The pericardium (from the Greek περι, “around,” and κάρδιον, “heart,”/ perikardion/) is the sac surrounding the heart. Its primary function is to provide a natural barrier to infections of the myocardium and prevent adhesion

CONTENTS

6.1 Introduction ................................................................................................ 123 6.2 Structure, Composition, and Mechanical Properties of Pericardium.....124 6.3 Structure, Composition, and Mechanical Properties

of AOV Leaets .......................................................................................... 126 6.3.1 Role of the Valve Interstitial Cells and Valve

Endothelial Cells ............................................................................ 127 6.4 Bioprosthetic AOVs: Modalities of Preparation, Durability,

and Main Failure Causes .......................................................................... 129 6.4.1 Types of Bioprosthetic Valves for Human Implantation .......... 129 6.4.2 Fixation Protocols That Ensure Prosthetic

AOV Biocompatibility ................................................................... 130 6.4.3 Failure of Bioprosthetic Valves .................................................... 130 6.4.4 Approaches to Prevent AOV Xenograft Calcication ............... 131

6.5 Future Perspectives for Pericardium-Based Heart Valve Tissue Engineering .................................................................................... 133

6.6 Pericardium Medical Applications and International Regulatory Requirements for Human and Animal Tissue Use .............................. 134

6.7 Conclusions ................................................................................................. 135 References ............................................................................................................. 136

to surrounding tissues. In addition, it mechanically protects the heart from overdilation, it maintains its correct anatomical position, and regulates the pressure/volume ratio in the left ventricle during diastole (Ishihara et al. 1980). For its structure and resistance to mechanical stress, pericardium has been for long proposed as a suitable material to construct bioprosthesis for various medical applications such as vascular grafts (Matsagas et al. 2006; Schmidt and Baier 2000), patches for abdominal and vaginal wall reparation (Lazarou et al. 2005; Limpert et al. 2009), brain surgery (Filippi et al. 2001), and heart valves (Flanagan and Pandit 2003; Schoen and Levy 1999; Vesely 2005).