Author:

J Cardiothorac Surg. 2026 Jun 5;21(1):338. doi: 10.1186/s13019-026-04318-z.

ABSTRACT

BACKGROUND: The UFO procedure is an established surgical technique to treat extensive endocarditis of the aortic or mitral valve with involvement of the intervalvular fibrous body (IVFB). This technique can be used for radical resection of the whole infected tissue. Independently of the size of the infected region it is unavoidable to replace both valves. In this high-risk re-do case we performed a modified so-called hemi-UFO procedure with preservation of the mitral valve. We present a 71-year-old male patient initially diagnosed with severe stenosis of the aortic valve. An aortic valve replacement with a 23-mm prosthesis was performed via partial upper mini-sternotomy. Eight weeks after surgery an echocardiogram revealed a large vegetation and severe regurgitation of the aortic valve prosthesis. The risk of death following reintervention heart surgery (EuroSCORE II) was calculated as 50.64%. We performed a re-do with full sternotomy. Intraoperatively it was observed that the aortic prosthesis was partially torn out. The aortic annulus exhibited circular infection with an abscess connecting to the left atrium. The tissue of the left atrial roof was partially destroyed, similar to a phlegmonous infection. We opened the left atrial roof and radically resected the infected tissue up to the IVFB. We prepared a custom-made conduit prosthesis of bovine pericardium with a 25-mm valve prosthesis. We replaced two thirds of the ascending aorta with re-implantation of the coronary arteries using the Bentall-de Bono technique. We were able to stabilise and implant the new aortic valve prosthesis with sutures through the opened left atrial roof. The stitches began close to the anterior mitral leaflet region and ended in the direction of the left ventricle outflow tract. All sutures were pericardium-pledgeted and were passed through a bovine pericardial patch. This patch formed a new mitral annulus and was used for the closure of the left atrial roof. We had to reconstruct the IVFB, the roof of the left atrium and the mitral annulus in the anterior (A1), middle (A2) and posterior (A3) segments. The patient was transferred to the intensive care unit with no inotropes and in sinus rhythm. The 3-year follow-up was uneventful.

CONCLUSION: We showed a successful surgical treatment of aortic prosthesis endocarditis with involvement of the IVFB. We were able to perform a radical resection of the infected tissue, reconstruct and replaced all sacrificed tissue with biological tissue and preserved the native mitral valve in a modified hemi-UFO procedure.

PMID:42249393 | PMC:PMC13244841 | DOI:10.1186/s13019-026-04318-z

Ann Biomed Eng. 2026 Jun 9. doi: 10.1007/s10439-026-04207-5. Online ahead of print.

ABSTRACT

BACKGROUND: The biomechanical performance of bileaflet transcatheter mitral valves (TMVs) depends on complex interactions between leaflet material behavior and stent design. However, the contributions of leaflet materials and constitutive models, stent materials, and stent geometry to valve function and durability remain poorly understood.

METHODS: A parametric finite element study was conducted using a CAD model of a bileaflet TMV subjected to physiological pressure loading. Five leaflet material models were evaluated: 3 glutaraldehyde-fixed tissues-bovine pericardium (BP; FBP1, FBP2) and porcine pericardium (PP; FPP)-and 2 unfixed tissues-bovine (UBP) and porcine pericardium (UPP). BP was modeled as a linear elastic (FBP1) and Ogden (FBP2). Each was paired with 2 stent materials, cobalt chromium (CoCr) and nitinol, and 3 stent cell densities (low, medium, high), yielding 30 configurations. Von Mises stresses and relative leaflet opening were quantified.

RESULTS: UPP achieved the largest opening (30-32%) with the lowest leaflet 99th percentile stresses (0.048-0.050 MPa), while FBP1 produced the smallest opening (8-9%) and highest leaflet stresses (0.077-0.078 MPa). Leaflet 99th percentile stress was strongly inversely correlated with valve opening (Spearman r=-0.9, p<0.01). Stent material had a negligible effect on valve opening but affected stent stress notably, with nitinol exhibiting about 2-3 orders of magnitude lower stresses compared to CoCr. Increasing stent cell density improved stress distribution with only a modest reduction in opening.

