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Aljassam Y, Caputo M, Biglino G. Surgical Patching in Congenital Heart Disease: The Role of Imaging and Modelling. Life (Basel) 2023; 13:2295. [PMID: 38137896 PMCID: PMC10745019 DOI: 10.3390/life13122295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
In congenital heart disease, patches are not tailored to patient-specific anatomies, leading to shape mismatch with likely functional implications. The design of patches through imaging and modelling may be beneficial, as it could improve clinical outcomes and reduce the costs associated with redo procedures. Whilst attention has been paid to the material of the patches used in congenital surgery, this review outlines the current knowledge on this subject and isolated experimental work that uses modelling and imaging-derived information (including 3D printing) to inform the design of the surgical patch.
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Affiliation(s)
- Yousef Aljassam
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol BS2 8HW, UK;
| | - Massimo Caputo
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol BS2 8HW, UK;
- Cardiac Surgery, University Hospitals Bristol & Weston, NHS Foundation Trust, Bristol BS2 8HW, UK
| | - Giovanni Biglino
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol BS2 8HW, UK;
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Botes L, Laker L, Dohmen PM, van den Heever JJ, Jordaan CJ, Lewies A, Smit FE. Advantages of decellularized bovine pericardial scaffolds compared to glutaraldehyde fixed bovine pericardial patches demonstrated in a 180-day implant ovine study. Cell Tissue Bank 2022; 23:791-805. [PMID: 35037183 DOI: 10.1007/s10561-021-09988-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 12/19/2021] [Indexed: 12/12/2022]
Abstract
Glutaraldehyde (GA)-fixed bovine pericardial patches remain the cardiovascular industry standard despite reports of degradation, thickening, inflammation, calcification and lack of tissue remodelling. Decellularization provides the opportunity to attenuate some of these immune-mediated processes. This study compared the mechanical and morphological integrity of bovine pericardium that is GA-fixated (Glycar® patches) or decellularized (BPS), using a proprietary protocol, following implantation in an ovine model. The impact of the processing methods on tissue strength and morphology was assessed prior to implantation. Pericardial patches were then implanted in the descending aorta and main pulmonary artery of juvenile sheep (n = 6 per group) for 180 days, and clinically evaluated using echocardiography. At explanation, patches were evaluated for strength, calcification and biological interaction. Histology demonstrated a wave-like appearance of well-separated collagen fibers for BPS scaffolds that provided pore sizes adequate to promote fibroblast infiltration. The collagen of the Glycar® patches showed loss of collagen fiber integrity, making the collagen densely compacted, contributing to insignificant recipient cell infiltration. The clinical performance of both groups was excellent, and echocardiography confirmed the absence of aneurysm formation, calcification and degeneration. Explanted Glycar® patches demonstrated cells in abundance within the fibrous encapsulation that separated the implant from the host tissue. More importantly, the fibrous encapsulation also contributed to patch thickening of both the explanted aorta and pulmonary patches. The decellularized pericardial scaffolds demonstrated recellularization, resistance to calcification, re-endothelialization and adequate strength after 180-day implantation. The proprietary decellularization protocol produced pericardial scaffolds that could be considered as an alternative to GA-fixed pericardial patches.
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Affiliation(s)
- L Botes
- Department of Health Sciences, Central University of Technology, Free State (CUT) Private Bag X20539, Bloemfontein, 9300, South Africa.
