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Tricuspid Valve ECM Tube Graft exhibits Growth Potential in a Porcine Model
Diana M. Ropcke, Christine Ilkjaer, Marcell J. Tjornild, Soren N. Skov, Steffen Ringgaard, Vibeke E. Hjortdal, Sten L. Nielsen.
Aarhus University Hospital, Aarhus N, Denmark.

Objective
Total tricuspid valve reconstruction using small intestinal submucosal extracellular matrix (ECM) designed as a tube graft has been performed successfully in selected patients. In a small number of animals, ECM tube grafts have demonstrated early physiological remodeling, but the potential for growth and durable function remains unknown.
Cardiac magnetic resonance imaging (MRI) was used to evaluate growth potential and function of tricuspid ECM tube grafts after six months in a growing porcine model.
Methods
Ten pigs received a tricuspid valve tube graft. A baseline MRI was performed after 2 weeks. After 6 months, MRI and histological examination were performed in survivors (n=3) to assess annular and leaflet measurements of the tricuspid tube graft. Comparison between baseline and follow up evaluation was performed.
Results
The three pigs grew from 666 kg to 1083 kg over 6 months (p=0.01). Heart rate, left and right ejection fraction and cardiac output did not differ significantly between time points. At follow up, all animals showed a septal dehiscence with paravalular leakage.
All valvular measurements tended to increase during follow-up, though only end-diastolic annular circumference was significantly enlarged after six months (Table 1).
Histology showed physiologic recellularization after six months.
Conclusions
Pigs showed considerable somatic growth over 6 months and a tendency to increase both annular dimensions and coaptation parameters, indicative for inherent growth adaptation of the ECM valve. The observed recellularization of the ECM is possibly a prerequisite for growth, while the septal dehiscence of the tube grafts suggests that valvular growth is exceeded by somatic growth.


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