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Ann Thorac Surg 1992;53:487-492
© 1992 The Society of Thoracic Surgeons

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Articles

Experimental in vitro endothelialization of cardiac valve leaflets

^a Department of Cardiovascular Surgery, University of Freiburg, Freiburg, Germany
^b Second Department of Surgery, University ot Vienna, Vienna, Austria
^c Department of Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa

Accepted for publication September 9, 1991.

^_* Address reprint requests to Dr Fasol, Department of Cardiovascular Surgery, University of Freiburg, Hugstelterstrasse 55, W-7800 Freiburg/ i.Br., Germany.

This study reports our results with in vitro endothelialization of fresh nonpreserved homograft valve leaflets compared with mild alternatively preserved valves and valves treated by preservation procedures commonly used for commercially available tissue valves. In vitro lining of biological heart valves with cultured autologous endothelial cells might help prevent the detrimental effects of degeneration on valve durability. To investigate the growth characteristics of endothelial cells on valve bioprostheses, three different methods of storage and preservation were compared. After precoating with fibronectin and seeding of 4.4 x 10⁴ endothelial cells/cm² onto the different leaflet surfaces, primary adherence, growth kinetics, morphology, and maintenance of monolayer integrity were studied over a period of 10 days. On valve leaflet surfaces of group 1 (fresh nonpreserved homograft valve leaflets) and group 2 (mild alternatively preserved valves), endothelial cells grew to persistent monolayers between days 6 and 10. In contrast, endothelial cell proliferation with monolayer growth could not be achieved on the group 3 leaflets (preserved like commercially available biological valve prostheses). In that group, no viable endothelial cells could be found on the valve surfaces 2 days after seeding. These results demonstrate the theoretical feasibility of endothelializing biological heart valve leaflets in vitro if they are not preserved and stored according to commonly used procedures. Provided such an endothelium can withstand the mechanical forces after implantation in vivo, in vitro endothelialization might contribute either to the development of new biological heart valves for modern cardiac surgery or to the improvement of clinical results with homograft valve transplants.

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