title: Bioengineered human and allogeneic pulmonary valve conduits chronically implanted orthotopically in baboons: hemodynamic performance and immunologic consequences.
abstract: OBJECTIVE
  This study assesses in a baboon model the hemodynamics and human leukocyte antigen immunogenicity of chronically implanted bioengineered (decellularized with collagen conditioning treatments) human and baboon heart valve scaffolds.
  
  
  METHODS
  Fourteen baboons underwent pulmonary valve replacement, 8 with decellularized and conditioned (bioengineered) pulmonary valves derived from allogeneic (N = 3) or xenogeneic (human) (N = 5) hearts; for comparison, 6 baboons received clinically relevant reference cryopreserved or porcine valved conduits. Panel-reactive serum antibodies (human leukocyte antigen class I and II), complement fixing antibodies (C1q binding), and C-reactive protein titers were measured serially until elective sacrifice at 10 or 26 weeks. Serial transesophageal echocardiograms measured valve function and geometry. Differences were analyzed with Kruskal-Wallis and Wilcoxon rank-sum tests.
  
  
  RESULTS
  All animals survived and thrived, exhibiting excellent immediate implanted valve function by transesophageal echocardiograms. Over time, reference valves developed a smaller effective orifice area index (median, 0.84 cm(2)/m(2); range, 1.22 cm(2)/m(2)), whereas all bioengineered valves remained normal (effective orifice area index median, 2.45 cm(2)/m(2); range, 1.35 cm(2)/m(2); P = .005). None of the bioengineered valves developed elevated peak transvalvular gradients: 5.5 (6.0) mm Hg versus 12.5 (23.0) mm Hg (P = .003). Cryopreserved valves provoked the most intense antibody responses. Two of 5 human bioengineered and 2 of 3 baboon bioengineered valves did not provoke any class I antibodies. Bioengineered human (but not baboon) scaffolds provoked class II antibodies. C1q(+) antibodies developed in 4 recipients.
  
  
  CONCLUSIONS
  Valve dysfunction correlated with markers for more intense inflammatory provocation. The tested bioengineering methods reduced antigenicity of both human and baboon valves. Bioengineered replacement valves from both species were hemodynamically equivalent to native valves.
authors: Cardiac Regenerative Surgery Research Laboratories, The Ward Family Center for Congenital Heart Disease, Children's Mercy Hospital, Kansas City, Mo. Electronic address: rahopkins@cmh.edu.
authors: Richard A
authors: RA
authors: Hopkins
authors: Cardiac Regenerative Surgery Research Laboratories, The Ward Family Center for Congenital Heart Disease, Children's Mercy Hospital, Kansas City, Mo; Department of Surgery (Division of Cardiac Anesthesiology), Warren Alpert School of Medicine, Brown University, Providence, RI.
authors: Arthur A
authors: AA
authors: Bert
authors: Cardiac Regenerative Surgery Research Laboratories, The Ward Family Center for Congenital Heart Disease, Children's Mercy Hospital, Kansas City, Mo.
authors: Stephen L
authors: SL
authors: Hilbert
authors: Cardiac Regenerative Surgery Research Laboratories, The Ward Family Center for Congenital Heart Disease, Children's Mercy Hospital, Kansas City, Mo.
authors: Rachael W
authors: RW
authors: Quinn
authors: Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Tex.
authors: Kathleen M
authors: KM
authors: Brasky
authors: Cardiac Regenerative Surgery Research Laboratories, The Ward Family Center for Congenital Heart Disease, Children's Mercy Hospital, Kansas City, Mo.
authors: William B
authors: WB
authors: Drake
authors: Cardiac Regenerative Surgery Research Laboratories, The Ward Family Center for Congenital Heart Disease, Children's Mercy Hospital, Kansas City, Mo.
authors: Gary K
authors: GK
authors: Lofland
mesh_terms: D000818:Animals; D001705:Bioprosthesis; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics; D008297:Male; D010215:Papio; D011474:Prosthesis Design; D011664:Pulmonary Valve / Q000276:immunology* / Q000601:surgery*; D023822:Tissue Engineering