Category: General

Interdiscip Cardiovasc Thorac Surg. 2026 Mar 12;41(3):ivag044. doi: 10.1093/icvts/ivag044.

ABSTRACT

We present a novel technique for tricuspidation of the very asymmetrical bicuspid aortic valve (AV) with commissural orientation of about 120-140, via replacement of the fused AV cusp with 2 neo-cusps. The neo-cusps are fashioned from bovine pericardium and sutured to the annulus. Successful repair using the described technique requires good quality and adequate commissure height of the non-fused cusp. Since 2020, this technique has been applied to 15 patients. To date, all patients are alive with well-functioning AVs, presenting no or trivial insufficiency, large orifice areas, and nearly physiological transvalvular gradients.

PMID:41840768 | PMC:PMC13098162 | DOI:10.1093/icvts/ivag044

Yonsei Med J. 2026 Apr;67(4):297-305. doi: 10.3349/ymj.2025.0174.

ABSTRACT

PURPOSE: Aortic prostheses are used in pulmonary positions due to structural similarities between the pulmonary and aortic valves. However, there are no available studies that have comprehensively evaluated the mechanism of bioprosthetic aortic valves under pulmonary conditions.

MATERIALS AND METHODS: Using a mock circulatory system, we evaluated the hydrodynamic characteristics of bovine pericardial and porcine valves. Geometric orifice area, regurgitant and leakage volume, regurgitant fraction, peak pressure gradient, and forward flow volume were evaluated in different pulmonary pressure conditions (from 15/5 mm Hg to 75/35 mm Hg) and normal aortic pressure (110/80 mm Hg).

RESULTS: Bovine pericardial valves were associated with larger opening area (0.93±0.01 vs.1.70±0.01 for 23-mm valve; 0.99±0.01 vs.1.75±0.01 for 25-mm valve; 1.58±0.01 vs. 2.25±0.02 for 27-mm valve; all p<0.01) and forward flow volume (42.27±0.05 vs. 64.79±0.14 for 23-mm valve; 46.41±0.06 vs. 64.28±0.18 for 25-mm valve; 72.64±0.17 vs.73.25±0.07 for 27-mm valve; all p<0.01). Porcine valves were associated with incomplete opening, smaller opening area, and lower regurgitant fraction. Bovine pericardial valves demonstrated lower peak pressure gradients (15.75±0.14 vs. 12.57±0.47 for 23-mm valve; 14.85±0.05 vs. 12.87±0.28 for 25-mm valve; 15.72±0.32 vs. 7.91±0.03 for 27-mm valve).

CONCLUSION: Bovine pericardial and porcine bioprosthetic valves has different hydrodynamic characteristics under various pulmonary pressure conditions.

PMID:41914313 | PMC:PMC13040176 | DOI:10.3349/ymj.2025.0174

Yonsei Med J. 2026 Apr;67(4):297-305. doi: 10.3349/ymj.2025.0174.

ABSTRACT

PURPOSE: Aortic prostheses are used in pulmonary positions due to structural similarities between the pulmonary and aortic valves. However, there are no available studies that have comprehensively evaluated the mechanism of bioprosthetic aortic valves under pulmonary conditions.

MATERIALS AND METHODS: Using a mock circulatory system, we evaluated the hydrodynamic characteristics of bovine pericardial and porcine valves. Geometric orifice area, regurgitant and leakage volume, regurgitant fraction, peak pressure gradient, and forward flow volume were evaluated in different pulmonary pressure conditions (from 15/5 mm Hg to 75/35 mm Hg) and normal aortic pressure (110/80 mm Hg).

RESULTS: Bovine pericardial valves were associated with larger opening area (0.93±0.01 vs.1.70±0.01 for 23-mm valve; 0.99±0.01 vs.1.75±0.01 for 25-mm valve; 1.58±0.01 vs. 2.25±0.02 for 27-mm valve; all p<0.01) and forward flow volume (42.27±0.05 vs. 64.79±0.14 for 23-mm valve; 46.41±0.06 vs. 64.28±0.18 for 25-mm valve; 72.64±0.17 vs.73.25±0.07 for 27-mm valve; all p<0.01). Porcine valves were associated with incomplete opening, smaller opening area, and lower regurgitant fraction. Bovine pericardial valves demonstrated lower peak pressure gradients (15.75±0.14 vs. 12.57±0.47 for 23-mm valve; 14.85±0.05 vs. 12.87±0.28 for 25-mm valve; 15.72±0.32 vs. 7.91±0.03 for 27-mm valve).

CONCLUSION: Bovine pericardial and porcine bioprosthetic valves has different hydrodynamic characteristics under various pulmonary pressure conditions.

