1
|
Landolff Q, Lefèvre T, Fajadet J, Sainsous J, Lhermusier T, Elhadad S, Tarragano F, Ranc S, Ghostine S, Cayla G, Marco F, Garot P, Maillard L, Motreff P, Delarche N, De Labriolle A, Pansieri M, Morelle JF, Cazaux P, Moulichon ME, Chopat P, Angoulvant D, Bataille V, Le Breton H, Koning R. Five-year clinical outcomes using the bioresorbable vascular scaffold: Insights from the FRANCE ABSORB registry. Arch Cardiovasc Dis 2022; 115:505-513. [PMID: 36123284 DOI: 10.1016/j.acvd.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/19/2022] [Accepted: 05/23/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Randomized trials comparing the first-generation absorb bioresorbable vascular scaffold (BVS) (Abbott Vascular, Santa Clara, CA, USA) with a drug-eluting stent showed a moderate but significant increase in the rate of 3-year major adverse cardiac events and scaffold thrombosis, followed by a decrease in adverse events after 3 years. AIM The objective of this study was to assess the 5-year outcomes of patients treated with at least one absorb BVS and included in the FRANCE ABSORB registry. METHODS All patients treated in France with an absorb BVS were prospectively included in a large nationwide multicentre registry. The primary efficacy outcome was the occurrence of 5-year major adverse cardiac events. Secondary efficacy outcomes were the rates of 5-year target vessel revascularization and definite/probable scaffold thrombosis. RESULTS Between September 2014 and April 2016, 2,070 patients were included in 86 centres (mean age 55±11 years; 80% men; 49% with acute coronary syndrome). The rates of 1-, 3- and 5-year major adverse cardiac events were 3.9%, 9.4% and 12.1%, respectively (including cardiac death in 2.5% and target vessel revascularization in 10.4%). By multivariable analysis, diabetes, oral anticoagulation, the use of multiple Absorb BVSs and the use of a 2.5mm diameter absorb BVS were associated with 5-year major adverse cardiac events. The rates of 1-, 3- and 5-year definite/probable scaffold thrombosis were 1.5%, 3.1% and 3.6%, respectively. By multivariable analysis, older age, diabetes, anticoagulation at discharge and the use of a 2.5mm diameter absorb BVS were associated with 5-year scaffold thrombosis. CONCLUSIONS Absorb BVS implantation was associated with low rates of 1-year major adverse cardiac events, which increased significantly at 3-year follow-up. There was a clear decrease in the rates of scaffold thrombosis and major adverse cardiac events after 3 years.
Collapse
Affiliation(s)
| | - Thierry Lefèvre
- Institut cardiovasculaire Paris Sud, Ramsay-Générale de Santé, hôpital privé Jacques-Cartier, 91300 Massy, France
| | | | | | | | - Simon Elhadad
- Centre hospitalier de Marne-la-Vallée, 77600 Jossigny, France
| | | | - Sylvain Ranc
- Centre hospitalier Saint-Joseph Saint-Luc, 69007 Lyon, France
| | - Saïd Ghostine
- Hôpital Marie-Lannelongue (groupe hospitalier Paris Saint-Joseph), 92350 Le Plessis-Robinson, France
| | | | | | - Philippe Garot
- Hôpital privé Claude-Galien, 91480 Quincy-sous-Sénart, France
| | | | | | | | | | | | | | - Pierre Cazaux
- Centre hospitalier de Bretagne Sud Site de Scorff, 56322 Lorient, France
| | | | - Patrick Chopat
- Centre hospitalier territorial, hôpital Gaston-Bourret, 98800 Nouméa, Nouvelle-Calédonie, France
| | | | - Vincent Bataille
- ADIMEP, université Paul-Sabatier, Toulouse III, 31400 Toulouse, France
| | | | - René Koning
- Clinique Saint-Hilaire, 76000 Rouen, France.
| | | |
Collapse
|
2
|
Yin T, Du R, Wang Y, Huang J, Ge S, Huang Y, Tan Y, Liu Q, Chen Z, Feng H, Du J, Wang Y, Wang G. Two-stage degradation and novel functional endothelium characteristics of a 3-D printed bioresorbable scaffold. Bioact Mater 2021; 10:378-396. [PMID: 34901554 PMCID: PMC8636822 DOI: 10.1016/j.bioactmat.2021.08.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 12/13/2022] Open
Abstract
Bioresorbable scaffolds have emerged as a new generation of vascular implants for the treatment of atherosclerosis, and designed to provide a temporary scaffold that is subsequently absorbed by blood vessels over time. Presently, there is insufficient data on the biological and mechanical responses of blood vessels accompanied by bioresorbable scaffolds (BRS) degradation. Therefore, it is necessary to investigate the inflexion point of degradation, the response of blood vessels, and the pathophysiological process of vascular, as results of such studies will be of great value for the design of next generation of BRS. In this study, abdominal aortas of SD rats were received 3-D printed poly-l-actide vascular scaffolds (PLS) for various durations up to 12 months. The response of PLS implanted aorta went through two distinct processes: (1) the neointima with desirable barrier function was obtained in 1 month, accompanied with slow degradation, inflammation, and intimal hyperplasia; (2) significant degradation occurred from 6 months, accompanied with decreasing inflammation and intimal hyperplasia, while the extracellular matrix recovered to normal vessels which indicate the positive remodeling. These in vivo results indicate that 6 months is a key turning point. This “two-stage degradation and vascular characteristics” is proposed to elucidate the long-term effects of PLS on vascular repair and demonstrated the potential of PLS in promoting endothelium function and positive remodeling, which highlights the benefits of PLS and shed some light in the future researches, such as drug combination coatings design. Proposed two-stage degradation of a PLLA BRS to reveal distinct neointimal recovery and vascular responsive processes. Revealed novel benefits of BRS, including fine endothelium function, anti-thrombosis, and anti-inflammatory. Drug combination coatings should be designed concerning special degradation of BRS and the key turning point, 6 months.
Collapse
Affiliation(s)
- Tieying Yin
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China
| | - Ruolin Du
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China
| | - Yang Wang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China
| | - Junyang Huang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China
| | - Shuang Ge
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China
| | - Yuhua Huang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China
| | - Youhua Tan
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Qing Liu
- Beijing Advanced Medical Technologies Inc., Beijing, 102609, China
| | - Zhong Chen
- Beijing Anzhen Hospital of Capital Medical University, Beijing, 100029, China
| | - Hanqing Feng
- Beijing Advanced Medical Technologies Inc., Beijing, 102609, China
| | - Jie Du
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Ave, Beijing, 10029, China
| | - Yazhou Wang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China.,School of Medicine, Chongqing University, Chongqing, 400044, China
| | - Guixue Wang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China
| |
Collapse
|