• Title/Summary/Keyword: Bioprosthesis

검색결과 54건 처리시간 0.023초

Comparable Outcomes of Bicuspid Aortic Valves for Rapid-Deployment Aortic Valve Replacement

  • Somin Im;Kyung Hwan Kim;Suk Ho Sohn;Yoonjin Kang;Ji Seong Kim;Jae Woong Choi
    • Journal of Chest Surgery
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    • 제56권6호
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    • pp.435-444
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    • 2023
  • Background: Edwards Intuity is recognized as a relatively contraindicated bioprosthesis for bicuspid aortic valve disease. This study compared the early echocardiographic and clinical outcomes of rapid-deployment aortic valve replacement for bicuspid versus tricuspid aortic valves. Methods: Of 278 patients who underwent rapid-deployment aortic valve replacement using Intuity at Seoul National University Hospital, 252 patients were enrolled after excluding those with pure aortic regurgitation, prosthetic valve failure, endocarditis, and quadricuspid valves. The bicuspid and tricuspid groups included 147 and 105 patients, respectively. Early outcomes and the incidence of paravalvular leak were compared between the groups. A subgroup analysis compared the outcomes for type 0 versus type 1 or 2 bicuspid valves. Results: The bicuspid group had more male and younger patients. Comorbidities, including diabetes mellitus, hypertension, chronic kidney disease, and coronary artery disease, were less prevalent in the bicuspid group. Early echocardiographic evaluations demonstrated that the incidence of ≥mild paravalvular leak did not differ significantly between the groups (5.5% vs. 1.0% in the bicuspid vs. tricuspid groups, p=0.09), and the early clinical outcomes were also comparable between the groups. In the subgroup analysis between type 0 and type 1 or 2 bicuspid valves, the incidence of mild or greater paravalvular leak (2.4% vs. 6.7% in type 0 vs. type 1 or 2, p=0.34) and clinical outcomes were comparable. Conclusion: Rapid-deployment aortic valve replacement for bicuspid aortic valves demonstrated comparable early echocardiographic and clinical outcomes to those for tricuspid aortic valves, and the outcomes were also satisfactory for type 0 bicuspid aortic valves.

우심낭편의 석회화 방지에 관한 연구 - 계면활성제 전처치 효과 - (Prevention of calcification in bovine pericardial bioprosthesis -pretreatment with surfactants-)

  • 안재호;한재진;박성수
    • Journal of Chest Surgery
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    • 제31권6호
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    • pp.560-566
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    • 1998
  • 서론: 심혈관계 수술 시 이용되는 조직판막 등 glutaraldehyde(GA)에 보존한 이종보철편들은 석회화에 의한 변성으로 환자의 장기성적에 나쁜 영향을 주게 된다. 이에 연구자는 GA 용액에 Mg 염을 첨가, 자유 알데히드와 미리 결합하게 함으로 조직 및 혈중의 칼슘과 반응하는 것을 막아 석회화를 완화하고자 시도하였고 계면활성제로 sodium dodecyl sulfate(SDS)와 Triton X-100을 사용, 전처치하여 GA에 고정, 석회화 완화 효과를 관찰하였다. 대상 및 방법: 우심낭을 정방형 조각으로 만들어 40 조각의 우심낭편은 대조군으로 MgCl2.6H2O를 4g/L 첨가한 0.625% GA 용액에 보존하고(1 군), 40 조각은 SDS에 전처치 후 이 GA 용액에 보존(2 군), 또 다른 40 조각은 Triton X-100에 전처치 후 GA에(3 군) 각각 한달 간 보관한다. 이들을 40 마리의 백서의 복부 피하에 각각 한 조각씩 이식하여 1 개월, 2 개월, 3 개월 및 6 개월 째에 적출, spectrophotometry로 이 우심낭편에 침착한 칼슘을 정량분석하였다. 결과: 이식 후 1 개월에는 세 군 간의 석회화 정도에 차이가 없었으나, 2 개월 부터 차이를 보여 1 군 0.921$\pm$0.121 mg/g, 2 군 0.481$\pm$0.037 mg/g, 3 군 1.369$\pm$0.200 mg/g의 통계적 차이를 보였고(p<0.05), 3 개월에 1 군 0.786$\pm$0.080 mg/g, 2 군 0.584$\pm$0.054 mg/g, 3 군 1.139$\pm$0.188 mg/g, 마지막 6 개월에 1 군 1.623$\pm$0.601 mg/g, 2 군 0.501$\pm$0.043 mg/g, 3 군 1.625$\pm$0.382 mg/g으로 정량되어 2 군에서 유의한 석회화 완화 효과가 관찰되고 있다 (p<0.05). 결론: 음성 계면활성제인 SDS의 전처치로 중기 이상 시간이 경과함에 따라 피하에 이식된 보철편의 석회화가 완화되었으나 중성 계면활성제인 Triton X-100의 전처치로는 완화 효과가 관찰되지 않았다.

