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ORIGINAL ARTICLE

Evaluation of bovine pericardium valved conduit in an animal experimental model

José Luiz Verde dos Santos; Domingo M Braile; Marcelo José F Soares; Walter Rade; Marcos Antônio Rossi; Rubens Thevenard; Dorotéia R. Silva Souza

DOI: 10.1590/S0102-76381990000100003

ABSTRACT

Congenital diseases as pulmonary atresia, tetralogy of Fallot, among others, have been corrected using the extracardiac conduits. There is a variety of conduits valved or not that make possible the access of sanguineous flux from right ventricle to pulmonary circulation. However, the synthetic conduits with biologic or metalic valves shows prosthesis degeneration and obstruction problems and peeling of the conduit, moreover, they are very expensive. The experience with treated bovine pericardium showing it is impermeable and easy to suture, led to the production of valved conduits that in this study were evaluated for obstruction, calcification and stretching. The utilization of an animal experimental model allowed the detailed periodic evaluation by echodopplercardiography and cateterism during one, three and six months. The recuperated conduits were studied by optical microscopy and X ray, with several parts of the bioprosthesis analysed. The microscopic examination showed the conduits pericardium preserved with signs of pseudo-endotelization, and the majority of valves with moderate calcification, but with good function yet. The surgery technique without extracorporeal circulation and the results with the follow-up of five animals during six months are presented and discussed. The authors conclude that the bovine pericardium valved conduit showed good results in the right ventricule outlet, allowing to expect a satisfatory result when applied in human beings by the known relation of acelerated degeneration of the biological prostheses on the studied experimental model, several times greater than in man.

RESUMO

Doenças congênitas, como a atresia pulmonar e a tétrade de Fallot, entre outras, têm sido corrigidas com o uso de condutos extracardíacos. Existe uma variedade de condutos, valvulados ou não, que possibilita o acesso do fluxo sangüíneo do ventrículo direito à circulação pulmonar. Contudo, os tubos plásticos com válvulas biológicas ou metálicas apresentam problemas de degeneração e obstrução da prótese e peeling do tubo, além do alto custo. A experiência adquirida com o pericárdio bovino tratado, mostrando-se impermeável e de fácil sutura, possibilitou a confecção de tubos valvulados que, neste estudo, foram avaliados quanto a obstrução, calcificação e dilatação. A utilização de um modelo experimental animal permitiu a avaliação periódica detalhada por ecodopplercardiografia e cateterismo durante um, três e seis meses de evolução. As peças recuperadas foram estudadas por microscopia óptica e raios X, com a análise de diversas regiões da bioprótese. O exame macroscópico mostrou o pericárdio dos tubos preservados com sinais de pseudo-endotelizaçáo, e a maioria das válvulas com calcificação moderada, mas ainda com boa função. São apresentados e discutidos a técnica operatória empregada sem circulação extracorpórea e os resultados com o seguimento de cinco animais (carneiros), durante seis meses. Os autores concluem que o enxerto tubular valvulado de pericárdio bovino mostrou bons resultados na via de saída do ventrículo direito, permitindo prever um resultado satisfatório quando empregado em seres humanos, pela conhecida relação de degeneração acelerada das próteses biológicas no modelo experimental estudado, muitas vezes maior que no homem.
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REFERENCES

1. AGARWALL, K. C.; EDWARDS, W. D.; FELDT, R. H.; DANIELSON, G. K.; PUGA, F. J.; McGOON, D. C. - Clinicopathological correlates of obstructed righ-sided porcine-valved extracardiac conduits. J. Thorac. Surg., 81: 591-601, 1981.