CONCLUSION: Leaflet material model was the primary determinant of bileaflet TMV biomechanical performance, whereas stent material and cell density exerted secondary but meaningful effects. These findings offer insights that may guide the design of more optimized TMV replacement devices.

PMID:42262702 | DOI:10.1007/s10439-026-04207-5

Oper Neurosurg. 2026 Jun 3. doi: 10.1227/ons.0000000000002083. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Circumferential defects of the dural sleeve of exiting lumbar nerve roots may occur after incidental durotomy, trauma, or deliberate opening of the root cuff during resection of nerve sheath tumors. Standard onlay duraplasty can control cerebrospinal fluid (CSF) leakage but does not restore the tubular dural-epineural conduit. We describe a collagen-matrix cuff technique for root sleeve reconstruction and report our initial institutional experience.

METHODS: This single-center, retrospective case series includes 9 consecutive reconstructions performed between January 2022 and October 2025 for intraoperatively recognized circumferential defects of exiting lumbar nerve root sleeves not amenable to safe primary suturing. The cohort comprised 6 iatrogenic root sleeve defects occurring during elective lumbar procedures (including instrumented and noninstrumented decompressive and/or stabilizing surgeries), 2 post-traumatic cases, and 1 elective tumor case presented as the illustrative case (L3 nerve root ganglioneuroma resection). Clinical records, intraoperative notes, and imaging were reviewed retrospectively. Minimum clinical and MRI follow-up was 6 months for all patients. Adjunctive lumbar drainage was used in one iatrogenic case.

RESULTS: In all cases, a bovine pericardium-derived collagen matrix was prehydrated, tailored, positioned under the root, sutured proximally to the dural margin at the root axilla, and wrapped to form a tubular cuff bridging the dural sac to the epineural segment, with distal reinforcement using fat and fibrin sealant. No patient required reoperation for CSF leak or pseudomeningocele. There were no cases of symptomatic nerve root herniation or new permanent neurological deficit. Radicular symptoms were stable or improved at the last follow-up.

CONCLUSION: Collagen-matrix cuff reconstruction is a simple, anatomically oriented option for circumferential lumbar root sleeve defects when primary closure is not feasible. In this initial single-center experience, the technique provided stable reconstruction without CSF-related complications and may represent a useful adjunct in selected complex root sleeve injuries.

PMID:42233683 | DOI:10.1227/ons.0000000000002083

Pediatr Surg Int. 2026 May 19;42(1):236. doi: 10.1007/s00383-026-06441-3.

ABSTRACT

PURPOSE: We aimed to investigate whether pledget presence, pledget composition, and full versus partial thickness suture technique affect the force esophageal tissue can withstand before tearing.

METHODS: A right thoracotomy was performed on 10 deceased fetal sheep, 110-114 days gestation. The esophagus was divided at the level of the carina and 2 cm of tissue was removed to mimic long-gap esophageal atresia. The pouches were sutured with horizontal mattress non-absorbable braided polyester suture using one of three methods: polytetrafluoroethylene (PTFE) pledgets, bovine pericardial pledgets, or no pledget, in full or partial thickness manner. Each suture was attached to a tensiometer and manually tightened at 50 gram-force / 30 s. Maximal force before esophageal tearing and time to tearing were measured. Results were compared using a linear mixed model.

RESULTS: PTFE pledgets withstood significantly more force than pericardial pledgets (p = 0.029) and provided longer duration before tearing compared to no pledget (p = 0.017) and pericardial pledgets (p = 0.047). Full versus partial-thickness technique made no difference.

CONCLUSION: In a deceased fetal lamb long-gap esophageal atresia model, PTFE pledgets improved tissue resistance to tearing (PTFE > pericardial) and prolonged stretch duration (PTFE > pericardial or no pledget). Suture thickness (full vs. partial) made no difference.

PMID:42154275 | DOI:10.1007/s00383-026-06441-3

Int J Biol Macromol. 2026 Jun;367:152551. doi: 10.1016/j.ijbiomac.2026.152551. Epub 2026 May 14.