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아미노산 후처치의 이종 심낭보철편 석회화 완화 효과 (Mitigation of Calcification in Bovine Pericardial Bioprosthesis after Amino Acids Posttreatment)

  • 안재호
    • Journal of Chest Surgery
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    • 제36권3호
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    • pp.131-135
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    • 2003
  • Glutaraldehyde (GA)에 보존한 이종보철편들은 생체 이식 후 석회화 변성을 보이는 문제점을 나타내므로 이 단점을 보완하기 위해 연구자는 GA 용액에 Mg염을 첨가 칼슘의 반응을 막아 석회화를 완화하며 더불어 chitosan 및 glutamate 등의 아미노산으로 후처치하여 석회화 완화를 극대화하고자 하였다. 대상 및 방법: 우심낭을 정방형 조각으로 만들어 40조각의 우심낭편은 대조군으로 MgC1$_2$6$H_2O$를 4g/L 첨가한 0.625% GA 용액에 보존하고(1군), 40조각은 이 GA 용액에 보관하다 이식 24시간 전 2% chitosan 용액에 옮겨 보존(2군), 또 다른 40조각 역시 같은 방법으로 8% glutamate 용액에 후처치(3군)하여, 이들을 40마리의 백서 복부 피하에 각각 한 조각씩 이식하여 1개월, 2개월, 3개월 및 4개월째에 적출, spectophotometry로 침착한 칼슘을 정량하였다. 결과: 이식 후 1개월 및 2개월에는 세균간의 석회화 정도에 차이가 없었으나. 3개월째에는 1군 5.45$\pm$0.42 mg/g, 2군 3.22$\pm$1.31 mg/g, 3군 4.20$\pm$0.55 mg/g의 통계적 차이를 보여, 2군에서 유의한 석회화 완화 효과가 관찰되고 있고 (p<0.05), 4개월째에는 1군 6.01$\pm$1.21 mg/g, 2군 3.78$\pm$1.82 mg/g, 3군 3.92$\pm$0.92 mg/g으로 2, 3군에서 유의한 석회화 완화 효과를 보여주고 있다(p<0.05). 결론: 즉 2% chitosan 후처치로 3개월의 시간이 경과함에 따라 피하에 이식된 보철편의 석회화가 완화되었으며 8% glutamate는 4개월에서 그 완화효과를 보여주고 있다.다. 현대의 실정 에 맞는 과학적 제조방법을 이용하여 산업화한다면 재래식으로 인해 걸리는 시간, 노력 에 걸맞은 가격, 품질 등을 유지해 나갈 수 있으리라 본다.는 음식 10위를 조사한 결과 선호음식의 경우 저체중군과 정상군의 경우 순위는 달랐지만 10위에 선별된 음식들이 주로 과 (수박, 귤, 딸기, 복숭아, 바나나, 포도, 사과)과 음료수(사이다, 환타) 등 열량밀도가 낮고 수분함량이 높은 식품인 반면 과체중군은 햄버거, 돈까스, 튀김 만두, 샌드위치, 쇠고기 및 돼지고기 구이 등이 선호음식 10위내에 포함되어 정상군이나 저체중군보다 고지방.고단백 음식들의 기호도가 과체중군에서 높음을 확인하였다., 단맛을 좋아하는 사람이 싫어하는 사람보다 열량과 당질섭취량은 유의 적으로 적게, 지방 섭취량은 유의적으로 높았다. 짠맛을 좋아하는 사람은 나트륨 섭취량이 7890 mg으로 짠맛을 싫어하는 사람 5579 mg보다 유의적 (p < 0.05)으로 많은 양을 섭취하였다.고, Ca : P 중량비가 각각 2.63$\pm$1.99, 1.79$\pm$0.39, 2.80$\pm$0.53, 8.35$\pm$12.87이었으며, Ca : Mg 중량비는 각각 11.86$\pm$540, 9.29$\pm$1.34, 9.09$\pm$2.09, 32.50$\pm$41.35이었다. 칼슘과 마그네슘의 흡수에 영향을 미치는 P : Mg 분자량비는 곡류가공품이 4.11$\pm$1.54, 라면류가 4.17$\pm$0.67, 레토르트식품은 2.58$\pm$0.45, 음료류는 2.59$\pm$2.50으로 나타났다. 위의 연구결과에서 볼 때 시료의 93.0%가 실제측정값이 표시량의 80% 이상이어야

