EARLY FAILURE OF AN AUTOLOGOUS PERICARDIUM AORTIC HEART-VALVE (ATCV) PROSTHESIS

Background and aims of the study: The risk of reoperation due to calci fic degeneration is the most important. drawback of biological heart v alves compared with mechanical prostheses. Concepts to mitigate clinic ally have been tested experimentally and clinically, but none has prov en completely to prevent degeneration. Methods: Renewed interest has i nvolved the use of autologous pericardium for intraoperative construct ion of autologous aortic valves (ATCV). Results: Of 10 ATCV implanted between 1994 and 1996, one was removed from an 84-year-old female 27 m onths after implantation because of severe valvular insufficiency. Eig ht months earlier, a broken spring of the stent system was detected ra diographically, with normal valvular competence at echocardiography. V alve dysfunction was due to shrinkage of one leaflet. Measurement of t issue calcium by atomic absorption spectroscopy showed high levels in the shrunken leaflet compared with two intact leaflets (42.82 versus 0 .51 and 2.42 mg Ca2+/g). Histology and immunohistology demonstrated ex tensive fiber degeneration without inflammation or immune reactions in the destroyed leaflet and moderate fiber degeneration in intact leafl ets. Scanning electron microscopy showed smooth surfaces in the normal leaflet and exposure of collagen in the degenerated leaflet in associ ation with calcium deposition. Conclusions: In contrast to the outcome in animal studies, intraoperative tanning did not prevent tissue shri nkage in this case. Leaflet malfunction was associated with calcificat ion At present, the clinical use of salves constructed from autologous pericardium can not be recommended.