{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T06:04:31Z","timestamp":1770789871243,"version":"3.50.0"},"reference-count":40,"publisher":"Archives of Pathology and Laboratory Medicine","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2009,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    <jats:italic>Context.<\/jats:italic>\n                    \u2014From January 1995 to June 2003, there were 514 patients who underwent pulmonary valve replacements at either the Hospital for Sick Children or Toronto General Hospital. Fifty-four (10.5%) of these adults returned for replacement of their prostheses because of failure. Forty (74.1%) of the 54 explants were bioprostheses, and 14 (25.9%) were homografts.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Objective.<\/jats:italic>\n                    \u2014To present the morphologic findings from this consecutive series of 40 pulmonary-site bioprostheses.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Design.<\/jats:italic>\n                    \u2014Data were obtained by review of pathologic, clinical, and surgical records for all 40 patients with bioprosthetic pulmonary valves explanted from 1995 to June of 2003.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Results.<\/jats:italic>\n                    \u2014The mean duration of valve implantation was 14.3 \u00b1 5.2 years (2\u201326 years). Median age at implantation was 16.7 \u00b1 10.3 years (range, 3 months to 53 years). Structural valve deterioration was found in 39 (97.5%) of the valves. Morphologic evidence of stenosis was found in all valves, whereas incompetence was found in 28 (70.0%). Calcification was present in 32 (80.0%) of the valves and was severe and diffuse in 22 (55.0%). Host tissue overgrowth, or pannus, was present on 39 (97.5%) of the valves and was severe in 35 (87.5%). Tears were present in 19 (47.5%) of the valves.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Conclusions.<\/jats:italic>\n                    \u2014Explanted bioprostheses showed a high degree of calcification and pannus, which together led to stenosis. Cusp immobilization, involving all 3 cusps, was frequent and was more common in patients younger than 30 years of age at explantation (\n                    <jats:italic>P<\/jats:italic>\n                    &lt; .001). Host-tissue overgrowth is a significant problem with bioprostheses, and pulmonary-site bioprostheses are no exception.\n                  <\/jats:p>","DOI":"10.5858\/133.5.797","type":"journal-article","created":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T09:58:44Z","timestamp":1613123924000},"page":"797-802","source":"Crossref","is-referenced-by-count":10,"title":["Pulmonary Site Bioprostheses: Morphologic Findings in 40 Cases"],"prefix":"10.5858","volume":"133","author":[{"given":"Gursharan S.","family":"Soor","sequence":"first","affiliation":[{"name":"From the Departments of Pathology and Cardiovascular Surgery, Toronto General Hospital and University of Toronto (Messrs Soor and Leong and Drs Butany and Shapero); and the Division of Cardiovascular Surgery, The Hospital for Sick Children, University of Toronto (Dr Williams), Toronto, Ontario. Dr Shapero is now with the Department of Dermatology, University of British Columbia, Vancouver, British Columbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shaun W.","family":"Leong","sequence":"additional","affiliation":[{"name":"From the Departments of Pathology and Cardiovascular Surgery, Toronto General Hospital and University of Toronto (Messrs Soor and Leong and Drs Butany and Shapero); and the Division of Cardiovascular Surgery, The Hospital for Sick Children, University of Toronto (Dr Williams), Toronto, Ontario. Dr