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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.v22.i2.10
pages 95-111

Cuspal Dehiscence at a Post and Along the Stent Cloth in a Bovine Pericardium Heart Valve Implanted for Seven Years

Robert Guidoin
Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada; Axe Medecine Regeneratrice, Centre de Recherche du CHU, Quebec, QC, Canada
Taniela Marli Bes
Quebec Biomaterials Institute, St. Francois d'Assise Hospital CHUQ and Department of Surgery Laval University, Québec (QC) Canada
Tomas Francisco Cianciulli
Hospital del Gobierno de la Ciudad de Buenos-Aires, "Dr. Cosme Argerich", Department of Cardiology, Buenos-Aires, Argentina
Julianne Klein
Departments of Pathology and Vascular Surgery and Research Centre St Boniface General Hospital, Winnipeg (MB), Canada
Bin Li
Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada; Axe Medecine Regeneratrice, Centre de Recherche du CHU, Quebec, QC, Canada; Department of Vasular Surgery Changhai Hospital, Secondary Military Medical University, Shanghai, China
Robert Gauvin
Centre Québécois sur les Matériaux Fonctionnels (CQMF); Centre LOEX de l'Université Laval, Génie tissulaire et régénération, Department of Surgery, Faculty of Medicine, Laval University, Québec (QC) Canada
Randolph Guzman
Vascular Surgery, St. Boniface General Hospital and Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
Olivier Rochette-Drouin
Department of Surgery, Laval University and Division of Regenerative Medicine CHU de Quebec Research Center, Quebec, Quebec City, Canada
Lucie Germain
Departments of Surgery and Radiology, Faculty of Medicine, Laval University, Axe Medecine Regeneratrice, Centre de Recherche, CHU, Quebec, (QC) Canada
Ze Zhang
Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada; Axe Medecine Regeneratrice, Centre de Recherche du CHU, Quebec, QC, Canada

ABSTRACT

A failing mitral valve prosthesis made from bovine pericardium was explanted from a 50-year-old patient. Preoperative transthoracic–echocardiography had confirmed severe mitral regurgitation due to structural failure of this HP Bio bovine pericardium heart valve prosthesis. The explanted device was examined macroscopically, by scanning electron microscopy (SEM), by light microscopy, and by transmission electron microscopy (TEM). Samples of unassembled patches of bovine pericardium were used as a pre-implantation control to better understand the changes that occurred in the structure of the pericardium following the 7 years of implantation. Examination confirmed complete dehiscence of a cusp along a valve post and the stent: This detached cusp was observed floating in the bloodstream at echocardiography. The fibrous pannus overgrowth was well developed along the stent and extended to the bottom of the cusps both on the inflow and the outflow sides. The fibrous panni were found to be poorly adhesive to the pericardium cusps and had become stiff, thus impairing the opening and closure of the valve. The structure of the pericardium cusps was severely deteriorated compared to the control bovine pericardium tissue samples. The collagen bundles were frequently broken and more stretched in the explanted device, lacking the wavy histological pattern of normal collagen fibers. However, the tissues were devoid of any calcification. In conclusion, the failure mode of this valve was the dehiscence of a cusp from a valve post and along the stent cloth in the absence calcification.