Transplantation of a decellularized mitral valve complex in pigs

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Conventional mitral valve replacement is associated with the loss of natural continuity of the mitral valve complex. This study evaluated the morphologic/histological characteristics and function of a decellularized mitral valve used as a transplantable graft.


Hearts excised from pigs were decellularized by perfusion using detergent. Grafts with the mitral annulus, valve, chordae, and papillary muscle isolated from the decellularized heart were then transplanted into recipient pigs. After transplantation, the function of the graft was analyzed through echocardiography. A histological analysis was performed to evaluate the postoperative features of the decellularized graft.


The decellularized graft was successfully transplanted in all cases but one. The remaining grafts maintained their morphology and function. They did not exhibit mitral regurgitation or stenosis. Only one animal survived for 3 weeks, and a histological analysis was able to be performed in this case. The transplanted valve was re-covered with endothelial cells. The microvessels in the papillary muscle were recellularized with vascular endothelial cells, and the papillary muscle was completely attached to the papillary muscle of the recipient.


The early outcome of decellularized mitral graft transplantation was acceptable. This native organ-derived acellular scaffold is a promising candidate for the replacement of the mitral valve complex.

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The authors thank Hitoshi Inoue and Shintaro Hashiba from Sasazuka Animal Clinic; Yosuke Kawahira and Shingo Sato from the Division of Clinical Engineering; Toshio Otake, Koji Matsumoto and Keiko Kumagai from the Laboratory Animal Center; Shinsuke Shibata, Toshihiro Nagai from the Department of Electron Microscope Laboratory; Naho Murakawa, Rie Kinoshita from the Department of Surgery; So Takasugi, Yusuke Aoki, Tadafumi Tamura and Kaori Katsumata from the Department of Cardiovascular Surgery, School of Medicine, Keio University.


This work was supported by JSPS KAKENHI Grant number JP 18K08582.

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Correspondence to Hiroshi Yagi.

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Yu Inaba and the other co-authors have no conflicts of interest.

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Inaba, Y., Yagi, H., Kuroda, K. et al. Transplantation of a decellularized mitral valve complex in pigs. Surg Today (2019) doi:10.1007/s00595-019-01869-8

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  • Mitral valve
  • Organ engineering
  • Tissue engineering
  • Decellularization