title: Analysis of sixty-two explanted Liotta bioprostheses: biocompatibility, biofunctionality, and biodurability issues.
abstract: Sixty-two explanted Liotta porcine bioprostheses were examined to review the issues related to their biocompatibility, biofunctionality, and biodurability. These bioprostheses were harvested from 56 patients with implantation times ranging from only a few hours to more than nine years of implantation. There were 10 acute and short-term (< 1 year), 20 midterm (1 < t < 5 years), and 32 long-term (> 5 years) cases. The indications for the reoperations were: hemodynamic (59), thrombosis (10), and endocarditis (3). The major indications varied according to the duration of implantation: blood infiltration, fibrin buildup, thrombosis in the short-term; endocarditis and hemodynamic insufficiency in the midterm; and mineralization and tears causing hemodynamic incompetence in the long term. Mineralization proved to be the main threat to long-term durability for porcine valves. Besides a few short-term failures, these explanted devices slowly degenerated over time and were replaced to prevent congestive heart failure. Documentation of the failure modes of these porcine valves is important since the demand for bioprostheses will increase in the future, in particular for percutaneous devices. Such bioprostheses emphasize a critical biocompatibility issue following implantation because they have the capacity to remain free of thrombus in the absence of anticoagulation. The biofunctionality appears to be adequate in the absence of subsequent pathology with restoration of normal valve function. However, the documentation of such significant long-term biodurability issues raises questions that have been addressed but not fully answered yet with the new generations of bioprostheses.
authors.affiliation: College of Biological Engineering, Chongqing University, Chongqing, PR China.
authors.forename: Hongbo
authors.initials: H
authors.lastname: Zhang
authors.forename: Georgi
authors.initials: G
authors.lastname: Marinov
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Deng
authors.forename: Ze
authors.initials: Z
authors.lastname: Zhang
authors.forename: André-Pierre
authors.initials: AP
authors.lastname: Legrand
authors.forename: Randolph
authors.initials: R
authors.lastname: Guzman
authors.forename: Tieying
authors.initials: T
authors.lastname: Yin
authors.forename: Alain
authors.initials: A
authors.lastname: Pavie
authors.forename: Iradj
authors.initials: I
authors.lastname: Gandjbakhch
authors.forename: Tomàs Francisco
authors.initials: TF
authors.lastname: Cianciulli
authors.forename: Jorge
authors.initials: J
authors.lastname: Jordana
authors.forename: Patrick
authors.initials: P
authors.lastname: Mathieu
authors.forename: Robert
authors.initials: R
authors.lastname: Guidoin
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D001672:Biocompatible Materials / Q000009:adverse effects; D001705:Bioprosthesis / Q000009:adverse effects*; D019544:Equipment Failure Analysis; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008422:Materials Testing; D008875:Middle Aged; D011474:Prosthesis Design / Q000009:adverse effects; D011475:Prosthesis Failure; D013552:Swine; D055815:Young Adult
chemical_list: D001672:Biocompatible Materials