PMID:41914313 | PMC:PMC13040176 | DOI:10.3349/ymj.2025.0174

Int J Surg Case Rep. 2026 Jan 28;138(3):674-679. doi: 10.1097/RC9.0000000000000083. eCollection 2026 Mar.

ABSTRACT

INTRODUCTION: Primary aortoenteric fistulas are rare, life-threatening conditions, usually secondary to abdominal aortic aneurysms. Primary aortoduodenal fistula (PADF) without aneurysmal disease is extremely rare, with very few cases reported in the literature. Delayed diagnosis is common and contributes to high mortality.

CASE PRESENTATION: We report the case of a 71-year-old woman with high-grade serous ovarian cancer who developed a PADF in the absence of an aortic aneurysm. The patient presented with hematemesis and abdominal pain. Initial investigations, including Computed Tomography (CT) scan and upper endoscopy (EGDS), were inconclusive. Although she was initially stabilized, she experienced recurrent gastrointestinal bleeding leading to hemodynamic deterioration. Emergency CT showed active arterial hemorrhage near the duodenum. An urgent exploratory laparotomy confirmed the presence of a PADF, which was surgically repaired using a bovine pericardial patch. Despite surgical intervention, the patient succumbed to postoperative multiorgan failure.

CLINICAL DISCUSSION: PADFs most frequently involve the third or fourth portion of the duodenum and are strongly correlated with aneurysmal disease. However, rare etiologies such as radiation therapy, malignancy, or infection may precipitate fistula formation even in the absence of aneurysms. Our literature review identified only 16 similar cases reported since 2015. Diagnosis remains challenging due to non-specific symptoms and inconclusive early imaging. A high index of suspicion is essential. CT angiography is the most effective diagnostic modality. Definitive management requires urgent surgical or endovascular repair, although prognosis remains poor in hemodynamically unstable patients.

CONCLUSION: This case underscores the need to consider PADF in the differential diagnosis of gastrointestinal bleeding, even in the absence of aneurysmal disease, particularly among oncologic patients with prior radiation exposure or retroperitoneal inflammation. Early diagnosis, prompt imaging, and a multidisciplinary approach are essential to improving patient outcomes.

PMID:41837109 | PMC:PMC12981790 | DOI:10.1097/RC9.0000000000000083

Yonsei Med J. 2026 Apr;67(4):297-305. doi: 10.3349/ymj.2025.0174.

ABSTRACT

PURPOSE: Aortic prostheses are used in pulmonary positions due to structural similarities between the pulmonary and aortic valves. However, there are no available studies that have comprehensively evaluated the mechanism of bioprosthetic aortic valves under pulmonary conditions.

MATERIALS AND METHODS: Using a mock circulatory system, we evaluated the hydrodynamic characteristics of bovine pericardial and porcine valves. Geometric orifice area, regurgitant and leakage volume, regurgitant fraction, peak pressure gradient, and forward flow volume were evaluated in different pulmonary pressure conditions (from 15/5 mm Hg to 75/35 mm Hg) and normal aortic pressure (110/80 mm Hg).

RESULTS: Bovine pericardial valves were associated with larger opening area (0.93±0.01 vs.1.70±0.01 for 23-mm valve; 0.99±0.01 vs.1.75±0.01 for 25-mm valve; 1.58±0.01 vs. 2.25±0.02 for 27-mm valve; all p<0.01) and forward flow volume (42.27±0.05 vs. 64.79±0.14 for 23-mm valve; 46.41±0.06 vs. 64.28±0.18 for 25-mm valve; 72.64±0.17 vs.73.25±0.07 for 27-mm valve; all p<0.01). Porcine valves were associated with incomplete opening, smaller opening area, and lower regurgitant fraction. Bovine pericardial valves demonstrated lower peak pressure gradients (15.75±0.14 vs. 12.57±0.47 for 23-mm valve; 14.85±0.05 vs. 12.87±0.28 for 25-mm valve; 15.72±0.32 vs. 7.91±0.03 for 27-mm valve).

CONCLUSION: Bovine pericardial and porcine bioprosthetic valves has different hydrodynamic characteristics under various pulmonary pressure conditions.

PMID:41914313 | PMC:PMC13040176 | DOI:10.3349/ymj.2025.0174

Yonsei Med J. 2026 Apr;67(4):297-305. doi: 10.3349/ymj.2025.0174.

ABSTRACT

PURPOSE: Aortic prostheses are used in pulmonary positions due to structural similarities between the pulmonary and aortic valves. However, there are no available studies that have comprehensively evaluated the mechanism of bioprosthetic aortic valves under pulmonary conditions.

