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Surface characteristics of the cardiac prostheses in vivo.

The pseudoneointima (PNI) deposited onto a cardiac prosthesis surface reflects many factors of biocompatibility, surface morphology, flow distribution, design, animal's physiological condition, and duration. In the evaluation of any prosthesis, the PNI is one of the prime considerations from both material and functional standpoints. Historically, Dacron fabric has been used as an internal lining for cardiac prostheses. However, we have observed cracks on the Dacron fibers, fiber fracture, fiber protrusion, and poor attachment to the diaphragm, which can cause potentially disastrous complications. In addition, there are basic differences in the PNI formation on aldehyde-treated pericardium and natural aortic valves as compared to the Dacron fabric. 1) Minimal degeneration takes place on the chemically treated natural tissue compared with the fabtic surface. Intact cells on the tissue suggest a greater compatibility. In later specimens (13 and 24 days), there is active cell infiltration onto the pericardium structure with capillary formation. 2) The deposits on natural tissue are mostly fibrin, with minimum cellular involvement and a trend toward reduction in thickness. 3) Fibroblast cells are found on the natural tissue as early as 7 days but were not observed on the Dacron fabrics. Based on these findings, the Dacron fabric-covered diaphragm studied was not favorable for use in long-term implantation of cardiac prostheses.