Percutaneous bioprosthetic venous valve: A long-term study in sheep

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Percutaneous bioprosthetic venous valve: A long-term study in sheep Dusan Pavcnik, MD, PhDa, Barry T. Uchida, BSa, Hans A. Timmermans, BFAa, Christopher L. Corless, MD, PhDb, Michael O'Hara, MDb, Naoyuki Toyota, MDa, Gregory L. Moneta, MDc, Frederick S. Keller, MDa, Josef Rösch, MDa Journal of Vascular Surgery Volume 35, Issue 3, Pages 598-602 (March 2002) DOI: 10.1067/mva.2002.118825 Copyright © 2002 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 1 Bicuspid venous valve (BVV) 14 to 15 mm in diameter. A, Nonrestricted BVV 20 mm long with four barbs retained by retention wire pusher connected to one barb. B, BVV front-loaded into 9F guiding catheter. C, BVV detached from retention wire. Journal of Vascular Surgery 2002 35, 598-602DOI: (10.1067/mva.2002.118825) Copyright © 2002 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 2 Function of BVVs placed into both EJVs immediately after placement. A, Jugular venogram with injection distal to valve demonstrates valve patency. This is analogous to animal standing upright. B, High-volume injection central to valve demonstrates closure of valve with no leak. Valves must function in this manner to prevent cephalic reflux when animal lowers its head to eat or drink. Journal of Vascular Surgery 2002 35, 598-602DOI: (10.1067/mva.2002.118825) Copyright © 2002 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 3 Lyophilized BVV placed across native valve in animal 2 at 1 month. A, Jugular vein specimen shows smooth incorporation of BVV into vein wall. B, BVV cusp consists of free border remodeled SIS and normal vein wall. C, Longitudinal microscopic view of one SIS leaflet. D, Magnified view of remodeled SIS leaflet reveals host tissue replacement and collagenous stroma remodeling with fibrocytes, plasma cells, and lymphocytes. Vascular endothelial cells (arrow) cover leaflet. (Hematoxylin & eosin stain; original magnification × 400.) Journal of Vascular Surgery 2002 35, 598-602DOI: (10.1067/mva.2002.118825) Copyright © 2002 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 4 Hydrated BVV at 6 months in animal 9. A, Jugular venogram injection distal to BVV demonstrates valve patency. B, Venogram with injection central to valve demonstrates closure of BVV with no reflux. C, Exposed vein is slightly distended by pressure of square stent wires with no reaction or damage to surrounding structures. D, Longitudinal microscopic view of both SIS leaflets. E, Magnified view of remodeled SIS leaflet shows endothelial cells covering valve leaflet with fibrous tissue, fibrocytes, and some inflammatory cells. There is evidence of neovascularization (arrows). (Hematoxylin & eosin stain; original magnification × 400.) Journal of Vascular Surgery 2002 35, 598-602DOI: (10.1067/mva.2002.118825) Copyright © 2002 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions