JTCS Email Content Delivery
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Tomaso Bottio
Giulio Rizzoli
Gianluigi Bisleri
Gino Gerosa
Gaetano Thiene
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Bottio, T.
Right arrow Articles by Thiene, G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Bottio, T.
Right arrow Articles by Thiene, G.
Related Collections
Right arrow Valve disease

J Thorac Cardiovasc Surg 2006;132:1017-1022
© 2006 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Commissural dehiscence: A rare and peculiar cause of porcine valve structural deterioration

Tomaso Bottio, MD, PhDa,*, Marialuisa Valente, MDb, Giulio Rizzoli, MDa, Vincenzo Tarzia, MDa, Gianluigi Bisleri, MDa, Elena Pettenazzo, BSc, PhDb, Gino Gerosa, MDa, Gaetano Thiene, MD, FRCPb

a Department of Cardiovascular Surgery, University of Padua Medical School, Padua, Italy
b Department of Pathology, University of Padua Medical School, Padua, Italy.

Received for publication February 2, 2006; revisions received May 23, 2006; accepted for publication June 7, 2006.

* Address for reprints: Tomaso Bottio, MD, PhD, Department of Cardiovascular Surgery, Piazza Spedali Civili 1, 25100, Brescia, Italy. (Email: bottio{at}med.unibs.it).

OBJECTIVE: Calcification is the main cause of structural valve deterioration; however, other causes of failure have been identified, and among them, dehiscence of a commissure from the stent has been reported in several models of porcine valves. The aim of this study was to analyze the rate and mode of occurrence of this complication in first- and second-generation porcine bioprosthetic explants.

METHODS: Among 586 porcine xenografts explanted and analyzed at the Institute of Pathological Anatomy of the University of Padua, 17 (2.9%) have been replaced for incompetence because of commissural dehiscence. All these explants were in the mitral position, with the exception of a Carpentier-Edwards supra-annular aortic valve prosthesis.

RESULTS: Dehiscence was observed in 9 (1.9%) of 455 Hancock standard explants, in 1 (3.2%) of 31 Hancock II, in 3 (8.6%, 2 standard and 1 supra-annular) of 35 Carpentier-Edwards, in 1 (2.4%) of 42 Bioimplants, and in 3 (50%) of 6 Xenotech after a mean time function of 157 ± 50, 156, 96 ± 29, 143, and 130 ± 8 months, respectively. Dehiscence was the sole cause of incompetence in 6 cases. An impending commissural dehiscence caused by blood creeping was observed in one case. This might be an explanation for the dehiscence other than excessive trimming of the aortic wall.

CONCLUSIONS: Commissural dehiscence is an uncommon and peculiar mode of failure of porcine valves implanted in the mitral position and was observed earlier and more frequently with Carpentier-Edwards porcine explants (P < .05). We speculate that pericardial strip protection of the suture between the Dacron fabric and porcine aortic wall, as used in the Biocor porcine valve, might prevent this complication.

Abbreviations and Acronyms SVD = structural valve deterioration






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2006 by The American Association for Thoracic Surgery.