Background

Aortic stentless bioprosthetic valve (SLBPV), either porcine or pericardial, minimizes transvalvular gradient and favors regression of left ventricular hypertrophy. The drawback consists of longer time for suturing. While structural valve deterioration (SVD) in stented porcine and pericardial BPVs has been extensively investigated, less information is available on SLBPVs.

Material and Methods

We studied 82 SLBPVs explants, either porcine (Toronto SPV, [St. Jude Medical, MN, USA], CryolifeO'Brien Model 300 and CryoLife-O'Brien [Cryolife International, GA, USA], BioCor PVS [St. Jude Medical, MN, USA] Prima and Prima Plus [Edwards Lifesciences Corp. One Edwards Way, CA, formerly Baxter Inc, CA, USA]) or pericardial ([Pericarbon Freedom and Freedom Solo [Sorin-Biomedica, S.p.A., Saluggia, Italy]).

Results

By excluding cases with leak and endocarditis, we focused the investigation on 46 SLBPVs, which failed because of SVD.

Gender was male in 29 (63%).

Mean age of patients at time of implant was 59.8 years. Postoperative time of SVD was 115.0 months for porcine and 79.0 months for pericardial SLBPVs. Dysfunction requiring reoperation was mainly incompetence for porcine and stenosis for pericardial SLBPVs.

Even pinpoint mineralization at the commissures resulted in sudden cusp tearing and incompetence. Cuspal atheromasia accounted for cusp tearing even in the absence of calcification.

Mineralization showed progression with time in pericardial but not in porcine SLBPVs.

Conclusions

Tissue mineralization remains the nightmare also of SLBPVs, with the peculiar features of pinpoint calcific deposits at commissures, tearing and abrupt incompetence in porcine SLBPVs and of massive cuspal mineralization and stenosis in pericardial SLBPVs.

中文翻译：

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无支架生物人工瓣膜的结构瓣膜退化和失效模式

背景

猪的或心包的无主动脉无生物瓣膜（SLBPV）可使瓣膜跨度最小化并有利于左心室肥大的消退。缺点是缝合时间较长。尽管已经广泛研究了带支架的猪和心包BPV中的结构瓣膜退化（SVD），但关于SLBPV的信息较少。

材料与方法

我们研究了82种SLBPVs外植体，包括猪（多伦多SPV，[美国犹他州圣裘德医疗]，CryolifeO'Brien Model 300和CryoLife-O'Brien [Cryolife International，GA，美国]，BioCor PVS [圣裘德医疗[美国爱荷华州明尼苏达州] Prima和Prima Plus [爱德华兹生命科学公司，加利福尼亚州爱德华兹路，前身为美国加利福尼亚州百特公司]）或心包（[Pericarbon Freedom and Freedom Solo [Sorin-Biomedica，SpA，Saluggia，Italy]） 。

结果

通过排除有渗漏和心内膜炎的病例，我们将调查重点放在了46例SLBPV（由于SVD而失败）上。

性别是男性的29（63％）。

植入时患者的平均年龄为59.8岁。猪的SVD术后时间为115.0个月，心包SLBPV为79.0个月。要求再次手术的功能障碍主要是猪的心功能不全，心包SLBPV的狭窄。

即使在连合处精确地矿化，也会导致突然的尖头撕裂和无能。即使没有钙化，动脉粥样硬化也可导致尖裂撕裂。

心包中的矿化显示随时间的进展，而猪SLBPV中则没有。

结论

组织矿化仍然是SLBPVs的噩梦，其特殊特征是在连合处有明确的钙化沉积物，在猪SLBPVs中有撕裂和突然的无力，在心包SLBPVs中有大量的pal骨矿化和狭窄。