ABSTRACT

The longevity and applicability of glutaraldehyde cross-linked commercial bioprosthetic heart valves (BHVs) that are the first choice for the transcatheter heart valve replacement (THVR) remain limited due to thrombus accumulation, calcification, inflammatory reactions and poor endothelialization. In this study, we first performed the prefunctionalization treatment of dual crosslinking by carboxymethylated λ-carrageenan and 4-pentenoic acid on decellularized bovine pericardium; subsequently, we conducted a post-functionalization treatment by dual modification of immobilizing the cyclodextrin (CD)/rutin and organic selenium onto above-mentioned doubly cross-linked (DC) bovine pericardium through the amidation reaction; finally, we obtained the anticipated bioprosthetic heart valve with multiple functions (DC + CD/Rutin+Se-BP). Uniaxial tensile tests demonstrated that this doubly cross-linked BHV exhibited superior mechanical properties compared with glutaraldehyde-treated bovine pericardium, which is expected to increase its structural stability and service life. By introducing the CD/Rutin complex and organic selenium, DC + CD/Rutin+Se-BP not only exhibited the ability to inhibit the adsorption of plasma proteins, platelet aggregation and thrombosis but also presented the excellent anti-inflammatory and anti-calcification characteristics both in vitro and in vivo. Furthermore, DC + CD/Rutin+Se-BP also exhibited stable in situ nitric oxide (NO) catalytic release ability due to the immobilization of organic selenium, which endowed bioprosthetic heart valve with excellent compatibility with human umbilical vein endothelial cells (HUVECs) and facilitated the long-term promotion of its endothelialization process. In summary, this approach combining dual cross-linking and dual modification provides a promising strategy for future design of BHVs, and DC + CD/Rutin+Se-BP exhibits a bright prospect in the clinical applications of BHVs.

PMID:42140293 | DOI:10.1016/j.ijbiomac.2026.152551

Multimed Man Cardiothorac Surg. 2026 May 19;2026. doi: 10.1510/mmcts.2026.008.

ABSTRACT

Surgery for radiation-associated valve disease is technically demanding due to challenging exposure, extensive calcification, and risk of paravalvular leak or atrioventricular groove disruption. An oblique aortotomy revealed heavy calcification extending to the aortomitral continuity, where only a 23 mm sizer could barely pass. The aortotomy was extended into the non-coronary sinus adjacent to the left-non commissure. An extended transseptal approach was employed and connected to the aortotomy. The anterior mitral leaflet was excised. From trigone to trigone, non-everting buttressed stitches were placed in the posterior annulus to avoid the mitral annular calcification. A 2-cm-wide felt strip collar, corresponding to the mitral annular calcification depth, was secured to a 31 mm mitral bioprosthesis with running polypropylene sutures. The valve stitches were passed through the felt strip, and after tying them down, a folded bovine pericardial patch was sewn to the anterior annulus of the mitral prosthesis using a running suture. One side of the patch was used to close the dome of the left atrium; the other side was used to close the aortotomy. A 27 mm aortic prosthesis was then easily implanted due to root enlargement. The aortotomy was closed, and the patient was weaned from cardiopulmonary bypass without difficulty.

PMID:42153558 | DOI:10.1510/mmcts.2026.008

Int Braz J Urol. 2026 Sep-Oct;52(5):e20269906. doi: 10.1590/S1677-5538.IBJU.2026.9906.

ABSTRACT

OBJECTIVE: Penile urethral stricture is a potential complication after any form of urethral instrumentation. Treatment options may be limited when considering direct urethrotomies or urethroplasties without grafting, due to the increased risk of penile shortening and functional compromise. In this context, among the various graft materials described in the literature (including buccal mucosa, lingual mucosa, bladder mucosa, colonic mucosa, augmentation urethroplasty with skin flaps, and injectable antifibrotic agents) (1, 2) the use of bovine pericardium appears promising (3). In this video, we present a clinical case in which the L-Hydro® tissue treatment technology 100% aldehyde free, VIVENDI™ graft was used as a graft for the surgical repair of penile urethral stricture following radical prostatectomy.

