The use of CorMatrix extracellular matrix for aortic root enlargement
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CASE REPORT
Open Access
The use of CorMatrix extracellular matrix for aortic root enlargement Derek R Brinster1,2* and Jay A Patel1,2
Abstract This manuscript presents a published record of the use and efficacy of the extracellular matrix CorMatrix and why it may be superior to other materials used for aortic root enlargement. The potential benefits of an extracellular matrix are the natural ingrowth and development of native arterial cells and structure. Keywords: Aorta, Aortic valve replacement, Aortic root enlargement, CorMatrix, Extracellular matrix
Background Aortic root enlargement (ARE) is a surgical procedure used to widen the annulus of the aortic root to facilitate aortic valve replacement (AVR). ARE is sometimes necessary to prevent patient-prosthesis mismatch, which occurs when the area of the prosthesis is insufficient relative to the size of the patient, and is associated with higher rates mortality [1]. Both the orifice area of the prosthesis and the resulting pressure gradient across the aortic valve are important determinants to successful AVR. Procedures used to enlarge the aortic root include the Nicks’ Procedure which is the most common, Manougian Technique, Seybold-Epting Technique, modified Bentall Procedure, and aortoventriculoplasty. During AVR, an effective means towards repair and augmentation of the aortic root is necessary. Materials currently used for reconstruction are Dacron (cloth), polytetrafluroethlyene (polymer), and bovine/patient derived pericardium [2]. Significant drawbacks to these materials include difficulty in resorption and difficulty in promoting full functioning of the reconstructed area [2]. An important alternative to these methods is the CorMatrix ECM, an extracellular matrix (ECM) derived from porcine small intestinal submucosa [3], which includes a matrix of structural proteins normally found outside cells that provide tissue support.
* Correspondence: [email protected] 1 Department of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, VA, USA 2 Divisions of Cardiothoracic and Vascular Surgery, Virginia Commonwealth University Medical Center Medical College of Virginia Campus, West Hospital Building, 7th Floor, South Wing, 1200 East Broad Street, P.O. Box 980068, Richmond, VA 23298-0068, USA
This manuscript will review the initial use of CorMatrix in ARE.
Case presentation The following seven patients had an ARE procedure performed between October 2011 and April 2013 due to small annular size during AVR: Case 1 patient. A 79-year-old female who presented with significant shortness of breath, flash pulmonary edema, severe aortic stenosis, ventricular hypertrophy, and diastolic heart failure. Case 2 patient. A 82-year-old male who presented with shortness of breath, stenosis of the coronary artery (LAD), severe atherosclerosis of the aortic valve, and a thin aortic root. Case 3 patient. A 40-year-old female who presented with aortic valve murmur and worsening aortic stenosis of her BAV. Case 4 patient. A 75-year-old male who presented wi
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