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Shabbak A, Masoumkhani F, Fallah A, Amani-Beni R, Mohammadpour H, Shahbazi T, Bakhshi A. 3D Printing for Cardiovascular Surgery and Intervention: A Review Article. Curr Probl Cardiol 2024; 49:102086. [PMID: 37716537 DOI: 10.1016/j.cpcardiol.2023.102086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/18/2023]
Abstract
3D printing technology can be applied to practically every aspect of modern life, fulfilling the needs of people from various backgrounds. The utilization of 3D printing in the context of adult heart disease can be succinctly categorized into 3 primary domains: preoperative strategizing or simulation, medical instruction, and clinical consultations. 3D-printed model utilization improves surgical planning and intraoperative decision-making and minimizes surgical risks, and it has demonstrated its efficacy as an innovative educational tool for aspiring surgeons with limited practical exposure. Despite all the applications of 3D printing, it has not yet been shown to improve long-term outcomes, including safety. There are no data on the outcomes of controlled trials available. To appropriately diagnose heart disease, 3D-printed models of the heart can provide a better understanding of the intracardiac anatomy and provide all the information needed for operative planning. Experientially, 3D printing provides a wide range of perceptions for understanding lower extremity arteries' spatial geometry and anatomical features of pathology. Practicing cardiac surgery processes using objects printed using 3D imaging data can become the norm rather than the exception, leading to improved accuracy and quality of treatment. This study aimed to review the various applications of 3D printing technology in cardiac surgery and intervention.
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Affiliation(s)
- Ali Shabbak
- Research Committee, School of Medicine, Guilan University of Medical Science, Rasht, Iran
| | - Fateme Masoumkhani
- Department of cardiology, Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Amir Fallah
- Research Committee, School of Medicine, Guilan University of Medical Science, Rasht, Iran
| | - Reza Amani-Beni
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hanieh Mohammadpour
- Research Committee, School of Medicine, Guilan University of Medical Science, Rasht, Iran
| | - Taha Shahbazi
- Neurosurgery Research Group (NRG), Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Arash Bakhshi
- Remember of Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
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Bowman T, O'Donoghue D, Diz Ferre JL, Marquez Roa LA, Hofstra R, Ayad S. Aortic Regurgitation After Right Coronary Cusp Injury During Percutaneous Coronary Intervention. Cureus 2024; 16:e52560. [PMID: 38371084 PMCID: PMC10874589 DOI: 10.7759/cureus.52560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
Injury of a coronary cusp of the aortic valve is a rare complication that can occur during coronary angiography. It usually occurs from multiple attempts with different catheters to access the ostia of the right coronary artery, but it has also occurred accessing the ostia of the left coronary artery. We present the case of a patient who underwent coronary angiography with suspected coronary cusp injury that remained asymptomatic but was found to have severe aortic regurgitation during coronary artery bypass graft surgery (CABG) one week later, requiring an aortic valve replacement.
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Affiliation(s)
- Taylor Bowman
- Anesthesiology, Cleveland Clinic South Pointe Hospital, Cleveland, USA
| | - Donal O'Donoghue
- Anesthesiology, Cleveland Clinic Fairview Hospital, Cleveland, USA
| | | | | | | | - Sabry Ayad
- Anesthesiology, Cleveland Clinic Fairview Hospital, Cleveland, USA
- Outcomes Research, Cleveland Clinic, Cleveland, USA
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Hülsmann J, Fraune T, Dodawatta B, Reuter F, Beutner M, Beck V, Hackert-Oschätzchen M, Ohl CD, Bettenbrock K, Janiga G, Wippermann J, Wacker M. Integrated biophysical matching of bacterial nanocellulose coronary artery bypass grafts towards bioinspired artery typical functions. Sci Rep 2023; 13:18274. [PMID: 37880281 PMCID: PMC10600183 DOI: 10.1038/s41598-023-45451-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 10/19/2023] [Indexed: 10/27/2023] Open
Abstract
Revascularization via coronary artery bypass grafting (CABG) to treat cardiovascular disease is established as one of the most important lifesaving surgical techniques worldwide. But the shortage in functionally self-adaptive autologous arteries leads to circumstances where the clinical reality must deal with fighting pathologies coming from the mismatching biophysical functionality of more available venous grafts. Synthetic biomaterial-based CABG grafts did not make it to the market yet, what is mostly due to technical hurdles in matching biophysical properties to the complex demands of the CABG niche. But bacterial Nanocellulose (BNC) Hydrogels derived by growing biofilms hold a naturally integrative character in function-giving properties by its freedom in designing form and intrinsic fiber architecture. In this study we use this integral to combine impacts on the luminal fiber matrix, biomechanical properties and the reciprocal stimulation of microtopography and induced flow patterns, to investigate biomimetic and artificial designs on their bio-functional effects. Therefore, we produced tubular BNC-hydrogels at distinctive designs, characterized the structural and biomechanical properties and subjected them to in vitro endothelial colonization in bioreactor assisted perfusion cultivation. Results showed clearly improved functional properties and gave an indication of successfully realized stimulation by artery-typical helical flow patterns.