| | - L Laker
- Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State (UFS), (Internal Box G32), P.O. Box 339, Bloemfontein, 9300, South Africa
| | - P M Dohmen
- Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State (UFS), (Internal Box G32), P.O. Box 339, Bloemfontein, 9300, South Africa.,Klinikdirektor (k), Klinik und Poliklinik für Herzchirurgie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - J J van den Heever
- Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State (UFS), (Internal Box G32), P.O. Box 339, Bloemfontein, 9300, South Africa
| | - C J Jordaan
- Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State (UFS), (Internal Box G32), P.O. Box 339, Bloemfontein, 9300, South Africa
| | - A Lewies
- Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State (UFS), (Internal Box G32), P.O. Box 339, Bloemfontein, 9300, South Africa
| | - F E Smit
- Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State (UFS), (Internal Box G32), P.O. Box 339, Bloemfontein, 9300, South Africa
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Zhuravleva IY, Karpova EV, Oparina LA, Poveschenko OV, Surovtseva MA, Titov AT, Ksenofontov AL, Vasilieva MB, Kuznetsova EV, Bogachev-Prokophiev AV, Trofimov BA. Cross-linking method using pentaepoxide for improving bovine and porcine bioprosthetic pericardia: A multiparametric assessment study. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 118:111473. [PMID: 33255052 DOI: 10.1016/j.msec.2020.111473] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/14/2020] [Accepted: 08/31/2020] [Indexed: 12/16/2022]
Abstract
Bioprosthetic heart valves made from bovine pericardium (BP) and porcine pericardium (PP) preserved with glutaraldehyde (GA) are commonly used in valve surgeries but prone to calcification in many patients. In this study, we compared BP and PP preserved with GA, ethylene glycol diglycidyl ether (DE), and 1,2,3,4,6-penta-O-{1-[2-(glycidyloxy)ethoxy]ethyl}-d-glucopyranose (PE). We studied the stabilities of DE and PE in preservation media along with the amino acid (AA) compositions, Fourier-transform infrared spectra, mechanical properties, surface morphologies, thermal stability, calcification, and the cytocompatibility of BP and PP treated with 0.625% GA, 5% DE, 2% PE, and alternating 5% DE and 2% PE for 3 + 11 d and 10 + 10 d, respectively. Both epoxides were stable in the water-buffer solutions (pH 7.4). DE provided high linkage densities in BP and PP owing to reactions with Hyl, Lys, His, Arg, Ser, and Tyr. PE reacted weakly with these AAs but strongly with Met. High cross-linking density obtained using the 10 d + 10 d method provided satisfactory thermal stability of biomaterials. The epoxy preservations improved cytocompatibility and resistance to calcification. PE enhanced the stress/strain properties of the xenogeneic pericardia, perhaps by forming nanostructures that were clearly visualised in BP using scanning electron microscopy. The DE + PE combination, in an alternating cross-linking manner, thus constitutes a promising option for developing bioprosthetic pericardia.
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Affiliation(s)
- Irina Yu Zhuravleva
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, 15 Rechkunovskaya St., Novosibirsk 630055, Russia.
| | - Elena V Karpova
- N. Vorozhtsov Institute of Organic Chemistry of SB RAS, 9 Lavrentyev Avenue, Novosibirsk 630090, Russia
| | - Ludmila A Oparina
- A. Favorsky Institute of Chemistry SB RAS, 1 Favorsky St., Irkutsk 664033, Russia
| | - Olga V Poveschenko
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, 15 Rechkunovskaya St., Novosibirsk 630055, Russia
| | - Maria A Surovtseva
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, 15 Rechkunovskaya St., Novosibirsk 630055, Russia
| | - Anatoly T Titov
- V. Sobolev Institute of Geology and Mineralogy SB RAS, 3 Academician Koptyug Avenue, Novosibirsk 630090, Russia
| | - Alexander L Ksenofontov
- A. Belozersky Research Institute of Physico-Chemical Biology MSU, House 1, Building 40 Leninskye gory, Moscow 119992, Russia
| | - Maria B Vasilieva
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, 15 Rechkunovskaya St., Novosibirsk 630055, Russia
| | - Elena V Kuznetsova
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, 15 Rechkunovskaya St., Novosibirsk 630055, Russia
| | - Alexander V Bogachev-Prokophiev
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, 15 Rechkunovskaya St., Novosibirsk 630055, Russia
| | - Boris A Trofimov
- A. Favorsky Institute of Chemistry SB RAS, 1 Favorsky St., Irkutsk 664033, Russia
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