Traumatic leaflet injury: comparison of porcine leaflet self-expandable and bovine leaflet balloon-expandable prostheses

• Published in: European journal of cardio-thoracic surgery 2018-05, Vol.53 (5), p.1062-1067
• Main Authors: Convelbo, Channing, El Hafci, Hanane, Petite, Hervé, Zegdi, Rachid
• Format: Article
• Language: English
• Subjects: Animals; Bioprosthesis - statistics & numerical data; Cattle; Heart Valve Prosthesis - statistics & numerical data; Pericardium - physiology; Swine; Transcatheter Aortic Valve Replacement - adverse effects; Transcatheter Aortic Valve Replacement - instrumentation; Transcatheter Aortic Valve Replacement - methods; Transcatheter Aortic Valve Replacement - statistics & numerical data
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezx451

Abstract OBJECTIVES The main goal of this study was to compare the occurrence of post-deployment leaflet injury between prostheses made of porcine and bovine pericardium. METHODS Two types of prostheses, self-expandable prostheses with porcine pericardial leaflet on one side and balloon-expandable prostheses with bovine pericardial leaflet on the other side, were used. In each group, crimped prostheses were compared with control non-crimped prostheses. Following a 15-min period of crimping, prostheses were deployed, and their leaflets were removed and subjected to analyses. The analyses included determination of global and local hydraulic conductance of the leaflets, leaflet plasma insudation and microscopic analysis. The results were expressed as percentage (standard error of the mean) or median (interquartile range). RESULTS A significant increase in the global hydraulic conductance was only observed in the crimped balloon-expandable prostheses: 20.1 (15.5–41.2) ml/h/m2/mmHg vs 12.3 (9.0–15.6) ml/h/m2/mmHg (P = 0.021). Similarly, areas of marked staining (a marker of local hydraulic conductance) were only seen in the bovine pericardium balloon-expandable prostheses. The incidence of leaflet plasmatic insudation was increased in the crimped prostheses compared with the control prostheses. The microscopic study revealed a higher occurrence of traumatic lesions in the crimped prostheses in comparison with the control prostheses: 33.3 ± 21.1% vs 5.5 ± 5.5% (P = 0.039) and 44.4 ± 20.5% vs 5.5 ± 5.5% (P = 0.017) in the bovine and the porcine leaflets, respectively. CONCLUSIONS Post-deployment leaflet injury occurred in both types of prostheses. However, alteration of the global and local hydraulic conductance was important in the bovine pericardium balloon-expandable prostheses.