2. ARBUSTINI, E.; JONES, M.; MOISES, R. D.; EIDBO, E. E.; CARROL, R. J.; FERRANS, V. J. - Modification by the Hancock T6 process of calcification of bioprosthetic cardiac valves implanted in sheep. Am. J. Cardiol., 53: 1388-1396, 1984. [MedLine]

3. ARDITO, R. V.; SANTOS, J. L. V.; MAYORQUIM, R. C.; GRECO, O. T.; ZAIANTCHICK, M.; SOTO, H. G.; JACOB, J. L. B.; BRAILE, D. M. - Substituição completa da aorta ascendente e da valva aórtica com tubo valvulado de pericárdio bovino. Rev. Bras. Cir. Cardiovasc., 2: 129-138, 1987.

4. BAILEY, W. W.; KIRKLIN, J. W.; BARGERON, L. M.; PACÍFICO, A. D.; KOUCHOUKOS, N. T. - Late results with conduits from venous ventricle to pulmonary arteries. Circulation, 56: (Parte 2): 73-79, 1977.

5. BEHRENDT, D. M. & ROCCHINI, A. - Relief of left ventricular outflow tract obstruction in infants and small children with valved extracardiac conduits. Ann. Thorac. Surg., 43: 82-86, 1987. [MedLine]

6. BEN-SHACHAR, G.; NICOLOFF, D. M.; EDWARDS, J. E. - Separation of neointima from Dacron graft causing obstruction. J. Thorac. Cardiovasc. Surg., 82: 268-271, 1981. [MedLine]

7. BOYCE, S. W.; TURLEY, K.; YEE, E. S.; VERRIER, E. D.; EBERT, P. A. - The fate of the 12 mm porcine valved conduit from the right ventricle to the pulmonary artery. J. Thorac. Cardiovasc. Surg., 95: 201-207, 1988. [MedLine]

8. BRAILE, D. M.; ARDITO, R. V.; GRECO, O. T. - Alargamento da raiz da aorta com "patch" de pericardio bovino preservado pelo glutaraldeído. Arq. Bras. Cardiol., 41: 289-296, 1983. [MedLine]

9. BRICK, A. V.; MIANA, A. A.; COLEN, E. A.; PASSOS, P. H. C.; BORGES, A.; JORGE, P. C.; BRAILE, D. M.; GRECO, O. T.; ARDITO, R. V.; SANTOS, J. L. V.; MAYORQUIM, R. C.; LIMA, E. R.; ZAIANTCHICK, M.; CAMPOS, K. L.; GOLLARZA, H. S.; SOUZA, R. S. D.; BROFMAN, P. R.; LOURES, D. R. R.; CARVALHO, R. G.; RIBEIRO, E. J. - Seguimento de 9 anos da bioprótese valvar cardíaca de pericardio bovino IMC-Biomédica: estudo multicéntrico. Rev. Bras. Cir. Cardiovasc., 2: 189-199, 1987.

10. BROWN, J. W.; HALPIN, M. P.; RESCORLA, F. J.; VANNATTA, B. W.; FIORE, A. C.; SHIPLEY, G. D.; BIZUNCH, M.; BILLS, R.; WALLER, B. - Externally stended polytetrafluoroethylene valved conduits for right heart reconstruction and experimental comparison with Dacron valved conduits. J. Thorac. Cardiovasc. Surg., 90: 833-841, 1985. [MedLine]

11. BULL, C.; MCARTNEY, F. J.; HORVATH, P.; ALMEIDA, R.; MERRILL, W.; DOUGLAS, J.; TAYLOR, J. F. N.; LEVAL, M. R.; STARK, J. - Evaluation of long-term results of homograft and heterograft valves in extracardiac conduits. J. Thorac. Cardiovasc. Surg., 94: 12-19, 1987. [MedLine]

12. CHUN, P. K. C.; ROCCHINI, A. P.; GIBBS, H. R.; ROBINOWITZ, M.; GREEN, D.; VIRMANI, R. - Pannus formation in a Hancock-valved conduit resulting in proximal intraconduit obstruction: late complication of Rastelli procedure for complete transposition of the great vessels with ventricular septal defect and pulmonic stenosis. Am. Heart J., 101: 855-857, 1981. [MedLine]