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Affiliation(s)
- Jörn Hülsmann
- Department for Cardiac Surgery, Medical Faculty, Otto von Guericke University, Magdeburg, Germany.
| | - Theresa Fraune
- Department for Cardiac Surgery, Medical Faculty, Otto von Guericke University, Magdeburg, Germany
| | - Baratha Dodawatta
- Laboratory of Fluid Dynamics and Technical Flows, Otto von Guericke University, Magdeburg, Germany
| | - Fabian Reuter
- Department Soft Matter, Otto von Guericke University, Magdeburg, Germany
| | - Martin Beutner
- Chair of Manufacturing Technology with Focus Machining, Institute of Manufacturing Technology and Quality Management, Otto von Guericke University, Magdeburg, Germany
| | - Viktoria Beck
- Department for Cardiac Surgery, Medical Faculty, Otto von Guericke University, Magdeburg, Germany
| | - Matthias Hackert-Oschätzchen
- Chair of Manufacturing Technology with Focus Machining, Institute of Manufacturing Technology and Quality Management, Otto von Guericke University, Magdeburg, Germany
| | - Claus Dieter Ohl
- Department Soft Matter, Otto von Guericke University, Magdeburg, Germany
| | - Katja Bettenbrock
- Max Plank Institute for Dynamics of Complex Technical Systems, Magdeburg, Germany
| | - Gabor Janiga
- Laboratory of Fluid Dynamics and Technical Flows, Otto von Guericke University, Magdeburg, Germany
| | - Jens Wippermann
- Department for Cardiac Surgery, Medical Faculty, Otto von Guericke University, Magdeburg, Germany
| | - Max Wacker
- Department for Cardiac Surgery, Medical Faculty, Otto von Guericke University, Magdeburg, Germany
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Thakare VS, Sontakke NG, Wasnik P, Kanyal D. Recent Advances in Coronary Artery Bypass Grafting Techniques and Outcomes: A Narrative Review. Cureus 2023; 15:e45511. [PMID: 37868547 PMCID: PMC10585183 DOI: 10.7759/cureus.45511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Coronary artery bypass grafting (CABG) has witnessed remarkable progress in recent years, driven by innovative techniques and refined approaches that have transformed patient outcomes and treatment paradigms. This review article comprehensively explores the latest advances in CABG techniques and their consequential impacts on patient outcomes. The advent of minimally invasive CABG techniques has revolutionized traditional surgical approaches. Robotic-assisted surgery and small thoracotomy methods offer reduced invasiveness, yielding shorter recovery times and improved patient satisfaction. Integrating CABG with percutaneous coronary intervention (PCI), hybrid procedures have emerged as a versatile strategy, providing tailored treatment solutions for complex coronary anatomies. The paradigm shift to off-pump CABG, which preserves the beating heart during surgery, has shown promise in reducing perioperative complications and neurocognitive deficits. Advances in graft selection, particularly the utilization of arterial grafts such as the internal thoracic artery and radial artery, have significantly enhanced graft patency rates and long-term survival. Adjunctive technologies, such as intraoperative imaging and graft flow assessment, have bolstered the precision of CABG procedures. Pharmacological agents have demonstrated their potential to improve graft outcomes. Surgical decision-making is now optimized based on patient characteristics and disease severity owing to the development of patient selection and risk stratification tools. Long-term results have also significantly improved. Patients undergoing CABG have higher survival rates, less angina, and better quality of life. Developing more resilient grafts through tissue engineering, using bioresorbable materials in graft fabrication, and using gene therapy to improve graft patency and overall cardiac recovery are all exciting future research directions. This review's summary of current developments in CABG procedures highlights their profoundly positive effects on patient outcomes. These developments can change the face of cardiovascular care by giving clinicians more tools to treat coronary artery disease (CAD) and enhance patients' quality of life.
