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Li C, Xie B, Tan R, Liang L, Peng Z, Chen Q. Current development of bovine jugular vein conduit for right ventricular outflow tract reconstruction. Front Bioeng Biotechnol 2022; 10:920152. [PMID: 35992331 PMCID: PMC9386425 DOI: 10.3389/fbioe.2022.920152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Right ventricular outflow tract (RVOT) reconstruction is a common surgical method to treat congenital cardiac lesions, and bovine jugular vein conduit (BJVC) has become a prevalent candidate of prosthetic material for this procedure since 1999. Although many clinical studies have shown encouraging results on BJVCs, complications such as stenosis, aneurysmal dilatation, valve insufficiency, and infective endocarditis revealed in other clinical outcomes still remain problematic. This review describes the underlying mechanisms causing respective complications, and summarizes the current technological development that may address those causative factors. Novel crosslinking agents, decellularization techniques, conduit coatings, and physical reinforcement materials have improved the performances of BJVCs. The authors expect that the breakthroughs in the clinical application of BJVC may come from new genetic research findings and advanced characterization apparatuses and bioreactors, and are optimistic that the BJVC will in the future provide sophisticated therapies for next-generation RVOT reconstruction.
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Affiliation(s)
- Chenggang Li
- Xuzhou Third People’s Hospital, Xuzhou, Jiangsu, China
| | - Bo Xie
- Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruizhe Tan
- Ningbo Regen Biotech, Co., Ltd., Ningbo, Zhejiang, China
| | - Lijin Liang
- Ningbo Regen Biotech, Co., Ltd., Ningbo, Zhejiang, China
| | - Zhaoxiang Peng
- The Affiliated Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, China
- *Correspondence: Zhaoxiang Peng, ; Qi Chen,
| | - Qi Chen
- Ningbo Regen Biotech, Co., Ltd., Ningbo, Zhejiang, China
- *Correspondence: Zhaoxiang Peng, ; Qi Chen,
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Huyan Y, Chang Y, Song J. Application of Homograft Valved Conduit in Cardiac Surgery. Front Cardiovasc Med 2021; 8:740871. [PMID: 34712711 PMCID: PMC8545902 DOI: 10.3389/fcvm.2021.740871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Valved conduits often correct the blood flow of congenital heart disease by connecting the right ventricle to the pulmonary artery (RV-PA). The homograft valved conduit was invented in the 1960s, but its wide application is limited due to the lack of effective sterilization and preservation methods. Modern cryopreservation prolongs the preservation time of homograft valved conduit, which makes it become the most important treatment at present, and is widely used in Ross and other operations. However, homograft valved conduit has limited biocompatibility and durability and lacks any additional growth capacity. Therefore, decellularized valved conduit has been proposed as an effective improved method, which can reduce immune response and calcification, and has potential growth ability. In addition, as a possible substitute, commercial xenograft valved conduit has certain advantages in clinical application, and tissue engineering artificial valved conduit needs to be further studied.
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Affiliation(s)
- Yige Huyan
- The Cardiomyopathy Research Group at Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Chang
- The Cardiomyopathy Research Group at Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiangping Song
- The Cardiomyopathy Research Group at Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Wan J, Zhong X, Xu Z, Gong D, Li D, Xin Z, Ma X, Li W. A decellularized porcine pulmonary valved conduit embedded with gelatin. Artif Organs 2021; 45:1068-1082. [PMID: 33730379 DOI: 10.1111/aor.13955] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/27/2021] [Accepted: 03/11/2021] [Indexed: 11/27/2022]
Abstract
To prepare a tissue-engineered pulmonary valved conduit (PVC) with good tensile strength and biocompatibility. Sixty adult porcine PVCs were used to determine the optimal decellularization time. Five juvenile porcine decellularized PVCs and five juvenile porcine crosslinked PVCs were subsequently prepared according to the optimized decellularization and crosslinking methods. All PVCs were implanted into juvenile sheep for 8 months and then were harvested for staining. With a low concentration of detergent (0.25% Triton X-100+0.25% sodium deoxycholate), the decellularization effect on porcine PVCs was complete by 24 hours, and there was minimal damage to the matrix. Gelatin embedding and 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC) crosslinking improved the biomechanical properties of decellularized PVCs and reduced their immunogenicity. After implantation, the diameter and thickness of the PVCs in the decellularized and crosslinked groups increased significantly. In both groups, the conduits were unobstructed, with soft and smooth inner walls and without thrombosis, ulceration or neoplasia. The valves slightly degenerated with mild to moderate regurgitation. CD31-positive endothelial cells were visible on the inner surface of the conduits and valves. Scattered smooth muscle actin-positive cells were found in the middle layer of the conduit. The percentage of CD4- and CD68-positive cells and the calcium content were highest in decellularized porcine PVCs and lowest in ovine PVCs. The percentage of the matrix that was laminin-positive in decellularized and crosslinked porcine PVCs was lower than it was in ovine PVCs. Gelatin-embedded and EDC-crosslinked porcine PVCs can be "hosted" in sheep, with good biocompatibility, growth potential, and reduced calcification.