13. CIARAVELLA, J. M.; McGOON, D. C.; DANIELSON, G. K.; WALLACE, R. B.; MAIR, D. D. - Experience with the extracardiac conduit. J. Thorac. Cardiovasc. Surg., 78: 920-930, 1979. [MedLine]

14. CLEVELAND, D. C.; KIRKLIN, J. K.; NAFTEL, D. C.; KIRKLIN, J. W.; BLACKSTONE, E. H.; PACÍFICO, A. D.; BARGERON, L. M. - Surgical treatment of tricuspid atresia. Ann. Thorac. Surg., 38: 447-457, 1984. [MedLine]

15. CRAWFORD Jr, F. A.; SADE, R. M.;SPIRALE, F. - Bovine pericardium for conection of congenital heart defects. Ann. Thorac. Surg., 41: 602-605, 1986. [MedLine]

16. DeLEON, S. Y.; IDRISS, F. S.; ILBAWI, M. N.; RASTEGAR, H.; MUSTER, A. J.; PAUL, M. M. - Neointimal obstruction of Carpentiers-Edwards valved conduit in two patients with modified Fontan procedure. Ann. Thorac. Surg., 34: 586-589, 1982. [MedLine]

17. FIORE, A. C.; PEIGH, P. S.; ROBINSON, R. J.; GLANT, M. D.; KING, H.; BROWN, J. W. - Valved and nonvalved right ventricular-pulmonary arterial extracardiac conduits: an experimental comparison. J. Thorac. Cardiovasc. Surg., 86: 490-497, 1983. [MedLine]

18. HAVERICH, A. & BORST, H. G. - Febrin glue for treatment of bleeding in cardiac surgery. In: BIRCKS, W.; OSTERMEYER, J.; SCHULTE, H. D. (eds.). Cardiovascular surgery. New York, Springer-Verlag, 1980. p. 621-635.

19. HELSETH, H. K.; HAGLIN, J. J.; MONSON, B. K.; WECKSTROM, P. H. - Results of composite graft replacement for aortic root aneurysms. J. Thorac. Cardiovasc. Surg., 80: 754-759, 1980. [MedLine]

20. IONESCU, M. I. & DEAC, R. C. - Fascia lata composite graft for right ventricular outflow tract and pulmonary artery reconstruction. Thorax, 25: 427-431, 1970.

21. JONAS, R. A.; FREED, M. D.; MOYER Jr., J. E.; CASTAÑEDA, A. R. - Long-term follow-up of patients with synthetic right heart conduits. Circulation, 72: (Parte 2): 77-83, 1985.

22. JONAS, R. A.; ZIEMER, G.; BRITTON, L.; ARMIGER, L. C. - Cryopreserved and fresh antibiotic-sterilized valved aortic homograft conduits in a long-term sheep model. J. Thorac. Cardiovasc. Surg., 96: 746-755, 1988. [MedLine]

23. JONES, M.; EIDBO, E. E.; HILBERT, S. L.; FERRANS, V. I.; CLARK, R. E. - The effects of anticalcification treatments on bioprosthetic heart valves implanted in sheep. Trans. Am. Artif. Intern. Organs., 34: 1027-1030, 1988.

24. KOUCHOUKOS, N. T.; MARSHALL, W. G.; WEDIGE-STECHER, T. A. - Eleven-year experience with composite graft replacement of the ascending aorta and aortic valve. J. Thorac. Cardiovasc. Surg., 92: 691-705, 1986. [MedLine]

25. LEVY, R. J.; SCHVEN, F. J.; LUND, S. A.; SMITH, M. S. - Preservation of leaflet calcification of bioprosthetic heart valves with diphosphonate infection therapy. J. Thorac. Cardiovasc. Surg., 94: 551-557, 1987. [MedLine]

26. MAIR, D. D.; FULTON, R. E.; JAMIELSON, G. K. - Thrombotic occlusion of Hancock conduit due to severe dehydratation after Fontan operation. Mayo Clin. Proc., 53: 397-400, 1978.