MATERIALS AND METHODS: Using a mock circulatory system, we evaluated the hydrodynamic characteristics of bovine pericardial and porcine valves. Geometric orifice area, regurgitant and leakage volume, regurgitant fraction, peak pressure gradient, and forward flow volume were evaluated in different pulmonary pressure conditions (from 15/5 mm Hg to 75/35 mm Hg) and normal aortic pressure (110/80 mm Hg).

RESULTS: Bovine pericardial valves were associated with larger opening area (0.93±0.01 vs.1.70±0.01 for 23-mm valve; 0.99±0.01 vs.1.75±0.01 for 25-mm valve; 1.58±0.01 vs. 2.25±0.02 for 27-mm valve; all p<0.01) and forward flow volume (42.27±0.05 vs. 64.79±0.14 for 23-mm valve; 46.41±0.06 vs. 64.28±0.18 for 25-mm valve; 72.64±0.17 vs.73.25±0.07 for 27-mm valve; all p<0.01). Porcine valves were associated with incomplete opening, smaller opening area, and lower regurgitant fraction. Bovine pericardial valves demonstrated lower peak pressure gradients (15.75±0.14 vs. 12.57±0.47 for 23-mm valve; 14.85±0.05 vs. 12.87±0.28 for 25-mm valve; 15.72±0.32 vs. 7.91±0.03 for 27-mm valve).

CONCLUSION: Bovine pericardial and porcine bioprosthetic valves has different hydrodynamic characteristics under various pulmonary pressure conditions.

PMID:41914313 | PMC:PMC13040176 | DOI:10.3349/ymj.2025.0174

J Vasc Access. 2026 Mar 11:11297298261424940. doi: 10.1177/11297298261424940. Online ahead of print.

ABSTRACT

BACKGROUND: Native arteriovenous fistulas remain the preferred vascular access for hemodialysis. However, critically unfavorable venous anatomy can impede their successful creation. Poor-quality or small-sized distal veins with areas of focal stenosis and thickened venous segments compromise the feasibility of placing a standard arteriovenous fistula or lead to fistula nonmaturation or malfunction, requiring adjuncts such as primary angioplasty or staged-balloon assisted maturation.

METHODS: This is a report of a single-stage technique using a short strip of bovine pericardium, tapered at the venous half of the patch in a “boat-shaped” configuration and flared at the arterial half of the patch, which is tubularized to create a cylindrical conduit and bridge an otherwise healthy vein with a focal stenosis to the target artery. With this onlay-tubularized bovine pericardial patch, the diseased segment can be enlarged and a smooth “neovein” created while preserving the autogenous cannulation segment.

RESULTS: The technique is illustrated in the case of a 56-year-old patient with immunoglobulin A nephropathy and a distal basilic vein focal defect. Immediate postoperative results were positive with strong bruit and thrill while follow-up duplex within 2 months showed excellent venous dilation and a flow exceeding 600 mL/min. Patency at 12 months remains intact.

CONCLUSIONS: It is appropriate to use this technique in patients with adequate inflow and outflow, but with focal vein stenoses or short, thickened vein segments that preclude the use of a standard AVF. This hybrid approach, combining principles of patch venoplasty and bovine pericardial bypass grafting, may be used as a salvage option in selected patients with focal venous stenotic lesions considered for native arteriovenous fistula creation.

PMID:41810476 | DOI:10.1177/11297298261424940

Angiogenesis. 2026 Mar 8;29(2):22. doi: 10.1007/s10456-026-10039-7.

ABSTRACT

BACKGROUND: Exploring the hemocompatibility of bioprosthetic heart valves (BHVs) has been challenging due to the scarcity of non-degenerated material.

OBJECTIVES: This study has two complementary objectives (1) To characterize the extent and temporal kinetics of endothelial coverage of BHVs implanted in humans; (2) To investigate, in a rat model, the impact of pericardial endothelialization on tissue calcification.

METHODS: We employed histology and electron microscopy to assess cellular organization in non-degenerated BHVs and conducted hemodynamic simulations to evaluate shear stress fields in the ejection valves area. Furthermore, we investigated the impact of pericardium endothelial coverage on calcification using endothelial colony-forming cells (ECFCs) cultured on bovine pericardium discs implanted in athymic nude rats for 18 days. Calcium content was quantified through acetylene flame atomic absorption spectrophotometry.

RESULTS: We observed inflammatory cell infiltration within all explanted BHVs, as well as fibrin deposit on top of the leaflets. Endothelial coverage emerged in long-term implants (> 180 days) but remained incomplete in aortic valves, which could be linked to high shear stress levels in aortic position confirmed in hemodynamic simulations. Besides, the rat experiments revealed that the discs covered with fibrin + ECFCs were significantly less calcified than those covered with fibrin alone (respectively, median = 0.9 µg Ca/mg tissue; IQR: 0.7–1.1 vs median = 18.3 µg Ca/mg tissue; IQR: 9–34.9; p = 0.0003), and less extensively colonized by neutrophils.

