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Journal of Long-Term Effects of Medical Implants
SJR: 0.332 SNIP: 0.491 CiteScore™: 0.89

ISSN Print: 1050-6934
ISSN Online: 1940-4379

Journal of Long-Term Effects of Medical Implants

DOI: 10.1615/JLongTermEffMedImplants.v18.i2.10
pages 91-131

Analysis of Sixty-Two Explanted Liotta Bioprostheses: Biocompatibility, Biofunctionality, and Biodurability Issues

Hongbo Zhang
Departments of Surgery and Radiology, Laval University and Quebec Biomaterials Institute, CHUQ, Quebec, Canada; Department of Biological Engineering, Chongqing University, Chongqing, PR China
Georgi R. Marinov
Department of Anatomy, Histology and Embryology, Medical University of Varna, Varna
Xiaoyan Deng
College of Biomedical Engineering, Chongqing University, Chongqing; Department of Bioengineering, Beihang University, Beijing, PR China
Ze Zhang
Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada; Axe Medecine Regeneratrice, Centre de Recherche du CHU, Quebec, QC, Canada
Andre-Pierre Legrand
Laboratoire de Physique Quantique, ESPCI, Paris, France
Randolph Guzman
Vascular Surgery, St. Boniface General Hospital and Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
Tieying Yin
Dept. of Surgery and Radiology, Laval University and Quebec Biomaterials Institute, CHUQ, Canada; Key Laboratory of Biorheological Science and Technology, Bioengineering College, Chongqing University, Chongqing, PR China
Alain Pavie
Department of Cardiovascular Surgery, Hospital de la Pitié, Paris, France
Iradj Gandjbakhch
Department of Cardiovascular Surgery, Hospital de la Pitié, Paris, France
Tomas Francisco Cianciulli
Hospital del Gobierno de la Ciudad de Buenos-Aires, "Dr. Cosme Argerich", Department of Cardiology, Buenos-Aires, Argentina
Jorge Jordana
Bio-Sud, Buenos Aires, Argentina
Patrick Mathieu
Quebec Institute of Cardiology, Laval Hospital and Department of Surgery Laval University, Quebec, Canada
Robert Guidoin
Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada; Axe Medecine Regeneratrice, Centre de Recherche du CHU, Quebec, QC, Canada

ABSTRACT

Sixty-two explanted Liotta porcine bioprostheses were examined to review the issues related to their biocompatibility, biofunctionality, and biodurability. These bioprostheses were harvested from 56 patients with implantation times ranging from only a few hours to more than nine years of implantation. There were 10 acute and short-term (< 1 year), 20 midterm (1 < t < 5 years), and 32 long-term (> 5 years) cases. The indications for the reoperations were: hemodynamic (59), thrombosis (10), and endocarditis (3). The major indications varied according to the duration of implantation: blood infiltration, fibrin buildup, thrombosis in the short-term; endocarditis and hemodynamic insufficiency in the midterm; and mineralization and tears causing hemodynamic incompetence in the long term. Mineralization proved to be the main threat to long-term durability for porcine valves. Besides a few short-term failures, these explanted devices slowly degenerated over time and were replaced to prevent congestive heart failure. Documentation of the failure modes of these porcine valves is important since the demand for bioprostheses will increase in the future, in particular for percutaneous devices. Such bioprostheses emphasize a critical biocompatibility issue following implantation because they have the capacity to remain free of thrombus in the absence of anticoagulation. The biofunctionality appears to be adequate in the absence of subsequent pathology with restoration of normal valve function. However, the documentation of such significant long-term biodurability issues raises questions that have been addressed but not fully answered yet with the new generations of bioprostheses.