승모판에서의 단고형 이오네스큐판막의 조직실패 (Tissue Failure of the Low-Profile lonescu-Shiley Pericardial Valve in Mitral Position)

  • 김종환
    • Journal of Chest Surgery
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    • 제30권7호
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    • pp.670-676
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    • 1997
  • 구르탈알데하이로 처리한 이종조직판막의 구조적 실패는 이미 임상초기부터 예견된 내구성상의 문제가 되 왔으며 장기간의 술후추적에서 생물학적 및 기계적 요소에 의한 일차성 조직실패의 빈도는 높아지고 있다. 단고형 우심낭조직판만인 이오네스큐판막을 일차성 조직실패 때문에 적출한 환자 27례에서 환자의 특성과 적출판막의 병리학적 특징을 분석하고 행콕판막과 표준형 이오네스큐판막의 승모판위치에서의 실패양상과 비교검토하였다. 첫 순술 당시의 환자연령은 16-56세(평균 38.0$\pm$11.0세)이고 적출판막의 크기는 평균 30.8 $\pm$ 1.3 m였다. 혈류역동학적 실패결과는 협착 29.6%, 폐쇄부전 44.4%, 혼합병변 14.8%와 정상 11.1%였다. 병 리학적소견상 조직손상과 무관하게 석회화변성은 적출판막의 63.0%에서 그리고 석회화의 유무와 무관하게 조직손상은 58.1%에서 관찰되었으며, 각각 조직손상이 우세한(76.8%) 행콕판막군과 석회화병변이 우세한 (76.1%)표준형 이오네스큐판막군에서의 특징과 대조적이었다. 판막의 내구성에 직접적으로 영향한다고 알려 져 온 젊은 연령층 환자에서의 석회화변성을 반영할 만한 특징적 증거는 보지 못하였다. 이전의 보 諮$[$\ulcorner\ulcorner다 연장된 적출기간은 술후 관찰중의 환자에서 판막손상의 기전이 진행적일 가능성을 강력하게 시사하며 더 욱 연장된 임상적 관찰과 분석이 필요하다고 보인다. 이종조직판막의 일차성 조직실패는 여러 보고에서 보는 것보다 훨씬 복합적인 생물학적 및 대사적 요소와 함께 복잡한 기계적 요소로 야기되며 구르텔알데하이드처리의 새세대의 이종조직판막이라도 판막의 구조적 실패를 결정적으로 개선하지는 못할 듯하다. 따라서 현재로는 일반적으로 이종조직판막은 고령의 환자에 제 한적으로 적응될 뿐일 듯하다.

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소 심낭의 무세포화에서 트립신이 이식편의 물리-역학적 및 조직학적 변화에 미치는 영향 (Effect of Trypsin on Physico-dynamic and Histological Changes after Decellularization of Bovine Pericardium)