Shapero is now with the Department of Dermatology, University of British Columbia, Vancouver, British Columbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jagdish","family":"Butany","sequence":"additional","affiliation":[{"name":"From the Departments of Pathology and Cardiovascular Surgery, Toronto General Hospital and University of Toronto (Messrs Soor and Leong and Drs Butany and Shapero); and the Division of Cardiovascular Surgery, The Hospital for Sick Children, University of Toronto (Dr Williams), Toronto, Ontario. Dr Shapero is now with the Department of Dermatology, University of British Columbia, Vancouver, British Columbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan L.","family":"Shapero","sequence":"additional","affiliation":[{"name":"From the Departments of Pathology and Cardiovascular Surgery, Toronto General Hospital and University of Toronto (Messrs Soor and Leong and Drs Butany and Shapero); and the Division of Cardiovascular Surgery, The Hospital for Sick Children, University of Toronto (Dr Williams), Toronto, Ontario. Dr Shapero is now with the Department of Dermatology, University of British Columbia, Vancouver, British Columbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William G.","family":"Williams","sequence":"additional","affiliation":[{"name":"From the Departments of Pathology and Cardiovascular Surgery, Toronto General Hospital and University of Toronto (Messrs Soor and Leong and Drs Butany and Shapero); and the Division of Cardiovascular Surgery, The Hospital for Sick Children, University of Toronto (Dr Williams), Toronto, Ontario. Dr Shapero is now with the Department of Dermatology, University of British Columbia, Vancouver, British Columbia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3906","reference":[{"key":"i1543-2165-133-5-797-b1","series-title":"J Heart Valve Dis","first-page":"4","article-title":"Morphologic findings in explanted Hancock II porcine bioprostheses.","volume":"8","author":"Butany, J.","year":"1999","unstructured":"Butany, J., W.Yu, M. D.Silver, and T. E.David. Morphologic findings in explanted Hancock II porcine bioprostheses.J Heart Valve Dis1999. 8:4\u201315."},{"key":"i1543-2165-133-5-797-b2","series-title":"Human Pathol","first-page":"1224","article-title":"Morphologic findings and causes of failure in 24 explanted Ionescu-Shiley low-profile pericardial heart valves.","volume":"11","author":"Butany, J.","year":"1992","unstructured":"Butany, J., K.Vanlerberghe, and M. D.Silver. Morphologic findings and causes of failure in 24 explanted Ionescu-Shiley low-profile pericardial heart valves.Human Pathol1992. 11:1224\u20131233."},{"key":"i1543-2165-133-5-797-b3","series-title":"Circulation","first-page":"618","article-title":"Causes of failure and pathologic findings in surgically removed Ionescu-Shiley Standard bovine pericardial hear valve bioprostheses: emphasis on progressive structural deterioration.","volume":"76","author":"Shoen, F. J.","year":"1987","unstructured":"Shoen, F. J., J.Fernandez, and L.Gonzalez-Lavin. et al. Causes of failure and pathologic findings in surgically removed Ionescu-Shiley Standard bovine pericardial hear valve bioprostheses: emphasis on progressive structural deterioration.Circulation1987. 76:618\u2013627."},{"key":"i1543-2165-133-5-797-b4","series-title":"Am J Cardiol","first-page":"1066","article-title":"Calcific degeneration as the main cause of porcine bioprosthetic valve failure.","volume":"53","author":"Milano, A.","year":"1984","unstructured":"Milano, A., U.Bortolotti, and E.Talenti. et al. Calcific degeneration as the main cause of porcine bioprosthetic valve failure.Am J Cardiol1984. 53:1066\u20131070."