Author + information
- Omkar Mankamea,b,
- Lilliam Valdes-Cruza,b,
- Steven Bibevskia,b,
- Frank Scholla,b,
- Ivan Baeza,b and
- Sharan Ramaswamya,b
Background: Infants and children with severe valve lesions have limited surgical options. It has been shown that acellular porcine small intestinal submucosa (PSIS) scaffolds support cell infiltration and tissue remodeling after implantation. Our group has implanted custom-made PSIS valves in 4 infants with critical valve disease unable to receive standard valves. Short term follow-up is promising. The purpose of this study was to conduct early assessment on acute in vitro functionality and hydrodynamics of custom PSIS mitral valves compared to commercially available trileaflet porcine bioprosthetic valves (BPV).
Methods: Bi-leafet PSIS (Diameter = 19 mm; n = 2) and tri-leaflet bioprosthetic (Diameter = 21mm; n = 3; BPV) control valves were tested in a pulse duplicator system (Vivitro Laboratories, Victoria, Canada) fitted with flow and pressure transducers. PSIS material (Cormatrix, Roswell, GA) was manually assembled into bi-leaflet valves and sutured into Dacron conduits. Holders tailored for each valve were 3-D printed. The valves-in-holders were press-fitted into the mitral location within the pulse duplicator. A 0.9% saline solution was introduced through the atrium chamber to fill the loop. A flow waveform representating the left ventricular outflow tract was selected. Heart rate = 70 beats/min stroke volume = 80 ml/beat. Ten cycles were recorded and averaged for each valve. Hydrodynamic metrics were subsequently computed. The testing protocol was repeated for BPVs.
Results: Mean diastolic Del_P (mmHg): BPV = 7.34 ± 0.41; PSIS = 8.11 ± 0.59 (NS). Qrms (ml/s): BPV = 230.8 ± 2.16; PSIS = 223.4 ±
4.21 (NS). EOA (cm2): BPV = 1.65 ± 0.04; PSIS = 1.51 ± 0.09 (NS), systolic %RF: BPV = 3.0 ± 0.5; PSIS = 3.7 ± 1.7 (NS) and closing energy loss: BPV = 31.8 ± 3.9; PSIS = 53.4 ± 23.4 (NS).
Conclusions: Mitral PSIS bi-leaflet valves were found to have similar hydrodynamics to a commercially-available BPV (Edwards Lifesciences, Irvine, CA; p > 0.05 in all metrics). A larger sample size is needed to confirm robust functionality of PSIS valves observed here. Subsequent assessment of PSIS bi-leaflet valve growth if successful, may lead to a potential breakthrough in treatment of critical congenital mitral valve disease.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Congenital Heart Disease: Progress in Pediatric Heart Surgery
Abstract Category: 10. Congenital Heart Disease: Pediatric
Presentation Number: 1101-012
- 2017 American College of Cardiology Foundation