Key result
Aortic valve repair using dECM in 6 pediatric patients resulted in significant valve insufficiency in 83.3% (5 of 6) of patients between 119 and 441 days postoperatively.
Why the study?
Does aortic valve repair using decellularized extracellular matrix (dECM) result in functional tissue remodeling and prevent valve failure in pediatric patients with severe aortic valve disease?
Observational (n=6)
Does aortic valve repair using decellularized extracellular matrix (dECM) result in functional tissue remodeling and prevent valve failure in pediatric patients with severe aortic valve disease?
The use of CorMatrix decellularized extracellular matrix for pediatric aortic valve repair is associated with early structural failure and chronic inflammation rather than functional tissue remodeling.
Early dECM failure in most pediatric cases cautions against routine use; leaves open whether refined scaffolds can achieve durable remodeling.
BACKGROUND: ) for aortic valve procedures. METHODS: We retrospectively reviewed the case histories of 6 patients (aged from 2 months - 14 years) who underwent surgery for severe aortic valve stenosis (n = 4) or regurgitation (n = 2). Aortic valve repair was performed on all patients using dECM as a leaflet replacement or leaflet extension. Follow-ups were performed using echocardiography. Reoperation was necessary in 4 cases, and the dECM was explanted and examined histologically and immunohistochemically. RESULTS: The early post-operative period was uneventful, and the scaffold fulfilled the mechanical requirements. Significant valve insufficiency developed in 5 patients during the post-operative period (119-441 days postoperatively). In all specimens, only a migration of inflammatory cells was identified, which induced structural and functional changes caused by the chronic inflammatory response. CONCLUSIONS: Our results suggest a mixed immunological response of remodeling and inflammation following the implantation. The expected process of seeding/migration and remodeling of the bioscaffold into the typical 3-layered architecture were not observed in our explanted specimens.
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Hofmann et al. (2017) conducted an observational in Severe aortic valve stenosis or regurgitation (n=6). Aortic valve repair using dECM (CorMatrix) was evaluated on Significant valve insufficiency. Aortic valve repair using dECM in 6 pediatric patients resulted in significant valve insufficiency in 83.3% (5 of 6) of patients between 119 and 441 days postoperatively.