},{"key":"i1543-2165-133-5-797-b5","series-title":"Hum Pathol","first-page":"549","article-title":"Anatomic analysis of removed prosthetic heart valves: causes of failure of 33 mechanical valves and 58 bioprostheses, 1980 to 1983.","volume":"16","author":"Schoen, F. J.","year":"1985","unstructured":"Schoen, F. J. and C. E.Hobson. Anatomic analysis of removed prosthetic heart valves: causes of failure of 33 mechanical valves and 58 bioprostheses, 1980 to 1983.Hum Pathol1985. 16:549\u2013559."},{"key":"i1543-2165-133-5-797-b6","series-title":"Am J Cardiol","first-page":"957","article-title":"Long-term failure rate and morphologic correlations in porcine bioprosthetic heart valves.","volume":"51","author":"Schoen, F. J.","year":"1983","unstructured":"Schoen, F. J., J. J. JrCollins, and L. H.Cohn. Long-term failure rate and morphologic correlations in porcine bioprosthetic heart valves.Am J Cardiol1983. 51:957\u2013964."},{"key":"i1543-2165-133-5-797-b7","series-title":"Chest","first-page":"607","article-title":"Glutaraldehyde-preserved porcine bioprosthesis: factors affecting performance as determined by pathologic studies.","volume":"83","author":"Valente, M.","year":"1983","unstructured":"Valente, M., U.Bortolotti, and E.Arbustini. et al. Glutaraldehyde-preserved porcine bioprosthesis: factors affecting performance as determined by pathologic studies.Chest1983. 83:607\u2013611."},{"key":"i1543-2165-133-5-797-b8","series-title":"J Heart Valve Dis","first-page":"180","article-title":"Pathology of the pericarbon bovine pericardial xenograft implanted in humans.","volume":"7","author":"Valente, M.","year":"1998","unstructured":"Valente, M., P.Ius, and U.Bortolotti. et al. Pathology of the pericarbon bovine pericardial xenograft implanted in humans.J Heart Valve Dis1998. 7:180\u2013189."},{"key":"i1543-2165-133-5-797-b9","series-title":"J Heart Valve Dis","first-page":"323","article-title":"Low-profile porcine bioprosthesis (Liotta): pathologic findings and mode of failure in the long-term.","volume":"5","author":"Ius, P.","year":"1996","unstructured":"Ius, P., G.Thiene, and M.Minarini. et al. Low-profile porcine bioprosthesis (Liotta): pathologic findings and mode of failure in the long-term.J Heart Valve Dis1996. 5:323\u2013327."},{"key":"i1543-2165-133-5-797-b10","series-title":"Eur J Cardiothorac Surg","first-page":"470","article-title":"Failure mode of a new pericardial valve prosthesis (Sorin pericarbon): a morphological study.","volume":"8","author":"Grabenwoger, M.","year":"1994","unstructured":"Grabenwoger, M., M.Grimm, and C.Leukauf. et al. Failure mode of a new pericardial valve prosthesis (Sorin pericarbon): a morphological study.Eur J Cardiothorac Surg1994. 8:470\u2013476."},{"key":"i1543-2165-133-5-797-b11","series-title":"J Cardiovasc Surg (Torino)","first-page":"307","article-title":"Late pathological changes of Carpentier-Edwards porcine bioprostheses in the mitral position.","volume":"27","author":"Isomura, T.","year":"1986","unstructured":"Isomura, T., T.Yanai, and H.Akagawa. et al. Late pathological changes of Carpentier-Edwards porcine bioprostheses in the mitral position.J Cardiovasc Surg (Torino)1986. 27:307\u2013315."},{"key":"i1543-2165-133-5-797-b12","series-title":"Am J Cardiol","first-page":"665","article-title":"Structure and classification of cuspal tears and perforations in porcine bioprosthetic cardiac valves implanted in patients.","volume":"48","author":"Ishihara, T.","year":"1981","unstructured":"Ishihara, T., V. J.Ferrans, and S. W.Boyce. et al. Structure and classification of cuspal tears and perforations in porcine bioprosthetic cardiac valves implanted in patients.Am J Cardiol1981. 48:665\u2013678."