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Affiliation(s)
- Vaishnavi S Thakare
- Hospital Administration, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nikhil G Sontakke
- Health Sciences, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Praful Wasnik
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Deepika Kanyal
- Hospital Administration, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Wang R, Li J, Chen H, Xiao Z, Xu R, Hu Y, Chen S, Wang X, Zheng S. Preoperative albumin corrected anion gap is associated with in-hospital and long-term mortality in patients undergoing coronary artery bypass grafting in a retrospective cohort study. J Thorac Dis 2022; 14:4894-4903. [PMID: 36647463 PMCID: PMC9840039 DOI: 10.21037/jtd-22-1633] [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: 10/20/2022] [Accepted: 12/20/2022] [Indexed: 12/31/2022]
Abstract
Background Coronary artery disease remains a global health concern and the leading cause of death. Till today, coronary artery bypass grafting (CABG) is one of the main treatment strategies for coronary artery disease, especially for Multivessel coronary disease or complex coronary lesions. The present study aimed to explore the relationship of preoperative albumin corrected anion gap (ACAG) with mortality in all those patients who undergoing CABG. Methods All the patients undergoing CABG were included in the study. All clinical data were collected from CareVue and MetaVision system. The predictive value of ACAG for mortality was determined by receiver operating characteristic (ROC) curves survival curves were estimated using the Kaplan-Meier method. Multivariate regression models were constructed to determine the association of ACAG with mortality. Results A total of 2,180 patients were identified and divided into a high ACAG group (ACAG ≥16.0 mmol/L) and low ACAG group (ACAG <16.0 mmol/L) according to the ROC analysis. Patients in the high ACAG group were older and presented with more comorbidities and concomitant valvular surgeries. Further more, in the high ACAG group, we observed a higher length of stay in the intensive care unit [3.88 (2.15, 7.09) vs. 2.29 (1.29, 3.94), P<0.001]. Both the in-hospital mortality [28 (4.5%) vs. 11 (0.7%), P<0.001], and the 4-year mortality [125 (27.1%) vs. 111 (12.7%), P<0.001] were also rised in those patients. And it was also showed in the survival curves, patients with ACAG ≥16.0 mmol/L had a significant lower 4-year survival (P<0.001). While in the multivariate regression model, we found ACAG was act as an independent risk factor for both the in-hospital mortality [odds ratio (OR): 1.248 (1.060, 1.470), P=0.008] and the 4-year mortality [hazard ratio (HR): 1.134 (1.063, 1.210), P<0.001]. An ACAG ≥16.0 mmol/L was significantly associated with a 2.7-fold risk of in-hospital mortality [OR: 2.732 (1.129, 6.610), P=0.026]. Conclusions Preoperative ACAG is an independent risk factor for in-hospital and long-term mortality in CABG patients. A higher ACAG may relate to severe coronary artery stenosis and cardiac dysfunction, which is more likely to lead to a postoperative systemic inflammatory response, microcirculation disorder, and subsequent complications.
