title: Prevention of device-related tissue damage during percutaneous deployment of tissue-engineered heart valves.
abstract: BACKGROUND
  Endovascular application of pulmonary heart valves has been recently introduced clinically. A tissue-engineering approach was pursued to overcome the current limitations of bovine jugular vein valves (degeneration and limited longevity). However, deployment of the delicate tissue-engineered valves resulted in severe tissue damage. Therefore the objective of this study was to prevent tissue damage during the folding and deployment maneuver.
  
  
  METHODS
  Porcine pulmonary heart valves, small intestinal submucosa, and ovine carotid arteries were obtained from a slaughterhouse. After dissection and antimicrobial incubation, the valves were trimmed (removal of sinus and most of the muscular ring) to fit into the deployment catheter. The inside (in-stent group, n = 6) or outside (out-stent group, n = 6) of a nitinol stent was covered by an acellular small intestinal submucosa, and the valves were sutured into the stent. The valves were folded, tested for placement in the deployment catheter, and decellularized enzymatically. Myofibroblasts were obtained from carotid artery segments and seeded onto the scaffolds. The seeded constructs were placed in a dynamic bioreactor system and cultured for 16 consecutive days. After endothelial cell seeding, the constructs were folded, deployed, and processed for histology and surface electron microscopy.
  
  
  RESULTS
  The valves opened and closed competently throughout the entire dynamic culture. Surface electron microscopy revealed an almost completely preserved tissue in the in-stent group. Stents covered with small intestinal submucosa on the outside, however, showed severe damage.
  
  
  CONCLUSIONS
  This study demonstrates that small intestinal submucosa covering of the inside of a pulmonary valved stent can prevent stent strut-related tissue damage.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Friedrich-Schiller-University, Jena, Germany. ulrich.stock@charite.de
authors.forename: U A
authors.initials: UA
authors.lastname: Stock
authors.forename: I
authors.initials: I
authors.lastname: Degenkolbe
authors.forename: T
authors.initials: T
authors.lastname: Attmann
authors.forename: K
authors.initials: K
authors.lastname: Schenke-Layland
authors.forename: S
authors.initials: S
authors.lastname: Freitag
authors.forename: G
authors.initials: G
authors.lastname: Lutter
mesh_terms: D000818:Animals; D001705:Bioprosthesis / Q000009:adverse effects*; D002478:Cells, Cultured; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011474:Prosthesis Design; D011664:Pulmonary Valve / Q000601:surgery*; D015607:Stents; D023822:Tissue Engineering