A Long-term Porcine Model for Evaluation of Prosthetic Heart Valves

Authors

  • Morten Smerup
  • Troels F. Pedersen
  • Camilla Nyboe
  • Jonas A. Funder
  • Thomas D. Christensen
  • Sten L. Nielsen
  • Vibeke Hjortdal
  • J. Michael Hasenkam

DOI:

https://doi.org/10.1532/HSF98.20041015

Abstract

Background: Animal experimental testing is imperative for preclinical evaluation of prosthetic heart valves and implantation techniques. Because human and pig cardiovascular structures including mitral valves show remarkable anatomical similarity, these animals are good candidates for preclinical testing. Previous attempts to establish such long-term models were hampered by both intra- and postoperative difficulties. Our aim was to overcome these difficulties to develop a porcine model for mitral valve replacement (MVR) and furthermore to investigate the practical feasibility of 3 chordal reconstruction procedures.

Methods: Sixteen 60-kg pigs were allocated to undergo 1 of 3 surgical procedures, (1) preservation of the entire subvalvular apparatus (n = 8), (2) preservation of the secondary chordae only (n = 4), or (3) excision of the native valve and papillary resuspension with sutures (n = 4). St. Jude Medical valves (29 mm) were implanted during extracorporeal circulation and cold cardioplegic arrest. Postoperative anticoagulation was administered by subcutaneous heparin injections.

Results: Fourteen animals survived 1 month, thriving and without signs of heart failure. One animal was euthanized due to irreversible bleeding in the tracheal tube, and another animal died on the third postoperative day owing to valve thrombosis.

Conclusion: A practically feasible long-term porcine model of MVR has been established. Because the pig is superior to other species with respect to anatomical and physiological similarity to humans, we consider this model as an optimal platform for experimental preclinical testing of heart valve prostheses.

References

International Organization for Standardization (ISO). 2004. Cardiovascular implants--cardiac valve prostheses. ISO 5840/TC150W62.nIrwin E, Lang G, Clack R, et al. 1993. Long-term evaluation of prosthetic mitral valves in sheep. J Invest Surg 62:133-41.nLomholt M, Nielsen SL, Hansen SB, Andersen NT, Hasenkam JM. 2002. Differential tension between secondary and primary mitral chordae in an acute in-vivo porcine model. J Heart Valve Dis 113:337-45.nMitchell G, Heffron JJ. 1982. Porcine stress syndromes. Adv Food Res 28167-230.nReverdiau-Moalic P, Watier H, Vallee I, Lebranchu Y, Bardos P, Gruel Y. 1996. Comparative study of porcine and human blood coagulation systems: possible relevance in xenotransplantation. Transplant Proc 282:643-4.nRijk-Zwikker GL, Delemarre BJ, Huysmans HA. 1994. Mitral valve anatomy and morphology: relevance to mitral valve replacement and valve reconstruction. J Card Surg 92(Suppl):255-61.nSwan H, Meagher DM. 1971. Total body bypass in miniature pigs. Postperfusion pulmonary hypertension. J Thorac Cardiovasc Surg 616:956-67.nSwan H, Piermattei DL. 1971. Technical aspects of cardiac transplantation in the pig. J Thorac Cardiovasc Surg 615:710-23.nSwindle MM. Anesthetic and Preoperative Techniques in Swine. Wilmington, Mass: Charles River Laboratories. 1991nSwindle MM. Surgery, anesthesia, and experimental techniques in swine. Iowa: Iowa State University Press. 1998nBianco RW, St Cyr JA, Schneider JR, et al. 1986. Canine model for long-term evaluation of prosthetic mitral valves. J Surg Res 412:134-40.nBjork VO, Sternlieb J. 1986. Artificial heart valve testing in goats. Scand J Thorac Cardiovasc Surg 202:97-102.nBodnar E. 1996. The Medtronic Parallel valve and the lessons learned. J Heart Valve Dis 56:572-3.nCommission Europeanne de Normalisation (CEN). 2004. CEN/TC/285WG3.nWalmsley R. 1978. Anatomy of human mitral valve in adult cadaver and comparative anatomy of the valve. Br Heart J 404:351-66.nCrick SJ, Sheppard MN, Ho SY, Gebstein L, Anderson RH. 1998. Anatomy of the pig heart: comparisons with normal human cardiac structure. J Anat 193(pt 1):105-19.nFillinger MP, Rassias AJ, Guyre PM, et al. 2002. Glucocorticoid effects on the inflammatory and clinical responses to cardiac surgery. J Cardio thorac Vasc Anesth 162:163-9.nGrehan JF, Hilbert SL, Ferrans VJ, Droel JS, Salerno CT, Bianco RW. 2000. Development and evaluation of a swine model to assess the preclinical safety of mechanical heart valves. J Heart Valve Dis 95:710-9.nGross DR. 1997. Thromboembolic phenomena and the use of the pig as an appropriate animal model for research on cardiovascular devices. Int J Artif Organs 204:195-203.nGross DR, Dewanjee MK, Zhai P, Lanzo S, Wu SM. 1997. Successful prosthetic mitral valve implantation in pigs. ASAIO J 435:M382-6.nHasenkam JM, Østergaard JH, Pedersen EM, et al. 1988. A model for acute haemodynamic studies in the ascending aorta in pigs. Cardiovasc Res 227:464-71.nHazekamp MG, Goffin YA, Huysmans HA. 1993. The value of the stentless biovalve prosthesis. An experimental study. Eur J Cardiothorac Surg 710:514-9.n

Published

2005-01-04

How to Cite

Smerup, M., Pedersen, T. F., Nyboe, C., Funder, J. A., Christensen, T. D., Nielsen, S. L., Hjortdal, V., & Hasenkam, J. M. (2005). A Long-term Porcine Model for Evaluation of Prosthetic Heart Valves. The Heart Surgery Forum, 7(4), E259-E264. https://doi.org/10.1532/HSF98.20041015

Issue

Section

Article