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Affiliation(s)
- Juyi Wan
- Department of Cardiovascular Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, P.R. China.,Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, P.R. China.,Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, P.R. China.,Key Laboratory of Medical Electrophysiology, Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, (Collaborative Innovation Center for Prevention of Cardiovascular Diseases) Institute of Cardiovascular Research, Southwest Medical University, Luzhou, P.R. China
| | - Xiaolin Zhong
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, P.R. China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, P.R. China
| | - Zhiwei Xu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, P.R. China
| | - Da Gong
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, P.R. China
| | - Diankun Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, P.R. China
| | - Zhifei Xin
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, P.R. China
| | - Xiaolong Ma
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, P.R. China
| | - Wenbin Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, P.R. China
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Hoashi T, Ichikawa H, Hirose K, Horio N, Sakurai T, Matsuhisa H, Ohsima Y, Sakurai H, Kasahara S, Sakamoto K. Mid-term outcomes of Contegra implantation for the reconstruction of the right ventricular outflow tract to proximal branch pulmonary arteries: Japan multicentre study. Interact Cardiovasc Thorac Surg 2021; 33:227-236. [PMID: 33755119 DOI: 10.1093/icvts/ivab075] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/08/2021] [Accepted: 02/18/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To reveal the mid-term outcomes of Contegra implantation for the reconstruction of the right ventricular outflow tract to proximal branch pulmonary arteries in a multicentre study. METHODS Between April 2013 and December 2019, 178 Contegra conduits were implanted at 5 Japanese institutes. The median age and body weight at operation were 16 months (25th-75th percentile: 8-32) and 8.3 kg (6.4-10.6). Sixteen patients were neonates (9.0%). Selected conduit sizes were 12 mm in 28 patients (15.7%), 14 mm in 67 patients (37.6%), 16 mm in 66 patients (37.1%), 18 mm in 5 patients (2.8%) and <12 mm in 12 patients (6.7%). Fifty-six grafts (31.4%) were ring supported. Proximal branch pulmonary arteries were concomitantly augmented in 85 patients (47.5%). Follow-up was completed in all patients and the median follow-up period was 3.1 years (1.3-5.1). RESULTS The overall, conduit explantation-free and conduit infection-free survival rates at 5 years were 91.3%, 71.0% and 83.7%, respectively. Infection (P = 0.009) and common arterial trunk (P = 0.024) were risk factors for explantation. Conduit durability was shorter in smaller one (P < 0.001). Catheter interventions (for conduit to proximal branch pulmonary artery)-free survival rates at 5 years was 52.9%; however, need for catheter interventions was not a risk factor for conduit explantation. CONCLUSIONS Mid-term outcomes of reconstruction of the right ventricular outflow tract to the proximal branch pulmonary arteries with Contegra were acceptable. The need for explantation over time was higher in smaller conduits. Conduit infection was a strong risk factor for conduit explantation. Frequently and repeated catheter interventions effectively extended the conduit durability.
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Affiliation(s)
- Takaya Hoashi
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hajime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Keiichi Hirose
- Department of Cardiovascular Surgery, Mt Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | - Naohiro Horio
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takahisa Sakurai
- Department of Cardiovascular Surgery, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Hironori Matsuhisa
- Department of Cardiovascular Surgery, Hyogo Children's Hospital, Kobe, Japan
| | - Yoshihiro Ohsima
- Department of Cardiovascular Surgery, Hyogo Children's Hospital, Kobe, Japan
| | - Hajime Sakurai
- Department of Cardiovascular Surgery, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kisaburo Sakamoto
- Department of Cardiovascular Surgery, Mt Fuji Shizuoka Children's Hospital, Shizuoka, Japan
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Hirai K, Baba K, Goto T, Ousaka D, Kondo M, Eitoku T, Kotani Y, Kasahara S, Ohtsuki S, Tsukahara H. Outcomes of Right Ventricular Outflow Tract Reconstruction in Children: Retrospective Comparison Between Bovine Jugular Vein and Expanded Polytetrafluoroethylene Conduits. Pediatr Cardiol 2021; 42:100-108. [PMID: 32968822 DOI: 10.1007/s00246-020-02458-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/16/2020] [Indexed: 11/27/2022]
Abstract
Bovine jugular vein (BJV) and expanded polytetrafluoroethylene (ePTFE) conduits have been described as alternatives to the homograft for right ventricular outflow tract (RVOT) reconstruction. This study compared RVOT reconstructions using BJV and ePTFE conduits performed in a single institution. The valve functions and outcomes of patients aged < 18 years who underwent primary RVOT reconstruction with a BJV or ePTFE conduit between 2013 and 2017 were retrospectively investigated. 44 patients (20 and 24 with BJV and ePTFE conduits, respectively) met the inclusion criteria. The mean follow-up time was 4.5 ± 1.5 years. No significant differences in peak RVOT velocity (1.8 ± 0.9 m/s vs 2.1 ± 0.9 m/s, P = 0.27), branch pulmonary stenosis (P = 0.50), or pulmonary regurgitation (P = 0.44) were found between the BJV and ePTFE conduit groups, respectively. Aneurysmal dilatation of the conduit was observed in 25.0% of the patients in the BJV conduit group but not in the ePTFE conduit group (P = 0.011). All the cases with aneurysmal dilatation of the BJV conduit were complicated with branch pulmonary stenosis up to 3.0 m/s (P = 0.004). No conduit infections occurred during the follow-up period, and no significant difference in conduit replacement (20.0% vs 8.3%, P = 0.43) was found between the BJV and ePTFE conduit groups, respectively. The outcomes of the RVOT reconstructions with BJV and ePTFE conduits were clinically satisfactory. Aneurysmal dilatation was found in the BJV conduit cases, with branch pulmonary stenosis as the risk factor.
