Calcification in porcine xenograft valves in children

doi:10.1016/S0002-9149(80)80022-1

The American Journal of Cardiology

Volume 45, Issue 3, March 1980, Pages 685-689

https://doi.org/10.1016/S0002-9149(80)80022-1 Get rights and content

Calcification developed in the degenerating collagen of the cusps of three porcine xenograft heart valves implanted in children for less than 4 years. The morphologic features and effects of this calcification are presented. Calcification of porcine xenografts seems to occur more frequently and at an earlier stage after insertion in children than in adults. Host factors, possibly related to calcium homeostasis, may promote calcification; hence, these valves may not be appropriate for use in children.

References (25)

BrownJW et al.
Late spontaneous disruption of a porcine xenograft mitral valve
J Thorac Cardiovasc Surg
(1978)
GehaAS et al.
Late failure of porcine valve heterografts in children
J Thorac Cardiovasc Surg
(1979)
FishbeinMC et al.
Pathologic findings after cardiac valve replacement with glutaraldehyde-fixed porcine valves
Am J Cardiol
(1977)
HetzerR et al.
Thrombosis and degeneration of Hancock valves: clinical and pathological findings
Ann Thorac Surg
(1978)
ZuhdiN et al.
Porcine aortic valves as replacements for human heart valves
Ann Thorac Surg
(1974)
PipkinRD et al.
Evaluation of aortic valve replacement with a porcine xenograft without long-term anticoagulation
J Thorac Cardiovasc Surg
(1976)
SprayTL et al.
Structural changes in porcine xenografts used as substitute cardiac valves
Am J Cardiol
(1977)
FerransVJ et al.
Structural changes in glutaraldehyde-treated porcine heterografts used as substitute cardiac valves
Am J Cardiol
(1978)
ClarkRE et al.
Durability of prosthetic heart valves
Ann Thorac Surg
(1978)
EisensteinR
Pathological calcification

CarpentierA et al.

Six-year follow-up of glutaraldehyde-preserved heterografts

J Thorac Cardiovasc Surg

(1974)

RootAW et al.

Recent advances in calcium metabolism

J Pediatr

(1976)

Cited by (124)

Morphologic and histologic findings in bioprosthetic valves explanted from the mitral position in children younger than 5 years of age
2018, Journal of Thoracic and Cardiovascular Surgery
Citation Excerpt :
MVR in the first few years of life poses a challenge, mostly because of the small size of the mitral valve annulus, left ventricle, and left atrium. Early experience with bioprosthetic valves in the 1970s and early 1980s revealed limited valve longevity as the result of intrinsic calcification, a process that appeared to be accelerated in children.8-10 Advances in fixation and antimineralization processes11 have led to a resurgence of bioprosthetic valve use in children.
Mitral valve replacement (MVR) in very young children is challenging. This study investigates the mechanisms for early bioprosthetic valve failure in very young patients through review of the macroscopic and microscopic findings in explanted bioprosthetic valves.
Patients who underwent MVR with a bioprosthetic valve at Boston Children's Hospital between January 2010 to April 2016 at <5 years of age were the subjects of this study. Valve failure was defined as prosthetic mitral valve explantation with mitral valve re-replacement.
Bioprosthetic valves were used in 31 of 77 MVRs during the study period. Valve failure occurred in 10 patients (32%). Freedom from valve failure was 80% at 1 year and was associated with older age at implantation. On gross and microscopic evaluation, valve failure (predominantly stenosis) was found to be due to pannus deposition and intrinsic leaflet calcification.
Successful long-term use of bioprosthetic valves in the mitral position in very young children continues to be a challenge. In addition to intrinsic calcification, excessive pannus deposition can lead to early bioprosthetic valve failure in this population. Early exuberant pannus growth appears due to thrombus deposition on the valves themselves and to the host's reaction to foreign material.
Critical Care After Surgery for Congenital Cardiac Disease
2011, Pediatric Critical Care: Expert Consult Premium Edition
Critical Care After Surgery for Congenital Cardiac Disease
2011, Pediatric Critical Care
Clinical results of Hancock II versus Hancock Standard at long-term follow-up
2006, Journal of Thoracic and Cardiovascular Surgery
We performed a multi-institutional study to compare the long-term structural valve deterioration of isolated Hancock Standard versus Hancock II bioprostheses.
From 1983 to 2002, 714 Hancock Standard and 1293 Hancock II bioprostheses were implanted at hospitals of the Venetian territory (Padova, Treviso, and Venice). Follow-up on January 1, 2003, included 14,749 patient-years with a median of 12 years and was 96% complete: 115 Hancock Standard and 53 Hancock II bioprostheses were at risk at 15 years. The 2 series were nonconcomitant, and many covariates differed (Table 1). Survival was analyzed with Cox analysis, and durability was analyzed with Weibull analysis. Balancing analysis with the logistic propensity score model was performed.
Perioperative mortality was 6% in Hancock II and 12% in Hancock Standard operations. The overall unadjusted 15-year survival was identical (39.7% ± 2.3% vs 39.9% ± 2.4%, respectively), but age-adjusted survival at 15 years was 46% versus 25% (P < .001). Late survival was unrelated to the prosthetic model, whereas it was adversely affected by older age, previous operations, aortic regurgitation, male sex, higher New York Heart Association class, atrial fibrillation, and coronary artery bypass grafting. In Hancock II patients aged 65 years and older, the cumulative hazard of structural valve deterioration at 15 years was 6%, versus 17.5% in Hancock Standard patients. In younger patients, it was 18% and 37%, respectively. Analysis of 541 propensity-balanced patients showed a hazard ratio of the Hancock Standard prosthesis of 2 and a risk reduction of older age of approximately 10% every 10 years.
After balancing risk factors and calibrating age effects, Hancock II propensity-matched bioprostheses showed similar survival but definitely increased durability.
Cardiac Intensive Care
2006, Pediatric Critical Care
Cardiac Intensive Care
2005, Pediatric Critical Care, Third Edition

View all citing articles on Scopus

^*: Present address: Department of Pathology, St. Joseph's Hospital, London, Ontario, Canada.

View full text

Case ReportCalcification in porcine xenograft valves in children

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Am J Cardiol

Ann Thorac Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

Am J Cardiol

Am J Cardiol

Ann Thorac Surg

J Thorac Cardiovasc Surg

J Pediatr

Case Report
Calcification in porcine xenograft valves in children