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Affiliation(s)
- Ruiling Wang
- Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jiale Li
- Department of Cardiovascular Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Huimin Chen
- Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zezhou Xiao
- Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Rongning Xu
- Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yu Hu
- Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Sikai Chen
- Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaowu Wang
- Department of Cardiovascular Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shaoyi Zheng
- Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Wang D, Maharjan S, Kuang X, Wang Z, Mille LS, Tao M, Yu P, Cao X, Lian L, Lv L, He JJ, Tang G, Yuk H, Ozaki CK, Zhao X, Zhang YS. Microfluidic bioprinting of tough hydrogel-based vascular conduits for functional blood vessels. SCIENCE ADVANCES 2022; 8:eabq6900. [PMID: 36288300 PMCID: PMC9604524 DOI: 10.1126/sciadv.abq6900] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Three-dimensional (3D) bioprinting of vascular tissues that are mechanically and functionally comparable to their native counterparts is an unmet challenge. Here, we developed a tough double-network hydrogel (bio)ink for microfluidic (bio)printing of mono- and dual-layered hollow conduits to recreate vein- and artery-like tissues, respectively. The tough hydrogel consisted of energy-dissipative ionically cross-linked alginate and elastic enzyme-cross-linked gelatin. The 3D bioprinted venous and arterial conduits exhibited key functionalities of respective vessels including relevant mechanical properties, perfusability, barrier performance, expressions of specific markers, and susceptibility to severe acute respiratory syndrome coronavirus 2 pseudo-viral infection. Notably, the arterial conduits revealed physiological vasoconstriction and vasodilatation responses. We further explored the feasibility of these conduits for vascular anastomosis. Together, our study presents biofabrication of mechanically and functionally relevant vascular conduits, showcasing their potentials as vascular models for disease studies in vitro and as grafts for vascular surgeries in vivo, possibly serving broad biomedical applications in the future.
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Affiliation(s)
- Di Wang
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Cambridge, MA 02139, USA
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, P. R. China
| | - Sushila Maharjan
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Cambridge, MA 02139, USA
| | - Xiao Kuang
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Cambridge, MA 02139, USA
| | - Zixuan Wang
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Cambridge, MA 02139, USA
| | - Luis S. Mille
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Cambridge, MA 02139, USA
| | - Ming Tao
- Department of Surgery and the Heart and Vascular Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Peng Yu
- Department of Surgery and the Heart and Vascular Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Xia Cao
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Cambridge, MA 02139, USA
| | - Liming Lian
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Cambridge, MA 02139, USA
| | - Li Lv
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Cambridge, MA 02139, USA
| | - Jacqueline Jialu He
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Cambridge, MA 02139, USA
| | - Guosheng Tang
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Cambridge, MA 02139, USA
| | - Hyunwoo Yuk
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - C. Keith Ozaki
- Department of Surgery and the Heart and Vascular Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Corresponding author. (Y.S.Z.); (X.Z.); (C.K.O.)
| | - Xuanhe Zhao
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Department of Civil and Environmental Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Corresponding author. (Y.S.Z.); (X.Z.); (C.K.O.)
| | - Yu Shrike Zhang
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Cambridge, MA 02139, USA
- Corresponding author. (Y.S.Z.); (X.Z.); (C.K.O.)
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Diagnostic and Management Strategies in Patients with Late Recurrent Angina after Coronary Artery Bypass Grafting. Curr Cardiol Rep 2022; 24:1309-1325. [PMID: 35925511 PMCID: PMC9556385 DOI: 10.1007/s11886-022-01746-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 11/04/2022]
Abstract
Purpose of Review This review will outline the current evidence on the anatomical, functional, and physiological tools that may be applied in the evaluation of patients with late recurrent angina after coronary artery bypass grafting (CABG). Furthermore, we discuss management strategies and propose an algorithm to guide decision-making for this complex patient population. Recent Findings Patients with prior CABG often present with late recurrent angina as a result of bypass graft failure and progression of native coronary artery disease (CAD). These patients are generally older, have a higher prevalence of comorbidities, and more complex atherosclerotic lesion morphology compared to CABG-naïve patients. In addition, guideline recommendations are based on studies in which post-CABG patients have been largely excluded. Summary Several invasive and non-invasive diagnostic tools are currently available to assess graft patency, the hemodynamic significance of native CAD progression, left ventricular function, and myocardial viability. Such tools, in particular the latest generation coronary computed tomography angiography, are part of a systematic diagnostic work-up to guide optimal repeat revascularization strategy in patients presenting with late recurrent angina after CABG.