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Affiliation(s)
- Kenta Hirai
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Kenji Baba
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama, 700-8558, Japan.
| | - Takuya Goto
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Daiki Ousaka
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Maiko Kondo
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Takahiro Eitoku
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Yasuhiro Kotani
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Shinichi Ohtsuki
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Hirokazu Tsukahara
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama, 700-8558, Japan
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Ismail MF, Elmahrouk AF, Arafat AA, Hamouda TE, Edrees A, Bogis A, Arfi AM, Dohain AM, Alkhattabi A, Alharbi AW, Shihata MS, Al‐Radi OO, Al‐Ata JA, Jamjoom AA. Bovine jugular vein valved xenograft for extracardiac total cavo‐pulmonary connection: The risk of thrombosis and the potential liver protection effect. J Card Surg 2020; 35:845-853. [DOI: 10.1111/jocs.14484] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Mohamed F. Ismail
- Department of Cardiothoracic SurgeryKing Faisal Specialist Hospital and Research CenterJeddah Saudi Arabia
- Department of Cardiothoracic Surgery, Faculty of MedicineMansoura UniversityMansoura Egypt
| | - Ahmed F. Elmahrouk
- Department of Cardiothoracic SurgeryKing Faisal Specialist Hospital and Research CenterJeddah Saudi Arabia
- Department of Cardiothoracic Surgery, Faculty of MedicineTanta UniversityTanta Egypt
| | - Amr A. Arafat
- Department of Cardiothoracic Surgery, Faculty of MedicineTanta UniversityTanta Egypt
| | - Tamer E. Hamouda
- Department of Cardiothoracic SurgeryKing Faisal Specialist Hospital and Research CenterJeddah Saudi Arabia
- Department of Cardiothoracic Surgery, Faculty of MedicineBenha UniversityBenha Egypt
| | - Azzahra Edrees
- Department of Cardiothoracic SurgeryKing Faisal Specialist Hospital and Research CenterJeddah Saudi Arabia
| | - Abdulbadee Bogis
- Department of Cardiothoracic SurgeryKing Faisal Specialist Hospital and Research CenterJeddah Saudi Arabia
| | - Amin M. Arfi
- Section of Pediatric Cardiology, Department of PediatricsKing Faisal Specialist Hospital and Research CenterJeddah Saudi Arabia
| | - Ahmed M. Dohain
- Division of Pediatric Cardiology, Department of PediatricsFaculty of Medicine Cairo UniversityCairo Egypt
- Section of Pediatric Cardiology, Department of PediatricsKing Abdulaziz UniversityJeddah Saudi Arabia
| | - Abdullah Alkhattabi
- Section of Gastroenterology, Department of Internal MedicineKing Faisal Specialist Hospital and Research CenterJeddah Saudi Arabia
| | - Ahmed W. Alharbi
- Section of Gastroenterology, Department of Internal MedicineKing Faisal Specialist Hospital and Research CenterJeddah Saudi Arabia
| | - Mohammad S. Shihata
- Department of Cardiothoracic SurgeryKing Faisal Specialist Hospital and Research CenterJeddah Saudi Arabia
| | - Osman O. Al‐Radi
- Department of Cardiothoracic SurgeryKing Faisal Specialist Hospital and Research CenterJeddah Saudi Arabia
- Section of Cardiothoracic Surgery, Department of SurgeryKing Abdulaziz UniversityJeddah Saudi Arabia
| | - Jameel A. Al‐Ata
- Section of Pediatric Cardiology, Department of PediatricsKing Faisal Specialist Hospital and Research CenterJeddah Saudi Arabia
- Section of Pediatric Cardiology, Department of PediatricsKing Abdulaziz UniversityJeddah Saudi Arabia
| | - Ahmed A. Jamjoom
- Department of Cardiothoracic SurgeryKing Faisal Specialist Hospital and Research CenterJeddah Saudi Arabia
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