},{"key":"i1543-2165-133-5-797-b13","series-title":"Cardiovasc Pathol","first-page":"4","article-title":"A 10-year comparison of explanted Hancock-II and Carpentier-Edwards supraannular bioprostheses.","volume":"16","author":"Butany, J.","year":"2007","unstructured":"Butany, J., S. W.Leong, and K. S.Cunningham. et al. A 10-year comparison of explanted Hancock-II and Carpentier-Edwards supraannular bioprostheses.Cardiovasc Pathol2007. 16:4\u201313."},{"key":"i1543-2165-133-5-797-b14","series-title":"Ann Thorac Surg","first-page":"248","article-title":"Durability of the Carpentier-Edwards porcine bioprosthesis: role of age and valve position.","volume":"60","author":"Bernal, J. M.","year":"1995","unstructured":"Bernal, J. M., J. M.Rabasa, and R.Lopez. et al. Durability of the Carpentier-Edwards porcine bioprosthesis: role of age and valve position.Ann Thorac Surg1995. 60:(suppl). 248\u2013252."},{"key":"i1543-2165-133-5-797-b15","series-title":"Ann Thorac Surg","first-page":"S40","article-title":"Carpentier-Edwards standard porcine bioprosthesis: a 21-year experience.","volume":"66","author":"Jamieson, W. R. E.","year":"1998","unstructured":"Jamieson, W. R. E., L. H.Burr, and A. I.Munro. et al. Carpentier-Edwards standard porcine bioprosthesis: a 21-year experience.Ann Thorac Surg1998. 66:S40\u201343."},{"key":"i1543-2165-133-5-797-b16","series-title":"J Thorac Cardiovasc Surg","first-page":"591","article-title":"Clinicopathological correlates of obstructed right-sided porcine-valved extracardiac conduits.","volume":"81","author":"Agarwal, K. C.","year":"1981","unstructured":"Agarwal, K. C., W. D.Edwards, and R. H.Feldt. et al. Clinicopathological correlates of obstructed right-sided porcine-valved extracardiac conduits.J Thorac Cardiovasc Surg1981. 81:591\u2013601."},{"key":"i1543-2165-133-5-797-b17","series-title":"J Thorac Cardiovasc Surg","first-page":"490","article-title":"Valved and nonvalved right ventricular-pulmonary arterial extracardiac conduits.","volume":"86","author":"Fiore, A. C.","year":"1983","unstructured":"Fiore, A. C., P. S.Peigh, and R. J.Robison. et al. Valved and nonvalved right ventricular-pulmonary arterial extracardiac conduits.J Thorac Cardiovasc Surg1983. 86:490\u2013497."},{"key":"i1543-2165-133-5-797-b18","series-title":"J Thorac Cardiovasc Surg","first-page":"1022","article-title":"Independent factors associated with longevity of prosthetic pulmonary valves and valved conduits.","volume":"120","author":"Caldarone, C. A.","year":"2000","unstructured":"Caldarone, C. A., B. W.McCrindle, and G. S.Van Arsdell. et al. Independent factors associated with longevity of prosthetic pulmonary valves and valved conduits.J Thorac Cardiovasc Surg2000. 120:1022\u20131031."},{"key":"i1543-2165-133-5-797-b19","series-title":"J Thorac Cardiovasc Surg","first-page":"228","article-title":"Conduit reconstruction of the right ventricular outflow tract.","volume":"106","author":"Albert, J. D.","year":"1993","unstructured":"Albert, J. D., D. A.Bishop, and D. A.Fullerton. et al. Conduit reconstruction of the right ventricular outflow tract.J Thorac Cardiovasc Surg1993. 106:228\u2013236."},{"key":"i1543-2165-133-5-797-b20","series-title":"Ann Thorac Surg","first-page":"259","article-title":"Spontaneous degeneration of the porcine bioprosthetic valve.","volume":"30","author":"Magilligan, D. J. Jr","year":"1980","unstructured":"Magilligan, D. J. Jr, J. W. JrLewis, and F. M.Jara. et al. Spontaneous degeneration of the porcine bioprosthetic valve.Ann Thorac Surg1980. 30:259\u2013266."},{"key":"i1543-2165-133-5-797-b1","series-title":"J Heart Valve Dis","first-page":"4","article-title":"Morphologic findings in explanted Hancock II porcine bioprostheses.","volume":"8","author":"Butany, J.","year":"1999","unstructured":"Butany, J., W.Yu, M. D.Silver, and T. E.David. Morphologic findings in explanted Hancock II porcine bioprostheses.J Heart Valve Dis1999. 