Author + information
- Received November 10, 2010
- Revision received January 25, 2011
- Accepted February 4, 2011
- Published online July 1, 2011.
- Maximilian Y. Emmert, MD⁎,‡,§,
- Benedikt Weber, MD⁎,‡,§,
- Luc Behr, VDM, PhD∥,
- Thomas Frauenfelder, MD†,
- Chad E. Brokopp, MSc⁎,§,
- Jürg Grünenfelder, MD‡,
- Volkmar Falk, MD‡ and
- Simon P. Hoerstrup, MD, PhD⁎,‡,§,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Simon P. Hoerstrup, Clinic for Cardiovascular Surgery, University Hospital of Zurich, Raemistrasse 100, 8091 CH-Zürich, Switzerland
Within 1 procedure, tissue-engineered, living heart valves (TEHVs), fabricated from biodegradable scaffolds seeded with autologous bone marrow–derived mononuclear cells (Fig. 1A), were integrated into self-expanding nitinol stents (20 mm × 30 mm) and transapically delivered into the descending aorta (n = 2) (distal to the brachiocephalic trunk) and the brachiocephalic trunk (n = 1) of sheep (Fig. 1A). Native valve incompetence was created by applying the Hufnagel procedure (1) before implantation (Fig. 1A). After successful deployment (Figs. 1B and 1C), valve function and optimal positioning were confirmed using fluoroscopy (Fig. 1B, Online Video 1), computed tomography (CT) (Figs. 1D and 1E, Online Video 2), and echocardiography (Figs. 1F to 1M, Online Videos 3A, 3B, and 3C). The crimping time of the TEHVs was 15 ± 2 min. The overall duration of the procedure, from the preparation of cells to the successful delivery, was 2 h. Post-mortem analysis displayed fully intact TEHVs and, in particular, well-defined leaflets showing coaptation. There were no signs of leaflet rupture, microstructure damage, or thrombus formation detectable.
So far, successful TEHV implantations have only been reported for low-pressure systems such as in the pulmonary position (2), and clinical trials have been initiated. This is the first report demonstrating the feasibility of the minimally invasive, catheter-assisted implantation of TEHV into the systemic circulation with adequate valvular functionality in an acute study based on an easily accessible, clinically relevant cell source (3) and minimally invasive techniques for both cell harvest and delivery (2) within 1 procedure. Such autologous and living heart valves may hold potential to overcome the limitations of the currently used bioprosthetic valves inherently prone to calcification and progressive dysfunctional degeneration. This may broaden the future clinical application of transcatheter valves beyond elderly high-risk patients.
For supplementary videos, please see the online version of this article.
The authors have reported that they have no relationships to disclose. Drs. Emmert and Weber contributed equally to this work.
- Received November 10, 2010.
- Revision received January 25, 2011.
- Accepted February 4, 2011.
- American College of Cardiology Foundation