27. MARVASTI, M. A.; PARKER, F. B.; RANDALL, P. A.; WITWER, G. A. - Composite graft replacement of the ascending aorta and aortic valve. J. Thorac. Cardiovasc. Surg., 95: 924-928, 1988. [MedLine]

28. MAZZERA, E.; CORNO, A.; DIDONATO, R.; BELLERINI, L.; MARINO, B.; CATENA, G.; MARCELLETTI, C. - Surgical bypass of the systemic atrioventricular valve in children by means of a valved conduit. J. Thorac. Cardiovasc. Surg., 96: 321-325, 1988. [MedLine]

29. MOODIE, D. S.; MAIR, D. D.; FULTON, L. E.; WALLACE, R. B.; DANIELSON, G. K.; McGOON, D. C. - Aortic homograft obstruction. J. Thorac. Cardiovasc. Surg., 72: 553-561, 1976. [MedLine]

30. MOON, B. C.; WILLIAMS, W. G.; TRUSLER, G. T.; COLES, J. G.; McLAUGHLIN, P. R. - Re-operation in patients with cryopreserved homograft valved conduits. Circulation, 80 (Supl. 2): 468, 1989. [MedLine]

31. MORAES, C. R. & RODRIGUES, J. V. - Conduto valvulado de pericardio bovino: relato de caso. Arq. Bras. Cardiol., 48: 173-177, 1987. [MedLine]

32. PETITE, H.; RINALDI, S.; MENASCHE, P.; PIWNICA, A.; HUC, A. - Low level of calcification mechanical properties of the acyl azide treated pericardium compared with glutaraldehyde treated pericardium. International Symposium on Surgery for Heart Valve Disease, London, Junho 1989. (Resumos).

33. PRENGER, K. B.; HESS, J.; CROMME-DIJKHUIS, A. H.; EJGELAAR, A. - Porcine-valved Dacron conduits in Fontan procedures. Ann. Thorac. Surg., 46: 526-530, 1988. [MedLine]

34. RASTELLI, G. C.; ONGLEY, A.; DAVIS, G. D.; KIRKLIN, J. W. - Surgical repair for pulmonary valve atresia with coronary-pulmonary artery fistula: report of a case. Mayo Clin. Proc., 40: 521-527, 1965. [MedLine]

35. ROSS, D. N. & SOMMERVILLE, J. - Conection of pulmonary atresia with a homograft aortic valve. Lancet, 2: 1446-1447, 1966. [MedLine]

36. ROSSI, M. A.; TEIXEIRA, M. D. R.; SOUZA, D. R. S.; PERES, L. C. - Lipid extraction attenuates the calcific degeneration of bovine pericardium used in cardiac valve bioprostheses. (No prelo). Br. J. Exp. Pathol., 1990).

37. SARAVALLI, O. A.; SOMMERVILLE, J.; JEFFERSON, K. E. - Calcification of aortic homograft used for reconstruction of the right ventricle outflow. J. Thorac. Cardiovasc. Surg., 80: 909-912, 1980.

38. SCHLICHTER, A. J. & KREUTZER, G. O. - Autologous pericardial valved conduit (APVC). Rev. Lat. Cardiol. Circ. Cardiovasc. Infantil, 1: 43-48, 1985.

39. TSAO, J. W.; SHOEN, F. J.; SHANKAR, R.; SALLIS, J. D.; LEVY, R. J. - Retardation of calcification of bovine pericardium used in bioprosthetic heart valves by phosphocitrate and a synthetic analogue. Annual Meeting of the Society for Biomaterials, 13. Junho, 1987 (Resumos).

40. WEBB, C. L.; BENEDICT, J. J.; SCHOEN, F. J.; LINDEN, J. A.; LEVY, R. J. - Inhibition of bioprosthetic heart valve calcification with aminodiphosphonate covalently bound to residual aldehyde groups. Ann. Thorac. Surg., 46: 309-316, 1988. [MedLine]

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