8:4\u201315."},{"key":"i1543-2165-133-5-797-b2","series-title":"Human Pathol","first-page":"1224","article-title":"Morphologic findings and causes of failure in 24 explanted Ionescu-Shiley low-profile pericardial heart valves.","volume":"11","author":"Butany, J.","year":"1992","unstructured":"Butany, J., K.Vanlerberghe, and M. D.Silver. Morphologic findings and causes of failure in 24 explanted Ionescu-Shiley low-profile pericardial heart valves.Human Pathol1992. 11:1224\u20131233."},{"key":"i1543-2165-133-5-797-b3","series-title":"Circulation","first-page":"618","article-title":"Causes of failure and pathologic findings in surgically removed Ionescu-Shiley Standard bovine pericardial hear valve bioprostheses: emphasis on progressive structural deterioration.","volume":"76","author":"Shoen, F. J.","year":"1987","unstructured":"Shoen, F. J., J.Fernandez, and L.Gonzalez-Lavin. et al. Causes of failure and pathologic findings in surgically removed Ionescu-Shiley Standard bovine pericardial hear valve bioprostheses: emphasis on progressive structural deterioration.Circulation1987. 76:618\u2013627."},{"key":"i1543-2165-133-5-797-b4","series-title":"Am J Cardiol","first-page":"1066","article-title":"Calcific degeneration as the main cause of porcine bioprosthetic valve failure.","volume":"53","author":"Milano, A.","year":"1984","unstructured":"Milano, A., U.Bortolotti, and E.Talenti. et al. Calcific degeneration as the main cause of porcine bioprosthetic valve failure.Am J Cardiol1984. 53:1066\u20131070."},{"key":"i1543-2165-133-5-797-b5","series-title":"Hum Pathol","first-page":"549","article-title":"Anatomic analysis of removed prosthetic heart valves: causes of failure of 33 mechanical valves and 58 bioprostheses, 1980 to 1983.","volume":"16","author":"Schoen, F. J.","year":"1985","unstructured":"Schoen, F. J. and C. E.Hobson. Anatomic analysis of removed prosthetic heart valves: causes of failure of 33 mechanical valves and 58 bioprostheses, 1980 to 1983.Hum Pathol1985. 16:549\u2013559."},{"key":"i1543-2165-133-5-797-b6","series-title":"Am J Cardiol","first-page":"957","article-title":"Long-term failure rate and morphologic correlations in porcine bioprosthetic heart valves.","volume":"51","author":"Schoen, F. J.","year":"1983","unstructured":"Schoen, F. J., J. J. JrCollins, and L. H.Cohn. Long-term failure rate and morphologic correlations in porcine bioprosthetic heart valves.Am J Cardiol1983. 51:957\u2013964."},{"key":"i1543-2165-133-5-797-b7","series-title":"Chest","first-page":"607","article-title":"Glutaraldehyde-preserved porcine bioprosthesis: factors affecting performance as determined by pathologic studies.","volume":"83","author":"Valente, M.","year":"1983","unstructured":"Valente, M., U.Bortolotti, and E.Arbustini. et al. Glutaraldehyde-preserved porcine bioprosthesis: factors affecting performance as determined by pathologic studies.Chest1983. 83:607\u2013611."},{"key":"i1543-2165-133-5-797-b8","series-title":"J Heart Valve Dis","first-page":"180","article-title":"Pathology of the pericarbon bovine pericardial xenograft implanted in humans.","volume":"7","author":"Valente, M.","year":"1998","unstructured":"Valente, M., P.Ius, and U.Bortolotti. et al. Pathology of the pericarbon bovine pericardial xenograft implanted in humans.J Heart Valve Dis1998. 7:180\u2013189."},{"key":"i1543-2165-133-5-797-b9","series-title":"J Heart Valve Dis","first-page":"323","article-title":"Low-profile porcine bioprosthesis (Liotta): pathologic findings and mode of failure in the long-term.","volume":"5","author":"Ius, P.","year":"1996","unstructured":"Ius, P., G.Thiene, and M.Minarini. et al. Low-profile porcine bioprosthesis (Liotta): pathologic findings and mode of failure in the long-term.J Heart Valve Dis1996. 