardiac Catheterization - adverse effects; Cardiac Catheterization - instrumentation; Cardiac Catheterization - methods; Chronic Disease; decellularized valves; Disease Models, Animal; Female; Gene Expression Regulation; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - instrumentation; Heart Valve Prosthesis Implantation - methods; Hemodynamics; Prosthesis Design; Recovery of Function; Severity of Illness Index; Sheep; Stents; Time Factors; tricuspid regurgitation; Tricuspid Valve - diagnostic imaging; Tricuspid Valve - metabolism; Tricuspid Valve - physiopathology; Tricuspid Valve - ultrastructure; Tricuspid Valve Insufficiency - diagnosis; Tricuspid Valve Insufficiency - physiopathology; Tricuspid Valve Insufficiency - therapy; Ultrasonography; Vena Cava, Inferior; Vena Cava, Superior
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.25380

BACKGROUND: Caval valve implantation has been suggested for transcatheter treatment of severe tricuspid regurgitation (TR). Combining the interventional technique with the promising surgical experience with decellularized valves, we sought to evaluate the functional and structural outcome of decellularized pericardial tissue valves (dTVs) in the low‐pressure venous circulation in a chronic model of TR. METHODS AND RESULTS: Sixteen pericardial tissue valves were heterotopically implanted in the inferior and superior vena cava in a sheep model (54–98 kg; median 74.5 kg, n = 8) of severe TR. The devices were assembled using self‐expanding nitinol stents and bovine pericardia decellularized by a detergent‐based protocol (group dTV; n = 8). Glutaraldehyde‐fixed pericardial tissue valves served as control (GaTV, n = 8). After 6 months, device function and structural maturation were analyzed using echocardiographic, histologic, immunohistologic, and electron microscopic approaches. After implantation, cardiac output increased significantly from 3.7 ± 1.1 l/min to 4.8 ± 1.1 l/min (P