Early failure of an autologous pericardium aortic heart valve (ATCV) prosthesis.
OBJECTIVE
The risk of reoperation due to calcific degeneration is the most important drawback of biological heart valves compared with mechanical prostheses. Concepts to mitigate calcification have been tested experimentally and clinically, but none has proven completely to prevent degeneration.


METHODS
Renewed interest has involved the use of autologous pericardium for intraoperative construction of autologous aortic valves (ATCV).


RESULTS
Of 10 ATCV implanted between 1994 and 1996, one was removed from an 84-year-old female 27 months after implantation because of severe valvular insufficiency. Eight months earlier, a broken spring of the stent system was detected radiographically, with normal valvular competence at echocardiography. Valve dysfunction was due to shrinkage of one leaflet. Measurement of tissue 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 extensive fiber degeneration without inflammation or immune reactions in the destroyed leaflet, and moderate fiber degeneration in intact leaflets. Scanning electron microscopy showed smooth surfaces in the normal leaflet and exposure of collagen in the degenerated leaflet in association with calcium deposition.


CONCLUSIONS
In contrast to the outcome in animal studies, intraoperative tanning did not prevent tissue shrinkage in this case. Leaflet malfunction was associated with calcification. At present, the clinical use of valves constructed from autologous pericardium can not be recommended.
Dahm
M
M
Department of Cardiothoracic and Vascular Surgery, University Hospital Mainz, Germany.
Prüfer
D
D
Mayer
E
E
Groh
E
E
Choi
Y H
YH
Oelert
H
H
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D001705:Bioprosthesis; D002114:Calcinosis / Q000209:etiology; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D011475:Prosthesis Failure; D015607:Stents; D013997:Time Factors; D014182:Transplantation, Autologous