Abstract 16130: In vivo Valvulogenesis: Initial Experience with Atrioventricular Valve Leaflet Augmentation with CorMatrix® Extracellular Matrix Scaffolds
OBJECTIVE Atrioventricular valve (AV) repair using patch augmentation has poor results, often due to patch retraction. Valvulogenesis using extracellular matrix scaffolds holds the promise of creating autologous leaflet tissue and improving results. The purpose of this report is to review our initial experience using a commercially available scaffold (CorMatrix© Cardiovascular Inc., Alpharetta, GA) in AV repair.
METHODS Among 181 mitral and 251 tricuspid valve procedures from 2009 to 2012, 25 patients (median age 4.8 years, range 3 days-27 years) underwent AV repair using CorMatrix patch leaflet augmentation, 18 in the mitral and 7 in the tricuspid position. The lesion was predominantly regurgitation in 13 patients, stenosis in 3 and mixed in 9 patients. A control group of contemporary valve repairs included 25 patients with patch augmentation using conventional materials (24 glutaraldehyde-treated pericardium and 1 endocardial patch).
RESULTS There were no deaths in either the CorMatrix or the control groups. Early post-operative echocardiography showed a mean AV regurgitation grade of 1.7±0.7 (trivial-mild; 5 patients with moderate, 12 with mild regurgitation, 8 trivial or none) and a mean transvalvular gradient of 3.8±3.2 mmHg in the CorMatrix group, compared to a regurgitation grade of 1.7±0.7 (P = 0.99) and a mean inflow gradient of 3.2±3.4 mmHg (P = 0.48) in the control group. During a mean follow-up of 12.1±11.1 months, 14/50 patients required an AV reoperation, 8 in the CorMatrix group and 6 in the control group (P = 0.38), all for the mitral valve. The indication for reoperation was patch retraction in 4 patients in the control group, while the CorMatrix group showed no patch retraction (P = 0.11). The mean late AV regurgitation grade was 2.3±0.9 (mild), with inflow gradients of 5.8±4.6 mmHg in the CorMatrix group, compared to 2.2±0.9 (P = 0.75) and 6.3±5.5 mmHg (P = 0.36), respectively, in controls.
CONCLUSIONS AV leaflet patch augmentation is used in a selected group of patients, with a particularly high burden of reoperation. Extracellular scaffolds did not show retraction, compared to traditionally used materials. CorMatrix represents a novel tool in the surgical armamentarium for valve repair, possibly leading to in vivo valvulogenesis.
- © 2012 by American Heart Association, Inc.