  • 성용원;김용진;김수환;민병주;이영옥;임홍국
    • Journal of Chest Surgery
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    • 제43권6호
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    • pp.565-575
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    • 2010
  • 배경: 이식편을 개발함에 있어서 숙주의 면역반응을 최소화하여 보다 더 오래 사용할 수 있게 하기위한 방법으로 무세포화에 대한 연구가 시행되고 있다. 저자들은 소 심낭의 무세포화의 과정에 효소제인 트립신 전처치가 물리역학적, 조직학적으로 미치는 영향에 대해 알아보고자 하였다. 대상 및 방법: 소 심낭편을 SDS와 Triton X-100 또는 N-lauroylsarcosinate와 Triton X-100으로 무세포화하는 것을 기본으로 한 군들과 0.1% 트립신/0.1% EDTA로 전처치를 추가한 군들에서 장력 검사를 실시하고, 생체 이식 후의 상태를 가정한 피로도 검사를 전후로 하여 투과도와 유순도는 검사하였고, 피로도 검사 전후로 조직학적인 변화를 광학현미경 및 전자현미경으로 관찰하였다. 결과: 트립신 처치를 추가한군과 아닌 군에서 기계적 장벽의 차이는 없었으나, 투과도와 유순도는 피로도검사 전과 후로 트립신 처치를 하지 않은 군에 비해 증가하였으며, 조직학적으로도 세포외 기질이 더 손상된 소견을 보였다. 걸론: 소 심낭의 무세포화에서 트립신 전처치는 세포외 기질의 손상을 유발하지만 기계적 장력에는 큰 영향을 미치지 않았으며, 피로도검사 전후 모두 투과도와 유순도를 증가시켰다. 무세포화과정에서 트립신과 같은 단백질 분해 효소제를 이용하기 위해서는 조직의 생체 물리적 손상을 최소화할 수 있는 다양한 방법을 조합한 연구가 더 필요하다.

Mechanical versus Tissue Aortic Prosthesis in Sexagenarians: Comparison of Hemodynamic and Clinical Outcomes

  • Son, Jongbae;Cho, Yang Hyun;Jeong, Dong Seop;Sung, Kiick;Kim, Wook Sung;Lee, Young Tak;Park, Pyo Won
    • Journal of Chest Surgery
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    • 제51권2호
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    • pp.100-108
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    • 2018
  • Background: The question of which type of prosthetic aortic valve leads to the best outcomes in patients in their 60s remains controversial. We examined the hemodynamic and clinical outcomes of aortic valve replacement in sexagenarians according to the type of prosthesis. Methods: We retrospectively reviewed 270 patients in their 60s who underwent first-time aortic valve replacement from 1995 to 2011. Early and late mortality, major adverse valve-related events, anticoagulation-related events, and hemodynamic outcomes were assessed. The mean follow-up duration was $58.7{\pm}44.0$ months. Results: Of the 270 patients, 93 had a mechanical prosthesis (mechanical group), and 177 had a bioprosthesis (tissue group). The tissue group had a higher mean age and prevalence of preoperative stroke than the mechanical group. The groups had no differences in the aortic valve mean pressure gradient (AVMPG) or the left ventricular mass index (LVMI) at 5 years after surgery. In a sub-analysis limited to prostheses in the supra-annular position, the AVMPG was higher in the tissue group, but the LVMI was still not significantly different. There was no early mortality. The 10-year survival rate was 83% in the mechanical group and 90% in the tissue group. The type of aortic prosthesis did not influence overall mortality, cardiac mortality, or major adverse valve-related events. Anticoagulation-related events were more common in the mechanical group than in the tissue group (p=0.034; hazard ratio, 4.100; 95% confidence interval, 1.111-15.132). Conclusion: The type of aortic prosthesis was not associated with hemodynamic or clinical outcomes, except for anticoagulation-related events.

글루타르알데하이드 고정 소심 낭막에서의 내피세포 증식에 대한 글루탕산 및 파라벤용액의 효과 (Effect of L-Glutamic Acid and Paraben Solution on the Endothelial Cell Proliferation in the Glutaraldehyde- Fixed Bovine Pericardium)

