Freestyle Aortic Bioprostheses in Patients 60 Years old and Younger

A rapid deployment valve option for failing Medtronic Freestyle full root: a single centre experience

BACKGROUND

There are several high-risk treatment options for valve failure of a biological full root replacement. When tailoring the best treatment option for the patient, implantation of a rapid deployment valve (RDV) should be considered.

CASE PRESENTATION

Six patients presented with aortic regurgitation in a full root Freestyle bioprosthesis. Three had a history of valve endocarditis, while the remaining had non-infectious structural valve deterioration with leaflet and commissural tears. All patients were treated with a rapid deployment EDWARDS INTUITY Elite valve. Follow-up was complete for all patients. Postoperative echocardiography showed well-functioning valve prostheses with no paravalvular leaks and acceptable pressure gradients. Echocardiographic follow-up demonstrated excellent pressure gradients and a considerable decrease in the left ventricular mass index and left ventricular end-diastolic dimensions. Follow-up cardiac CT showed no signs of coronary obstruction or other pathology. During a median follow-up of 30 months neither biological valve failure, nor any events within the composite endpoint of major adverse cardiac and cerebrovascular events occurred.

CONCLUSIONS

This case series presents the EDWARDS INTUITY valve as a good treatment option in patients with failing Freestyle roots.

Development potential of extracellular matrix hydrogels as hemostatic materials

The entry of subcutaneous extracellular matrix proteins into the circulation is a key step in hemostasis initiation after vascular injury. However, in cases of severe trauma, extracellular matrix proteins are unable to cover the wound, making it difficult to effectively initiate hemostasis and resulting in a series of bleeding events. Acellular-treated extracellular matrix (ECM) hydrogels are widely used in regenerative medicine and can effectively promote tissue repair due to their high mimic nature and excellent biocompatibility. ECM hydrogels contain high concentrations of extracellular matrix proteins, including collagen, fibronectin, and laminin, which can simulate subcutaneous extracellular matrix components and participate in the hemostatic process. Therefore, it has unique advantages as a hemostatic material. This paper first reviewed the preparation, composition and structure of extracellular hydrogels, as well as their mechanical properties and safety, and then analyzed the hemostatic mechanism of the hydrogels to provide a reference for the application and research, and development of ECM hydrogels in the field of hemostasis.