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Singh et al. Vessel Plus 2018;2:10 I http://dx.doi.org/10.20517/2574-1209.2018.18 Page 3 of 5

Figure 2. Preoperative electrocardiogram showing normal sinus rhythm

paravalvular leak.

He was extubated within 6 h of arrival to the intensive care unit, discharged to the high dependency unit
on post-operative day 1 and to the ward the following day. A peripherally inserted central catheter line was
inserted for subsequent doses of IV antibiotics post-operatively [Figure 3]. He was discharged home with the
remainder of his antibiotic course administered as an outpatient on the 9th post-operative day. He attended
the follow-up cardiology clinic with well-healed wounds and a transthoracic echocardiography revealed a
well-seated valve with no regurgitant flow.

DISCUSSION
Bio-prosthetic tissue valves are advantageous due to the lower frequency of thromboembolism thereby
avoiding long-term anticoagulation. Long-term durability, however, limits its usage in younger patients.
Calcification of these valves causes structural valve degeneration. The type of bio-prosthetic tissue used also
[2]
influences the rate of calcification. Liao et al. proved in rat models that bovine pericardium valves calcified
less than porcine valves. This, however, did not have any effect on long-term survival. Most bio-prosthetic
valves are fixed in glutaraldehyde to prevent early degeneration after implantation. This process in itself can
cause in-vivo calcification of tissue. Various fixation tissue treatments have been developed to circumvent
[3]
this effect. Carpentier et al. proved that the rate of calcification could be reduced by decreasing the
phosphate content or by blocking calcification binding sites with magnesium ions and using surfactant. The
enhancement of such properties may facilitate the use of tissue valves in younger patients. In one particular
single center experience utilizing the ResiliaTM technology, revealed excellent haemodynamic per formance
and safety outcomes at one year of follow-up with a paravalvular leak rate of < 1% at one year and no
[4]
[5]
reduction in effective orifice area . Flameng et al. looked at the anti-calcification efficacy of using a novel
method of treatment vs. standard anti-calcification in juvenile sheep. The novel technology involved:
1. Functional group capping which reduces the presence of aldehydes in glutaraldehyde-fixed tissues