LONG-TERM OUTCOMES OF YOUNG PATIENTS AFTER SURGICAL CLOSURE OF VENTRICULAR SEPTAL DEFECT WITH EPOXY-TREATED XENO-PERICARDIAL “KEMPERIPLAS-NEO” PATCH

Highlights

Ventricular septal defect is the most common congenital heart defect requiring open-heart surgery. The epoxy-treated patch made from xeno-pericardium used to correct this defect was assessed from the standpoint of efficacy, safety, thrombogenicity and degree of calcification

Annotation

Aim. To assess long-term outcomes of ventricular septal defect closure using epoxy-treated xeno-pericardial “KemPeriplas-Neo” patch in children.

Methods. This retrospective study included 42 patients aged 16 months to 18 years, diagnosed with ventricular septal defect (VSD, membranous and muscular) and undergoing VSD closure. The study did not include patients with congenital heart defects (CHD) and congenital and acquired valvular heart diseases. In the long-term follow-up, VSD patch closure (including pseudoaneurysms, fibrosis, recanalization of VSD and recurrence, macrocalcification) was assessed using postoperative transthoracic echocardiography (TTE).

Results. Mean age of patients at the time of surgery was 67.4 ± 53.4 months (range 16–216 months), and at the time of the study 178.2 ± 35.9 months (range 101–243 months). The mean follow-up period was 111.5 ± 18.5 months (range 70.0–147 months). According to TTE results, there were no complications after procedure. Valve function after surgical closure of VSD was satisfactory. Reoperations were not required, and there were no cases of acute stoke and myocardial infarction in the follow-up period. Moreover, there were no in-hospital deaths and no long-term fatal outcomes.

Conclusion. The data obtained indicate the safety and effectiveness of conducting ventricular septal defect closure using epoxy-treated xeno-pericardial “KemPeriplas-Neo” patch. The VSD patch did not disturb the movement of the interventricular septum, and it did not negatively affect the adjacent areas, including the aorta. However, it is necessary to increase the number of patients and conduct a comparative analysis with other types of patches (synthetic, glutaraldehyde–treated) for a more detailed study of the VSD patch efficacy.

1. Linde D., Konings E.E., Slager M.A., Witsenburg M., Helbing W.A., Takkenberg J.J., Roos-Hesselink J.W. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. JACC. 2011;58:2241-7. doi: 10.1016/j.jacc.2011.08.025.

2. Soto B, Becker A.E., Moulaert A.J., Lie J.T., Anderson R.H. Classification of ventricular septal defects. Br Heart J. 1980;43:332–343. doi: 10.1136/hrt.43.3.332.

3. Us M.H., Sungun M., Sanioglu S., Pocan S., Cebeci B.S., Ogus T., Ucak A., Guler A. A Retrospective Comparison of Bovine Pericardium and Polytetrafluoroethylene Patch for Closure of Ventricular Septal Defects. J Int Med Res. 2004; 32:218–221. doi: 10.1177/147323000403200216.

4. Geiger A.W., Zarubin A.M., Deiwick M., Asfour B., Fahrenkamp A., Hertel M., von Bally G., Scheld H.H. Comparative analysis of glutaraldehyde preserved porcine xenografts and fresh or glutaraldehyde treated human aortic valves by holographic interferometry Cardiovasc. Surg. 1994; 2(6): 693–697.

5. Myers D.J., Gross J., Nakaya G. A comparison between glutaraldehyde and diepoxide fixed stentless porcine aortic valves, biochemical and mechanical characterization and resistance to mineralization. J. Heart Valve Dis. 1995; 4 (1): 98–101.

6. Liao K., Frater R.W., LaPietra A., Ciuffo G., Ilardi C.F., Seifter E. Time dependent effect of glutaraldehyde on the tendency to calcify of both autografts and xenografts. Ann. Thorac. Surg. 1995; 60 (2): 343–347, doi: 10.1016/0003-4975(95)00286-t.

7. Vasudev S.C., Chandy T., Sharma C.P. Glutaraldehyde treated bovine pericardium: changes in calcification due to vitamins and platelet inhibitors. Artif Organs. 1997;21(9):1007-13. doi: 10.1111/j.1525-1594.1997.tb00516.x.