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Infrared Thermographic Imaging of Chest Wall Perfusion in Patients Undergoing Coronary Artery Bypass Grafting. Ann Biomed Eng 2022; 50:1837-1845. [PMID: 35773416 PMCID: PMC9794541 DOI: 10.1007/s10439-022-02998-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/22/2022] [Indexed: 12/31/2022]
Abstract
Coronary artery disease represents a leading cause of death worldwide, to which the coronary artery bypass graft (CABG) is the main method of treatment in advanced multiple vessel disease. The use of the internal mammary artery (IMA) as a graft insures an improved long-term survival, but impairment of chest wall perfusion often leads to surgical site infection and increased morbidity and mortality. Infrared thermography (IRT) has established itself in the past decades as a non-invasive diagnostic technique. The applications vary from veterinary to human medicine and from head to toe. In this study we used IRT in 42 patients receiving CABG to determine the changes in skin surface temperature preoperatively, two hours, 24 h and 6 days after surgery. The results showed a significant and independent drop of surface temperature 2 h after surgery on the whole surface of the chest wall, as well as a further reduction on the left side after harvesting the IMA. The temperature returned to normal after 24 h and remained so after 6 days. The study has shown that IRT is sufficiently sensitive to demonstrate the known, subtle reduction in chest wall perfusion associated with IMA harvesting.
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9
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Bioengineering silk into blood vessels. Biochem Soc Trans 2021; 49:2271-2286. [PMID: 34495327 DOI: 10.1042/bst20210359] [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: 07/01/2021] [Revised: 08/05/2021] [Accepted: 08/11/2021] [Indexed: 11/17/2022]
Abstract
The rising incidence of cardiovascular disease has increased the demand for small diameter (<6 mm) synthetic vascular grafts for use in bypass surgery. Clinically available synthetic grafts (polyethylene terephthalate and expanded polytetrafluorethylene) are incredibly strong, but also highly hydrophobic and inelastic, leading to high rates of failure when used for small diameter bypass. The poor clinical outcomes of commercial synthetic grafts in this setting have driven significant research in search of new materials that retain favourable mechanical properties but offer improved biocompatibility. Over the last several decades, silk fibroin derived from Bombyx mori silkworms has emerged as a promising biomaterial for use in vascular applications. Progress has been driven by advances in silk manufacturing practices which have allowed unprecedented control over silk strength, architecture, and the ensuing biological response. Silk can now be manufactured to mimic the mechanical properties of native arteries, rapidly recover the native endothelial cell layer lining vessels, and direct positive vascular remodelling through the regulation of local inflammatory responses. This review summarises the advances in silk purification, processing and functionalisation which have allowed the production of robust vascular grafts with promise for future clinical application.
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Karakaya C, van Asten JGM, Ristori T, Sahlgren CM, Loerakker S. Mechano-regulated cell-cell signaling in the context of cardiovascular tissue engineering. Biomech Model Mechanobiol 2021; 21:5-54. [PMID: 34613528 PMCID: PMC8807458 DOI: 10.1007/s10237-021-01521-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 09/15/2021] [Indexed: 01/18/2023]
Abstract
Cardiovascular tissue engineering (CVTE) aims to create living tissues, with the ability to grow and remodel, as replacements for diseased blood vessels and heart valves. Despite promising results, the (long-term) functionality of these engineered tissues still needs improvement to reach broad clinical application. The functionality of native tissues is ensured by their specific mechanical properties directly arising from tissue organization. We therefore hypothesize that establishing a native-like tissue organization is vital to overcome the limitations of current CVTE approaches. To achieve this aim, a better understanding of the growth and remodeling (G&R) mechanisms of cardiovascular tissues is necessary. Cells are the main mediators of tissue G&R, and their behavior is strongly influenced by both mechanical stimuli and cell-cell signaling. An increasing number of signaling pathways has also been identified as mechanosensitive. As such, they may have a key underlying role in regulating the G&R of tissues in response to mechanical stimuli. A more detailed understanding of mechano-regulated cell-cell signaling may thus be crucial to advance CVTE, as it could inspire new methods to control tissue G&R and improve the organization and functionality of engineered tissues, thereby accelerating clinical translation. In this review, we discuss the organization and biomechanics of native cardiovascular tissues; recent CVTE studies emphasizing the obtained engineered tissue organization; and the interplay between mechanical stimuli, cell behavior, and cell-cell signaling. In addition, we review past contributions of computational models in understanding and predicting mechano-regulated tissue G&R and cell-cell signaling to highlight their potential role in future CVTE strategies.
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Affiliation(s)
- Cansu Karakaya
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Jordy G M van Asten
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Tommaso Ristori
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands.,Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - Cecilia M Sahlgren
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands.,Faculty of Science and Engineering, Biosciences, Åbo Akademi, Turku, Finland
| | - Sandra Loerakker
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands. .,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands.
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