MATERIALS AND METHODS: The present study was approved by the hospital’s Institutional Ethics Committee in accordance with ethical standards for research involving human subjects. A 65-year-old male patient developed a penile urethral stricture following urethral instrumentation and prolonged urinary catheter use after radical prostatectomy. Preoperative evaluation included cystourethrography, which demonstrated a 1.2 cm stricture in the penile urethra. Urethroplasty was indicated for definitive surgical management. Under regional anesthesia, a longitudinal penile incision was made, followed by a ventral sagittal urethrotomy directly over the stricture segment. A free aldehyde-free bovine pericardium graft (VIVENDI™) was tailored to the defect and placed as a dorsal onlay within the urethrotomy. The graft was secured with interrupted 4-0 poliglecaprone 25 sutures. The ventral urethrotomy was closed over a 16 Fr silicone Foley catheter, and the penile incision was closed in layers. Follow-up assessments included uroflowmetry and post-void residual urine measurement at 4 weeks, with urethroscopy performed at 7 weeks postoperatively to evaluate urethral patency and graft integration.

RESULTS: No intraoperative or postoperative complications occurred. Seven weeks after surgery, the patient underwent urethroscopy, which demonstrated a well‑appearing urethral lumen without evidence of stricture or signs of infection. The graft was observed to be well incorporated into the urethral wall with no adverse tissue reaction. At follow‑up, the patient also demonstrated adequate bladder emptying, with satisfactory voiding parameters and low post‑void residual urine.

CONCLUSIONS: In this reported case, the use of a bovine pericardium graft demonstrated satisfactory results in penile urethroplasty for the treatment of a urethral stricture. Based on current evidence, bovine pericardium appears to be a feasible graft option for complex urethral reconstruction. However, further studies involving larger patient cohorts and multicenter collaboration are necessary to confirm these findings and better define the long‑term efficacy and safety of this approach.

PMID:42133856 | DOI:10.1590/S1677-5538.IBJU.2026.9906

Int Braz J Urol. 2026 Sep-Oct;52(5):e20269906. doi: 10.1590/S1677-5538.IBJU.2026.9906.

ABSTRACT

OBJECTIVE: Penile urethral stricture is a potential complication after any form of urethral instrumentation. Treatment options may be limited when considering direct urethrotomies or urethroplasties without grafting, due to the increased risk of penile shortening and functional compromise. In this context, among the various graft materials described in the literature (including buccal mucosa, lingual mucosa, bladder mucosa, colonic mucosa, augmentation urethroplasty with skin flaps, and injectable antifibrotic agents) (1, 2) the use of bovine pericardium appears promising (3). In this video, we present a clinical case in which the L-Hydro® tissue treatment technology 100% aldehyde free, VIVENDI™ graft was used as a graft for the surgical repair of penile urethral stricture following radical prostatectomy.

MATERIALS AND METHODS: The present study was approved by the hospital’s Institutional Ethics Committee in accordance with ethical standards for research involving human subjects. A 65-year-old male patient developed a penile urethral stricture following urethral instrumentation and prolonged urinary catheter use after radical prostatectomy. Preoperative evaluation included cystourethrography, which demonstrated a 1.2 cm stricture in the penile urethra. Urethroplasty was indicated for definitive surgical management. Under regional anesthesia, a longitudinal penile incision was made, followed by a ventral sagittal urethrotomy directly over the stricture segment. A free aldehyde-free bovine pericardium graft (VIVENDI™) was tailored to the defect and placed as a dorsal onlay within the urethrotomy. The graft was secured with interrupted 4-0 poliglecaprone 25 sutures. The ventral urethrotomy was closed over a 16 Fr silicone Foley catheter, and the penile incision was closed in layers. Follow-up assessments included uroflowmetry and post-void residual urine measurement at 4 weeks, with urethroscopy performed at 7 weeks postoperatively to evaluate urethral patency and graft integration.

