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| IJCEM Copyright © 2008-All rights reserved. Published by e-Century Publishing Corporation, Madison, WI 53711 |
Int J Clin Exp Med 2013;6(8):662-666
Original Article
A novel surgical procedure: scaffold-pulmonary autograft transplantation
Xiu-Fang Xu, Zhu-Heng Wang, Guo-Ying An, Hai-Ping Guo, Sheng Wang, Jin-Feng Pei, En-Ming Qin, Xue-Jun Ren, Zhi-Wei Xu, Da
Gong, Wen-Bin Li
Department of Cardiac Surgery (WBL, ZWX, DG), Department of Ultrasound Cardiography (JFP), Department of Molecular Biology (XFX),
Department of Cardiology (XJR), Department of Anaesthesiology (EMQ), Institute of Heart, Lung and Blood Vessel, Anzhen Hospital,
Capital Medical University, Beijing 100029, China; Department of ICU, Daxing Hospital, Beijing 102600, China; Department of Cardiac
Surgery, Jining Medical College Hospital, Jining 272029, Shandong, China; Department of Cardiac Surgery, First Hospital of Handan,
Handan 056002, Hebei, China; Department of Cardiac Surgery, People’s Hospital of Henan Province, Zhengzhou 450003, China.
Equal contributors.
Received July 31, 2013; Accepted August 19, 2013; Epub September 1, 2013; Published September 15, 2013
Abstract: Mitral valve-related operations are easy to perform and show good results, but to prevent severe thromboembolism or a high
ratio of prosthetic valve destruction by tissue, lifetime anticoagulant therapy is essential after the operation. Thus, identifying a new type
of surgical procedure and prosthetic valve to cure mitral valve diseases is necessary. Pulmonary valve autograft transplantation (Ross
II) with the “top hat” transplantation technique was first reported by Ross DN to cure mitral disease. Because the “top hat” procedure
has some shortcomings, we designed the scaffold-pulmonary autograft transplantation procedure and performed animal experiments
to confirm the feasibility and effectiveness of the procedure. A total of 13 minipigs, weighing 20-25 kg, were employed as experimental
animals to undergo scaffold-pulmonary autograft valve transplantation in our surgical animal lab. The surgical procedure was
performed under hypothermic general anaesthesia and extracorporeal circulation (or cardiopulmonary bypass, CPB). Briefly, the chest
cave was opened through the left intercostal, the pulmonary valve autograft was harvested during on-pump beating heart, and the
pulmonary valve autograft was mounted in a self-made pulmonary valve scaffold and transferred to the mitral valve annulus without
removing the mitral instruments. Finally, the outflow tract of the right ventricle was re-established with a pig pulmonary homograft. After
finishing data collection, all animals were executed 1 hour after removal from the CPB. For the 13 minipigs that underwent the
operation, the CPB time was 182.4 ± 23.4 min. Two of the thirteen cases died of bleeding during the operation and of a post-operative
pulmonary embolism, and the remaining eleven survived for one hour. The pressure of the left atrium did not increase significantly (P =
1.00), and the ultrasonic cardiograph (UCG) showed good function of the new mitral valves, with mean ejection fraction (EF) values of
63.6%. The mitral valve orifice areas were 1.10 ± 0.13 cm2 (pre-operation) and 1.01 ± 0.08 cm2 (post-operation) (P = 0.013). The
function and structure of the new mitral valves were normal. We preliminarily consider scaffold-pulmonary autograft valve
transplantation to be a new alternative to cure mitral valve disease, but advanced chronic animal experiments will be needed to confirm
the long-term results of the operation. The results showed it could be a new alternative to cure mitral valve disease. (IJCEM1307023).
