Identification of Autologous Tissue Sources and Optimization of a Treatment Method for Intraoperative Manufacturing of Heart Valve Constructs

INTRODUCTION: Valvular heart disease remains a leading cause of morbidity and mortality. Current biological and mechanical heart valve prostheses have significant limitations and fail to address the patient's needs. Most of the limitations arise from the use of foreign materials, which can largely be addressed by utilizing autologous pericardial tissue. However, not all patients have usable pericardium due to previous interventions. This study investigates peritoneum as a potential alternative to pericardium and evaluates an optimized treatment method for intraoperative tissue treatment. METHODS: A previously established cross-linking method was optimized and applied to pericardial and peritoneal tissues. The tissues were characterized with respect to biochemical composition, cross-linking degree, biomechanical properties, and structural organization. Furthermore, the feasibility of valve shaping was assessed, and constructs were subjected to acute hydrodynamic testing. RESULTS: Tissue treated with the optimized cross-linking method showed high cytocompatibility and was successfully applied to peritoneal tissue. Compared to pericardium, peritoneum exhibited a higher elastin content and a looser structural organization, resulting in distinct mechanical behavior. Both tissues could be shaped into valve constructs showing adequate acute hydrodynamic behavior under the applied test conditions. CONCLUSION: The findings suggest that the peritoneum is a promising candidate material for further investigation as a heart valve scaffold. However, differences in microstructure and mechanical behavior highlight the need for further testing, particularly regarding long-term durability, cyclic loading behavior, and tissue remodeling capacity.