  • 김범식;이문환;유세영;김원곤
    • Journal of Chest Surgery
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    • 제29권1호
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    • pp.7-13
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    • 1996
  • The conventional glutaraldehyde (GA) fixation method of tissue valves is considered to be responsible for accelerated valve degeneration. The release of toxic GA from the valve tissue is believed to limit endothelial cell (EC) ingrowth. Removal of toxic GA by reaction with L-glutamic acid and storage in a Paraben solution may offer good EC growth. To investigate the conditions for endothelialization of tissue valves, the growth properties of ECs on the conventionally and alternatively treated pericardial tissue were compared. Conventional preparation included zero-pressure fixation for 72 hours in phosphated-buffered saline (PBS) solution containing 0.5% GA at 4$^{\circ}C$ and storage into PBS containing 0.2% GA(group I). Alternatively treated pericardial tissues were divided into three postfixation treatment groups : (1) storage in PBS solution containing Paraben(group II), (2) treatment with PBS containing 8$^{\circ}C$ L-glutamic acid(PH 7.35) and storage in PBS solution containing Paraben (g oup III), (3) treatment with L-glutamic acid dissolved in distilled water (PH 3.5) (group IV). Pericardial tissue were transferred into the 24-well plate after storage for 4 weeks. ECs were harvested enzymatically from the bovine pulmonary artery and grown to confluence on culture flask surfaces. Detached ECs by trypsin were incubated into the each well of the 24-well plate including test pericardial tissues. Cells were detached by trypsin, 1, 2, 3, 5, 7 days after incubation and counted on the hemacytometer. Cell viability test was performed by frypan-blue exclusion method. Acute cell death in the group I were found even after prolonged washing. The group II showed prolonged cell survival compared with the group I. Both group III and group IV showed better cell growth than group II. There was no statistically significant difference between group III and group IV method in terms of EC growth. This results suggest that treatment by L-glutamic ac id and storage in a Paraben solution be a promising approach for improvement of durability of GA-treated tissue valves.

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The Anti-calcification Effect of Dithiobispropionimidate, Carbodiimide and Ultraviolet Irradiation Cross-linking Compared to Glutaraldehyde in Rabbit Implantation Models

  • Park, Samina;Kim, Soo Hwan;Lim, Hong-Gook;Lim, Cheong;Kim, Yong Jin
    • Journal of Chest Surgery
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    • 제46권1호
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    • pp.1-13
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    • 2013
  • Background: Glutaraldehyde (GA) is a widely used cross-linking agent for improving mechanical properties and resistance to enzymatic degradation of collagenous tissue, but it has several drawbacks such as calcification and cytotoxicity. The aim of this study was to find the alternative effective cross-linking methods to GA. Materials and Methods: Bovine pericardium was processed with GA with ethanol+octanol and glycine detoxification, and polyethylene glycol (PG) space filler, dimethyl 3,3'-dithiobispropionimidate (DTBP), 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC) treatment, and the physical fixation of ultraviolet irradiation were done. The biologic material properties of variously treated pericardial tissues were assessed by biochemical, mechanical and histological tests. Treated pericardial tissues were also implanted subcutaneously or intramuscularly into the rabbit for 10 weeks to assess the xenoreactive antibody response of immunoglobulin G and M, their anti-calcification effect. Results: The biochemical and mechanical properties of EDC fixed pericardial tissues were comparable to the GA fixed tissue. The cytotoxicity was lowest in space filler treated GA fixed group. In rabbit subcutaneous or intramuscular implantation models, decellularization, space filler, EDC treatment group showed significantly lower calcium content than GA only and DTBP treatment group (p<0.05, analysis of variance). The titer of anti $Gal{\alpha}1-3Gal{\beta}1$-4GlcNAc-R antibodies did not change in the postimplantation serial enzyme-linked immunosorbent assay. Hematoxylin and eosin and von Kossa staining showed that decellularization, space filler, EDC, and ultraviolet treatment had less inflammatory cell infiltration and calcium deposits. Conclusion: The decellularization process, PG filler, and EDC treatments are good alternative cross-linking methods compared to GA only fixation and primary amine of DTBP treatment for cardiovascular xenograft preservation in terms of the collagen cross-linking stability and in vivo anti-calcification effects.