8. Zhuravleva I.Ju., Barbarash L.S., Glushkova T.V. Method of anticalcium treatment of biological prostheses of heart valves. Pat. 2374843 RU.10.12.2009 (In Russian)

9. Neethling W.M., Strange G., Firth L., Smit F.E. Evaluation of a tissue-engineered bovine pericardial patch in paediatric patients with congenital cardiac anomalies: initial experience with the ADAPT-treated CardioCel(R) patch. Interact Cardiovasc Thorac Surg. 2013;17(4):698–702. doi: 10.1093/icvts/ivt268.

10. Di Eusanio M., Schepens M.A. Left atrial thrombus on a Teflon patch for ASD closure. Eur J Cardiothorac Surg. 2002;21:542. doi: 10.1016/s1010-7940(02)00012-x.

11. Li X., GuoY., Ziegler K., Model L., Eghbalieh S.D.D., Brenes R., Kim S.T., Shu C., Dardik A. Current usage and future directions for the bovine pericardial patch. Ann Vasc Surg. 2011; 25:561–568. doi: 10.1016/j.avsg.2010.11.007.

12. Bennink G.B., Hitchcock F.J., Molenschot M., Hutter P., Sreeram N. Aneurysmal pericardial patch producing right ventricular inflow obstruction. Ann Thorac Surg. 2001;71:1346–7. doi: 10.1016/s0003-4975(00)02270-0.

13. Matveyeva V.G., Golovkin A.S., Grigoryev E.V., Ponasenko A.V. Role of Triggering Receptor Expressed on Myeloid Cells in the Activation of Innate Immunity . General Reanimatology. 2011;7(3):70. doi:10.15360/1813-9779-2011-3-70 (In Russian)

14. 14 Prabhudas M., Bowdish D., Drickamer K., Febbraio M., Herz J., Kobzik L., Krieger M., Loike J., Means T.K., Moestrup S.K., Post S., Sawamura T., Silverstein S., Wang X.Y., El Khoury J. Standardizing scavenger receptor nomenclature. J Immunol. 2014;192(5):1997-2006. doi: 10.4049/jimmunol.1490003.

15. Jarilin A. A. Immunologija. Moscow: GJeOTAR-Media; 2010. (In Russian)

16. Fujiwara K., Murata I., Yagisawa S., Tanabe T., Yabuuchi M., Sakakibara R., Tsuru D. Glutaraldehyde (GA)-hapten adducts, but without a carrier protein, for use in a specificity study on an antibody against a GA-conjugated hapten compound: histamine monoclonal antibody (AHA-2) as a model. J Biochem. 1999;126(6):1170-4. doi: 10.1093/oxfordjournals.jbchem.a022563.

17. Ponasenko A.V., Khutornaya M.V., Kutikhin A.G., Yuzhalin A.E., Hryachkova O.N., Golovkin A.S. Toll-like receptor 2 gene polymorphism is associated with risk of mitral valve disease. Medicine in Kuzbass. 2015; 14(2).:24-32. (In Russian)

18. Ponasenko A.V., Kutikhin A.G., Khutornaya M.V., Rutkovskaya N.V., Kondyukova N.V., Odarenko Y.N., Kazachek Y.V., Tsepokina A.V., Yuzhalin A.E., Barbarash L.S., Barbarash O.L. Polymorphisms within innate immune response, calcium metabolism and lipid metabolism are predictors of infective endocarditis. Russian Journal of Infection and Immunity. 2017; 7(2): 130-140. doi: 10.15789/2220-7619-2017-2-130-140 (In Russian)

19. Rakhmanin Yu.A.1, Fedoseeva V.N., Makovetskaya A.K., Fedoskova T.G. Nonallergic hypersensitivity to environmental factors. Hygiene and Sanitation. 2013; 92 (3): 4-7. (In Russian)

20. Kuvacheva N.V., Morgun A.V., Khilazheva E.D., Malinovskaya N.A., Gorina Y.V., Frolova O.V., Trufanova L.V., Martynova G.P., Salmina A.B. Inflammasomes forming: new mechanisms of intercellular interactions regulation and secretory activity of the cells. Siberian Medical Review. 2013; 5:3-10. (In Russian)

21. Potapnev M.P. Immune mechanisms of sterile inflammation. Immunologiya. 2015; 36(5): 312-318. (In Russian)

22. Tsepokina A.V., Khutornaya M.V., Shabaldin A.V., Ponasenko A.V. The role of gene TREM-1 at children who have operation congenital heart diseases. Translational Medicine. 2019;6(4):5-12. doi: 10.18705/2311-4495-2019-6-4-5-12 (In Russian)