Keywords: Mitral valve disease, scaffold-pulmonary autograft valve transplantation, minipig
Address correspondence to: Dr. Wen-Bin Li, Department of Cardiac Surgery, Institute of Heart, Lung and Blood Vessels-Anzhen
Hospital, Capital Medical University, Beijing 100029, China. Tel: 0086-13701133521; Fax: 86-010-64444521; E-mail: liwenbin65@vip.
sina.com
Original Article
A novel surgical procedure: scaffold-pulmonary autograft transplantation
Xiu-Fang Xu, Zhu-Heng Wang, Guo-Ying An, Hai-Ping Guo, Sheng Wang, Jin-Feng Pei, En-Ming Qin, Xue-Jun Ren, Zhi-Wei Xu, Da
Gong, Wen-Bin Li
Department of Cardiac Surgery (WBL, ZWX, DG), Department of Ultrasound Cardiography (JFP), Department of Molecular Biology (XFX),
Department of Cardiology (XJR), Department of Anaesthesiology (EMQ), Institute of Heart, Lung and Blood Vessel, Anzhen Hospital,
Capital Medical University, Beijing 100029, China; Department of ICU, Daxing Hospital, Beijing 102600, China; Department of Cardiac
Surgery, Jining Medical College Hospital, Jining 272029, Shandong, China; Department of Cardiac Surgery, First Hospital of Handan,
Handan 056002, Hebei, China; Department of Cardiac Surgery, People’s Hospital of Henan Province, Zhengzhou 450003, China.
Equal contributors.
Received July 31, 2013; Accepted August 19, 2013; Epub September 1, 2013; Published September 15, 2013
Abstract: Mitral valve-related operations are easy to perform and show good results, but to prevent severe thromboembolism or a high
ratio of prosthetic valve destruction by tissue, lifetime anticoagulant therapy is essential after the operation. Thus, identifying a new type
of surgical procedure and prosthetic valve to cure mitral valve diseases is necessary. Pulmonary valve autograft transplantation (Ross
II) with the “top hat” transplantation technique was first reported by Ross DN to cure mitral disease. Because the “top hat” procedure
has some shortcomings, we designed the scaffold-pulmonary autograft transplantation procedure and performed animal experiments
to confirm the feasibility and effectiveness of the procedure. A total of 13 minipigs, weighing 20-25 kg, were employed as experimental
animals to undergo scaffold-pulmonary autograft valve transplantation in our surgical animal lab. The surgical procedure was
performed under hypothermic general anaesthesia and extracorporeal circulation (or cardiopulmonary bypass, CPB). Briefly, the chest
cave was opened through the left intercostal, the pulmonary valve autograft was harvested during on-pump beating heart, and the
pulmonary valve autograft was mounted in a self-made pulmonary valve scaffold and transferred to the mitral valve annulus without
removing the mitral instruments. Finally, the outflow tract of the right ventricle was re-established with a pig pulmonary homograft. After
finishing data collection, all animals were executed 1 hour after removal from the CPB. For the 13 minipigs that underwent the
operation, the CPB time was 182.4 ± 23.4 min. Two of the thirteen cases died of bleeding during the operation and of a post-operative
pulmonary embolism, and the remaining eleven survived for one hour. The pressure of the left atrium did not increase significantly (P =
1.00), and the ultrasonic cardiograph (UCG) showed good function of the new mitral valves, with mean ejection fraction (EF) values of
63.6%. The mitral valve orifice areas were 1.10 ± 0.13 cm2 (pre-operation) and 1.01 ± 0.08 cm2 (post-operation) (P = 0.013). The
function and structure of the new mitral valves were normal. We preliminarily consider scaffold-pulmonary autograft valve
transplantation to be a new alternative to cure mitral valve disease, but advanced chronic animal experiments will be needed to confirm
the long-term results of the operation. The results showed it could be a new alternative to cure mitral valve disease. (IJCEM1307023).
Keywords: Mitral valve disease, scaffold-pulmonary autograft valve transplantation, minipig
Address correspondence to: Dr. Wen-Bin Li, Department of Cardiac Surgery, Institute of Heart, Lung and Blood Vessels-Anzhen
Hospital, Capital Medical University, Beijing 100029, China. Tel: 0086-13701133521; Fax: 86-010-64444521; E-mail: liwenbin65@vip.
sina.com