Early Outcomes of Sutureless Aortic Valves

  • Hanedan, Muhammet Onur;Mataraci, Ilker;Yuruk, Mehmet Ali;Ozer, Tanil;Sayar, Ufuk;Arslan, Ali Kemal;Ziyrek, Ugur;Yucel, Murat
    • Journal of Chest Surgery
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    • 제49권3호
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    • pp.165-170
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    • 2016
  • Background: In elderly high-risk surgical patients, sutureless aortic valve replacement (AVR) should be an alternative to standard AVR. The potential advantages of sutureless aortic prostheses include reducing cross-clamping and cardiopulmonary bypass (CPB) time and facilitating minimally invasive surgery and complex cardiac interventions, while maintaining satisfactory hemodynamic outcomes and low rates of paravalvular leakage. The current study reports our single-center experience regarding the early outcomes of sutureless aortic valve implantation. Methods: Between October 2012 and June 2015, 65 patients scheduled for surgical valve replacement with symptomatic aortic valve disease and New York Heart Association function of class II or higher were included to this study. Perceval S (Sorin Biomedica Cardio Srl, Sallugia, Italy) and Edwards Intuity (Edwards Lifesciences, Irvine, CA, USA) valves were used. Results: The mean age of the patients was $71.15{\pm}8.60years$. Forty-four patients (67.7%) were female. The average preoperative left ventricular ejection fraction was $56.9{\pm}9.93$. The CPB time was $96.51{\pm}41.27minutes$ and the cross-clamping time was $60.85{\pm}27.08minutes$. The intubation time was $8.95{\pm}4.19hours$, and the intensive care unit and hospital stays were $2.89{\pm}1.42days$ and $7.86{\pm}1.42days$, respectively. The mean quantity of drainage from chest tubes was $407.69{\pm}149.28mL$. The hospital mortality rate was 3.1%. A total of five patients (7.69%) died during follow-up. The mean follow-up time was $687.24{\pm}24.76days$. The one-year survival rate was over 90%. Conclusion: In the last few years, several models of valvular sutureless bioprostheses have been developed. The present study evaluating the single-center early outcomes of sutureless aortic valve implantation presents the results of an innovative surgical technique, finding that it resulted in appropriate hemodynamic conditions with acceptable ischemic time.

Changes of the Structural and Biomechanical Properties of the Bovine Pericardium after the Removal of ${\alpha}$-Gal Epitopes by Decellularization and ${\alpha}$-Galactosidase Treatment

  • Nam, Jinhae;Choi, Sun-Young;Sung, Si-Chan;Lim, Hong-Gook;Park, Seong-Sik;Kim, Soo-Hwan;Kim, Yong Jin
    • Journal of Chest Surgery
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    • 제45권6호
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    • pp.380-389
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    • 2012
  • Background: Bovine pericardium is one of the most widely used materials in bioprosthetic heart valves. Immunologic responses have been implicated as potential causes of limited durability of xenogenic valves. This study aimed to determine the effectiveness of decellularization and ${\alpha}$-galactosidase (${\alpha}$-gal) to remove major xenoreactive antigens from xenogenic tissues. Materials and Methods: Recombinant Bacteroides thetaiotaomicron (B. thetaiotaomicron) ${\alpha}$-gal or decellularization, or both were used to remove ${\alpha}$-gal from bovine pericardium. It was confirmed by ${\alpha}$-gal-bovine serum albumin-based enzyme-linked immunosorbent assay (ELISA), high-performance anion exchange chromatography, flow cytometry, 3,3'-diaminobenzidine-staining, and lectin-based ELISA. The mechanical properties of bovine pericardium after decellularization or ${\alpha}$-gal treatment were investigated by tests of tensile-strength, permeability, and compliance. Collagen fiber rearrangement was also evaluated by a 20,000${\times}$ transmission electron microscope (TEM). Results: Recombinant B. thetaiotaomicron ${\alpha}$-gal could effectively remove ${\alpha}$-gal from bovine pericardium B. thetaiotaomicron (0.1 U/mL, pH 7.2) while recombinant human ${\alpha}$-gal removed it recombinant human ${\alpha}$-gal (10 U/mL, pH 5.0). There was no difference in the mechanical properties of fresh and recombinant ${\alpha}$-gal-treated bovine pericardium. Furthermore, the TEM findings demonstrated that recombinant ${\alpha}$-gal made no difference in the arrangement of collagen fiber bundles with decellularization. Conclusion: Recombinant B. thetaiotaomicron ${\alpha}$-gal effectively removed ${\alpha}$-gal from bovine pericardium with a small amount under physiological conditions compared to human recombinant ${\alpha}$-gal, which may alleviate the harmful xenoreactive immunologic responses of ${\alpha}$-gal. Recombinant ${\alpha}$-gal treatment had no adverse effects on the mechanical properties of bovine pericardium.