5:323\u2013327."},{"key":"i1543-2165-133-5-797-b10","series-title":"Eur J Cardiothorac Surg","first-page":"470","article-title":"Failure mode of a new pericardial valve prosthesis (Sorin pericarbon): a morphological study.","volume":"8","author":"Grabenwoger, M.","year":"1994","unstructured":"Grabenwoger, M., M.Grimm, and C.Leukauf. et al. Failure mode of a new pericardial valve prosthesis (Sorin pericarbon): a morphological study.Eur J Cardiothorac Surg1994. 8:470\u2013476."},{"key":"i1543-2165-133-5-797-b11","series-title":"J Cardiovasc Surg (Torino)","first-page":"307","article-title":"Late pathological changes of Carpentier-Edwards porcine bioprostheses in the mitral position.","volume":"27","author":"Isomura, T.","year":"1986","unstructured":"Isomura, T., T.Yanai, and H.Akagawa. et al. Late pathological changes of Carpentier-Edwards porcine bioprostheses in the mitral position.J Cardiovasc Surg (Torino)1986. 27:307\u2013315."},{"key":"i1543-2165-133-5-797-b12","series-title":"Am J Cardiol","first-page":"665","article-title":"Structure and classification of cuspal tears and perforations in porcine bioprosthetic cardiac valves implanted in patients.","volume":"48","author":"Ishihara, T.","year":"1981","unstructured":"Ishihara, T., V. J.Ferrans, and S. W.Boyce. et al. Structure and classification of cuspal tears and perforations in porcine bioprosthetic cardiac valves implanted in patients.Am J Cardiol1981. 48:665\u2013678."},{"key":"i1543-2165-133-5-797-b13","series-title":"Cardiovasc Pathol","first-page":"4","article-title":"A 10-year comparison of explanted Hancock-II and Carpentier-Edwards supraannular bioprostheses.","volume":"16","author":"Butany, J.","year":"2007","unstructured":"Butany, J., S. W.Leong, and K. S.Cunningham. et al. A 10-year comparison of explanted Hancock-II and Carpentier-Edwards supraannular bioprostheses.Cardiovasc Pathol2007. 16:4\u201313."},{"key":"i1543-2165-133-5-797-b14","series-title":"Ann Thorac Surg","first-page":"248","article-title":"Durability of the Carpentier-Edwards porcine bioprosthesis: role of age and valve position.","volume":"60","author":"Bernal, J. M.","year":"1995","unstructured":"Bernal, J. M., J. M.Rabasa, and R.Lopez. et al. Durability of the Carpentier-Edwards porcine bioprosthesis: role of age and valve position.Ann Thorac Surg1995. 60:(suppl). 248\u2013252."},{"key":"i1543-2165-133-5-797-b15","series-title":"Ann Thorac Surg","first-page":"S40","article-title":"Carpentier-Edwards standard porcine bioprosthesis: a 21-year experience.","volume":"66","author":"Jamieson, W. R. E.","year":"1998","unstructured":"Jamieson, W. R. E., L. H.Burr, and A. I.Munro. et al. Carpentier-Edwards standard porcine bioprosthesis: a 21-year experience.Ann Thorac Surg1998. 66:S40\u201343."},{"key":"i1543-2165-133-5-797-b16","series-title":"J Thorac Cardiovasc Surg","first-page":"591","article-title":"Clinicopathological correlates of obstructed right-sided porcine-valved extracardiac conduits.","volume":"81","author":"Agarwal, K. C.","year":"1981","unstructured":"Agarwal, K. C., W. D.Edwards, and R. H.Feldt. et al. Clinicopathological correlates of obstructed right-sided porcine-valved extracardiac conduits.J Thorac Cardiovasc Surg1981. 81:591\u2013601."},{"key":"i1543-2165-133-5-797-b17","series-title":"J Thorac Cardiovasc Surg","first-page":"490","article-title":"Valved and nonvalved right ventricular-pulmonary arterial extracardiac conduits.","volume":"86","author":"Fiore, A. C.","year":"1983","unstructured":"Fiore, A. C., P. S.Peigh, and R. J.Robison. et al. 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