CONCLUSIONS: Human explanted BHVs showed intact leaflets with a fibrin layer and organized endothelial coverage, without detectable calcification over the short observation period. In rats, endothelialization was associated with significantly reduced pericardial calcification, suggesting a potential protective effect. However, the limited follow-up in humans precludes conclusions on a causal role of endothelial coverage in hemocompatibility or protection against calcification.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10456-026-10039-7.

PMID:41795724 | PMC:PMC12968097 | DOI:10.1007/s10456-026-10039-7

Int J Surg Case Rep. 2026 Jan 28;138(3):674-679. doi: 10.1097/RC9.0000000000000083. eCollection 2026 Mar.

ABSTRACT

INTRODUCTION: Primary aortoenteric fistulas are rare, life-threatening conditions, usually secondary to abdominal aortic aneurysms. Primary aortoduodenal fistula (PADF) without aneurysmal disease is extremely rare, with very few cases reported in the literature. Delayed diagnosis is common and contributes to high mortality.

CASE PRESENTATION: We report the case of a 71-year-old woman with high-grade serous ovarian cancer who developed a PADF in the absence of an aortic aneurysm. The patient presented with hematemesis and abdominal pain. Initial investigations, including Computed Tomography (CT) scan and upper endoscopy (EGDS), were inconclusive. Although she was initially stabilized, she experienced recurrent gastrointestinal bleeding leading to hemodynamic deterioration. Emergency CT showed active arterial hemorrhage near the duodenum. An urgent exploratory laparotomy confirmed the presence of a PADF, which was surgically repaired using a bovine pericardial patch. Despite surgical intervention, the patient succumbed to postoperative multiorgan failure.

CLINICAL DISCUSSION: PADFs most frequently involve the third or fourth portion of the duodenum and are strongly correlated with aneurysmal disease. However, rare etiologies such as radiation therapy, malignancy, or infection may precipitate fistula formation even in the absence of aneurysms. Our literature review identified only 16 similar cases reported since 2015. Diagnosis remains challenging due to non-specific symptoms and inconclusive early imaging. A high index of suspicion is essential. CT angiography is the most effective diagnostic modality. Definitive management requires urgent surgical or endovascular repair, although prognosis remains poor in hemodynamically unstable patients.

CONCLUSION: This case underscores the need to consider PADF in the differential diagnosis of gastrointestinal bleeding, even in the absence of aneurysmal disease, particularly among oncologic patients with prior radiation exposure or retroperitoneal inflammation. Early diagnosis, prompt imaging, and a multidisciplinary approach are essential to improving patient outcomes.

PMID:41837109 | PMC:PMC12981790 | DOI:10.1097/RC9.0000000000000083

J Vitreoretin Dis. 2026 Feb 25:24741264261423306. doi: 10.1177/24741264261423306. Online ahead of print.

ABSTRACT

Purpose: To evaluate the efficacy and safety of bovine pericardium (Tutopatch) to seal peripheral retinal breaks located over areas of chorioretinal atrophy in highly myopic eyes. Methods: Highly myopic patients with retinal detachment (RD) caused by retinal breaks over areas of chorioretinal atrophy underwent 25-gauge pars plana vitrectomy, subretinal fluid drainage, and silicone oil (SO) tamponade. A trimmed Tutopatch was placed over the retinal breaks. Follow-up assessments were performed over 12 months, including best-corrected visual acuity (BCVA), intraocular pressure (IOP), fundus photography, and widefield optical coherence tomography. Results: Seven eyes of highly myopic patients were included in this study. All eyes achieved complete retinal reattachment, with no recurrence of detachment after SO removal. The median BCVA improved from 0.10 (20/200 Snellen) preoperatively to 0.20 (20/100 Snellen) postoperatively. In addition, the mean IOP increased preoperatively from 13.0 ± 2.6 mm Hg to 15.0 ± 4.2 mm Hg postoperatively. The Tutopatch remained adherent to the retina throughout follow-up, without signs of inflammation, epiretinal membrane formation, or other complications. Conclusions: Tutopatch appears to be a safe and effective method for sealing retinal breaks in areas of chorioretinal atrophy in which conventional treatments are not available. This technique may help prevent redetachment in highly myopic eyes. Larger studies are warranted to confirm our findings.

PMID:41767762 | PMC:PMC12945725 | DOI:10.1177/24741264261423306