Abstract 18226: Finding the Ideal Biomaterial for Aortic Valve Repair
Objectives: Cusp replacement in aortic valve repair (AVr) is associated with increased long-term repair failure. We measured hemodynamic and biomaterial properties after porcine AVr with 4 types of clinically relevant biomaterials to ascertain which material(s) would be best suited for repair.
Methods: Porcine aortic roots with intact aortic valves were placed in a left heart simulator mounted with a high-speed camera for baseline valve assessment. The non-coronary cusp (NCC) was excised and replaced with autologous porcine pericardium (APP), glutaraldehyde-fixed bovine pericardial patch (BPP; Synovis™), extracelluar matrix scaffold (CorMatrix™), or collagen-impregnated Dacron (HEMASHIELD™). Biomaterial properties, along with St. Jude Medical™ Pericardial Patch with EnCapTM Technology (SJM), were determined and finite element modeling of the aortic valve and root complex were constructed to determine hemodynamic characteristics and leaflet stresses.
Results: Post-repair geometric orifice areas were significantly reduced in the HEMASHIELD™ (5.06 cm2 [4.24-5.73];P<0.05), and CorMatrix™ ( 5.27 cm2 [4.57-5.56]; P=0.0001) groups when compared to unrepaired valves (6.08 cm2 [5.82-6.83]). Finite element modeling of biomaterials displayed differences in percent changes in total Von Mises stress for both repaired (NCC) and non-repaired left and right cusps with SJM (+4%,+24%) and APP (+5,+26%) having lower percent changes than BPP (+12%,+27%), HEMASHIELD™ (+30%,+9%), and CorMatrix™ (+13%,+32%) when compared to unrepaired valve stresses (Table 1).
Conclusions: Due to increased stresses found in bovine pericardial patch, HEMASHIELD™, and CorMatrix™ groups, these biomaterials may be associated with late repair failure in AVr. Finally, autologous porcine pericardium and St. Jude Medical™ Pericadial Patch have the closest profile to normal aortic valves; therefore, use of either biomaterial may be best suited.
- © 2013 by American Heart Association, Inc.