Comparison of fresh and glutaraldehyde-treated autologous pericardial patch in tricuspid valve repair: A long-term porcine study.

Abstract

Autologous pericardium (AP), the most common repair material used in tricuspid valve (TV) repair, has variable clinical outcomes with different treatments. To test this, we performed a long-term implantation porcine study to systematically evaluate the performance of fresh AP (FAP) and glutaraldehyde-treated AP (GAP) in TV repair. Twenty-six Bama pigs were to undergo TV septal leaflet repair and chordae tendineae reconstruction using FAP patches (n = 6), GAP patches (n = 6), and half-half mixed AP patches (n = 14) under cardiopulmonary bypass. Heart and TV function were evaluated by echocardiograph and laboratory methods immediately, 1, 3, and 9 months postimplant. Implanted AP was evaluated 9 months after operation by morphologic, histologic, and calcification examination. Outcomes were compared using t tests and mixed-effects linear regression analysis. All 26 animals underwent successful TV operations and survived 9 months after the operation. Echocardiographic analysis indicated comparable heart functions over the follow-up period but TV regurgitation class with GAP was significantly higher (P = .03) than the other 2 groups 1 month postoperation. After 9 months, the length of leaflets of pigs in the FAP and GAP groups were statistically reduced by 30.21% and 47.40%, respectively (P < .01). Patch thickness in the FAP and GAP groups increased 4.98 times and 7.21 times and were statistically significant (P = .02). The lengths of chordae tendineae in FAP and GAP groups were reduced by 61.19% and 25.96%, respectively (P < .01). Compared with the GAP group, FAP group pigs demonstrated a more homogenous contribution of collagen and elastic fibers in Elastica-van Gieson staining and less calcification in von Kossa staining. Hematoxylin and eosin staining and scanning electron microscopy showed comparable endothelial cell layers on FAP and GAP patches. The mean tissue calcium content of FAP and GAP patches was 19.32 ± 1.67 mg/g and 56.10 ± 3.75 mg/g, respectively (P < .01). AP is a reliable material for TV repair. An oversized FAP patch proved to be a better option in tricuspid leaflet repair, whereas GAP performed better in TV chordae tendineae reconstruction.