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February 25, 2017
Post CPB Alain Carpentier

Alain Carpentier (1933- )



Binet, JP, Carpentier A, Langlois J, Duran C, Covlez P. Implantation de valves heterogenes dans le traitement de cardiopathies aortiques. C R Acad Sci, 1965, 261, 5733



Carpentier A, Blondeau PH, Laurens B, Hay A, Laurent D, Dubost CH. Mitral and tricuspid valve replacement with frame-mounted aortic heterografts. J Thorac Cardiovasc Surg, 1968, 56, 388-394



Carpentier A, Lemaigre G, Robert L, Carpentier S, Dubost C. Biological factors affecting long-term results of valvular heterografts. J Thorac Cardiovasc Surg, 1969, 58(4), 467-83.




Alain Carpentier
Portrait of Alain Carpentier
Portrait of Alain Carpentier
Cesalpino Andrea
Cesalpino Andrea
Cesalpino Andrea

Following the first successful implantation of the Starr-Edwards ball valve, mechanical mitral valve replacement was carried out with an increasing frequency in patients with severe mitral valve disease. As life-saving as these valves were, they were also associated with valve-related complications including thromboembolic events requiring long-term anticoagulation.

Intense efforts were then directed toward developing biocompatible valvular substitute.  Donald Ross was the first to describe the use of aortic homograft in 1962.  Problems of procurement of cadaveric homograft led Alain Carpentier and his coworkers to investigate the use of heterograft valves.  Another major issue was the size limitation as aortic homografts were not large enough to fit the aortic or mitral valve orifice in some patients .  

Carpentier investigated the use of valvular heterografts initially in the aortic position. He performed extensive anatomic studies of the aortic root in human and various animals. Casts of the aortic root taken by injecting liquid wax under physiologic pressure made possible accurate measurements of the configuration of the valve. As Carpentier stated "It is essential to respect all three dimensional relationships if the grafted valve is to function properly." The constructed heterograft valve was then mounted into a metal frame stent to prevent its deformation during implantation. The figure shown below is the first porcine valve mounted into a stent.

The first successful xenograft implantation in human in the aortic position was performed in September 1965 by Binet, Carpentier and  Langlois.

Cesalpino Andrea
Courtesy of Alain Carpentier
Cesalpino Andrea
Courtesy of Alain Carpentier
Cesalpino Andrea
Courtesy of Alain Carpentier

Subsequently, Carpentier continued his experience in the mitral position. In a first experimental phase, he implanted 24 frame-mounted aortic heterografts in the mitral position in animal model. The heterografts valves were removed from young calves and prepared in a mercurial salt solution and then mounted in a Teflon-covered stainless steel frame. The second clinical phase consisted of the implantation of these heterografts in eleven patients in either mitral or tricuspid position in 1967. The early results were satisfactory.

Carpentier, however, noted two complications that occurred in some patients: inflammatory reaction and collagen denaturation causing early degeneration of these valves.

Cesalpino Andrea
Histological transformation of a grafted valve (heterograft mercurial salt preserved) 1 year after implantation- Courtesy of Alain Carpentier
Cesalpino Andrea
Inflammatory reaction (immuno competent cells) in a 5 month old graft - Courtesy of Alain Carpentier


Cesalpino Andrea
Collagen denaturation in a 10 month old graft - Courtesy of Alain Carpentier

Carpentier and his team focused their research on tissue conditioning and fixation.  All methods of chemical tissue fixation were experimented and that led to the discovery of the dual effects of glutaraldehyde on porcine valves: prevention of collagen denaturation by intermolecular cross linkages and reduction of immunological responses. Interestingly, tissue treated with glutaraldehyde preserved their nonthrombogenic characteristics.

Cesalpino Andrea
Courtesy of Alain Carpentier


Cesalpino Andrea
Diagrammatic representation of the procedure used for preparation of valvular bioprostheses - Courtesy of Alain Carpentier

Glutaraldehyde-treated porcine valves were mounted into a stent and the first generation of heterograft valve with improved durability became available. The picture shown below is the first glutaraldehyde-treated porcine valve implanted in human. Later, Carpentier stated "I proposed the term bioprosthesis which indicates the biological origin and the prosthetic fate of these valves."

Cesalpino Andrea
Courtesy of Alain Carpentier

In his seminal article published in 1969, Carpentier wrote:

"As opposed to a graft, the durability of which depends upon cell viability or tissue regeneration, the durability of a bioprosthetic tissue relies on the unfailing stability of the chemically treated biological material and the prevention of host cell ingrowth."

During the last two decades, Carpentier has continued his research work, in collaboration with his wife, Sophie to improve the durability of the bioprosthetic valves. Calcium-mitigating adjuncts and heat treatment have contributed in almost doubling the average durability of the bioprostheses extending their indication to younger patients. Today, bioprostheses  are the most commonly implanted valves in patients with advanced valvular disease.

For his seminal contributions to the treatment of patients with cardiovascular diseases, the Lasker foundation awarded Alain Carpentier in 2007.


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