Abstract
BackgroundHeart valve replacement in neonates and infants is one of the remaining unsolved problems in cardiac surgery because conventional valve prostheses do not grow with the children. Similarly, heart valve replacement in children and young adults with contraindications to anticoagulation remains an unsolved problem because mechanical valves are thrombogenic and bioprosthetic valves are prone to early degeneration. Therefore, there is an urgent clinical need for growing heart valve replacements that are durable without the need for anticoagulation.MethodsA human cadaver model was used to develop surgical techniques for aortic valve xenotransplantation.ResultsAortic valve xenotransplantation is technically feasible. Subcoronary implantation of the valve avoids the need for a root replacement.ConclusionAortic valve xenotransplantation is promising because the development of GTKO.hCD46.hTBM transgenic pigs has brought xenotransplantation within clinical reach.
Highlights
Valvular heart disease affects approximately 2.5% of the U.S population and causes over 25,000 deaths each year [1, 2]
We propose heart valve xenotransplantation as a new approach to deliver growing heart valve replacements that are durable without the need for anticoagulation (Fig. 1)
Partial heart xenotransplantation is a new approach to deliver growing heart valve replacements that are durable without the need for anticoagulation
Summary
Conventional heart valve prostheses do not contain live cells These prostheses fulfil the structural functions of native heart valves, but they cannot fulfil their biological functions, namely adaptive growth, avoiding thrombogenesis, and self-repair. This severely limits the lifespan of the conventional heart valve prostheses in growing children and young adults with contraindications for anticoagulation [42, 43]. The transplanted valves are fresh and contain live cells that allow the valve to perform biological functions such as growth, avoiding thrombogenesis, and self-repair of the extracellular matrix. These advantages do not come without disadvantages. Abbreviation GTKO.hCD46.hTBM: Alpha 1–3 galactosyltransferase gene knockout pigs, which express human complement regulatory protein CD46 and human thrombomodulin
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