RESULTS: No intraoperative or postoperative complications occurred. Seven weeks after surgery, the patient underwent urethroscopy, which demonstrated a well‑appearing urethral lumen without evidence of stricture or signs of infection. The graft was observed to be well incorporated into the urethral wall with no adverse tissue reaction. At follow‑up, the patient also demonstrated adequate bladder emptying, with satisfactory voiding parameters and low post‑void residual urine.

CONCLUSIONS: In this reported case, the use of a bovine pericardium graft demonstrated satisfactory results in penile urethroplasty for the treatment of a urethral stricture. Based on current evidence, bovine pericardium appears to be a feasible graft option for complex urethral reconstruction. However, further studies involving larger patient cohorts and multicenter collaboration are necessary to confirm these findings and better define the long‑term efficacy and safety of this approach.

PMID:42133856 | DOI:10.1590/S1677-5538.IBJU.2026.9906

BMC Oral Health. 2026 May 6. doi: 10.1186/s12903-026-08397-1. Online ahead of print.

ABSTRACT

BACKGROUND: The porcine acellular urinary bladder matrix (AUBM) is a three-dimensional scaffold rich in collagens type I, III, IV, and VI that could be used for guided bone regeneration (GBR). The objective of this study was to compare the physical, mechanical and biological properties of a AUBM with six other collagen membranes of porcine, equine and bovine origin.

METHODS: Seventy membranes were included (n = 10 per group). The properties of AUBM membrane were compared with the other animal collagen membranes available: porcine pericardium (PP), equine pericardium (EP), bovine pericaridium (BP), porcine peritoneum (PPE), equine Achilles tendon (EAT), bovine Achilles tendon (BAT). We analysed physical properties (surface morphology, hydrophilic property, degradation ratio and thermal stability), mechanical properties (tensile strength and dry and wet elongation), and biological properties (cell viability, quantification of type I collagen and osteopontin, Alkaline Phosphatase (ALP) activity and calcium deposition).

RESULTS: AUBM membranes showed a surface morphology (in smooth and rough surfaces) very similar to those of PP, EP, EAT, and BAT. The most hydrophilic membrane was PPE. The AUBM membranes showed a low degradation ratio and thermal stability similar to the other membranes. AUBM membranes had a tensile strength (dry and wet) and elongation (dry) similar to the other membranes. Their elongation was much higher than the rest when wet. AUBM membrane showed good biological properties.

CONCLUSIONS: AUBM membrane showed physical and mechanical properties similar to the other six membranes. However, upon wetting they were the membranes with the highest elongation capacity and showed similar properties to PPE membranes in promoting osteogenesis. AUBM could be an ideal collagen source for the manufacture of membranes for GBR, but further clinical studies are needed.

PMID:42092872 | DOI:10.1186/s12903-026-08397-1

Multimed Man Cardiothorac Surg. 2026 May 6;2026. doi: 10.1510/mmcts.2026.003.

ABSTRACT

Tricuspid regurgitation, associated with poor functional status and reduced survival, is common in patients with rheumatic heart disease after left-sided valve replacement. Although repair is preferred over replacement, surgical repair remains technically challenging. A 60-year-old woman presented with recurrent bilateral leg oedema for 2 years and dizziness with palpitations for 2 months. She had undergone mechanical mitral and aortic valve replacement 18 years earlier for rheumatic heart disease. Echocardiography demonstrated severe central tricuspid regurgitation with preserved prosthetic valve function and atrial arrhythmia. Via median sternotomy and cardiopulmonary bypass, classic rheumatic pathology of the tricuspid valve was identified. Repair consisted of detachment of the anterior and posterior leaflets, augmentation with an annuloplasty-shaped bovine pericardial patch to increase leaflet height and coaptation, and implantation of a partial rigid annuloplasty ring slightly smaller than the patch. Intra-operative echocardiography showed trace residual tricuspid regurgitation. Recovery was uneventful, with early resolution of oedema. Leaflet augmentation combined with partial ring annuloplasty is a simple and reproducible technique that restores early valve competence in complex rheumatic tricuspid regurgitation. Long-term follow-up is required to confirm durability.

PMID:42087840 | DOI:10.1510/mmcts.2026.003