In-vivo Model Of Bioscaffold Mitral Valve Replacement In The Juvenile Non-human Primate.
Steven Bibevski1, Brittany Gonzalez2, Sharan Ramaswamy2, Frank Scholl1.
1Joe DiMaggio Children's Hospital, Hollywood, FL, USA, 2Florida International University, Miami, FL, USA.
OBJECTIVE: In patients that require valvar replacement as infants and children, the need to accommodate somatic growth is a major issue. A potential solution is the use of extracellular matrix (ECM) scaffolds for the creation of cardiac structures. Here we describe the development of an in-vivo model of total mitral valve excision and replacement with a handmade, low cost, and anticoagulation free, mitral valve completely comprised of ECM that affords mitral-ventricular continuity and growth potential.
METHODS: Papio Hamadryas baboons undergo a rapid phase of growth at approximately 1 year of age, making this species ideal to assess growth potential of an implanted valve. Four juvenile P Hamadryas baboons between 12 months and 14 months of age and who weighed between 4.0 and 4.6 kg. were selected for the study. Via a left thoracotomy approach, we performed bi-caval cannulation with access to the mitral valve via dissection of Sondergaards groove and a left atriotomy. The mitral valve was resected leaving behind 1mm of mitral valve leaflet. Chordae were cut at the attachment to the papillary muscles. The ECM valve was implanted with the distal arms of the neovalve attached to the heart at the level of the papillary muscles. A running 5-0 Prolene suture was then used to suture the neovalve annulus to the patient annulus.
RESULTS: Valves were implanted at 12.4mm, 9.70mm, 17mm and 7.3mm for an average of 11.60mm. Serial echocardiograms were performed on a monthly basis during the acute phase and demonstrated flawless function during this period without anticoagulation. Echo measurements demonstrated plasticity of the ECM construct.
CONCLUSIONS: Mitral valve replacement with an ECM construct in the non-human primate is feasible and provides a model for development of a biological valve with growth potential.
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