1
|
Montagner G, Barbazza A, Lugas AT, Terzini M, Serino G, Bignardi C, Cacciatore M, Vida VL, Padalino MA, Trojan D. Decellularized cryopreserved human pericardium: a validation study towards tissue bank practice. Cell Tissue Bank 2024; 25:401-410. [PMID: 36696047 PMCID: PMC11142958 DOI: 10.1007/s10561-023-10072-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/18/2023] [Indexed: 01/26/2023]
Abstract
Pericardial patches are currently used as reconstructive material in cardiac surgery for surgical treatment of cardiac septal defects. Autologous pericardial patches, either treated with glutaraldehyde or not, can be used as an alternative to synthetic materials or xenograft in congenital septal defects repair. The availability of an allogenic decellularized pericardium could reduce complication during and after surgery and could be a valid alternative. Decellularization of allogenic tissues aims at reducing the immunogenic reaction that might trigger inflammation and tissue calcification over time. The ideal graft for congenital heart disease repair should be biocompatible, mechanically resistant, non-immunogenic, and should have the ability to growth with the patients. The aim of the present study is the evaluation of the efficacy of a new decellularization protocol of homologous pericardium, even after cryopreservation. The technique has proven to be suitable as a tissue bank procedure and highly successful in the removal of cells and nucleic acids content, but also in the preservation of collagen and biomechanical properties of the human pericardium.
Collapse
Affiliation(s)
| | | | - Andrea Tancredi Lugas
- PolitoBIOMed Lab, Politecnico Di Torino, Turin, Italy
- Department of Mechanical and Aerospace Engineering, Politecnico Di Torino, Turin, Italy
| | - Mara Terzini
- PolitoBIOMed Lab, Politecnico Di Torino, Turin, Italy
- Department of Mechanical and Aerospace Engineering, Politecnico Di Torino, Turin, Italy
| | - Gianpaolo Serino
- PolitoBIOMed Lab, Politecnico Di Torino, Turin, Italy
- Department of Mechanical and Aerospace Engineering, Politecnico Di Torino, Turin, Italy
| | - Cristina Bignardi
- PolitoBIOMed Lab, Politecnico Di Torino, Turin, Italy
- Department of Mechanical and Aerospace Engineering, Politecnico Di Torino, Turin, Italy
| | - Matilde Cacciatore
- Unità Operativa Complessa Anatomia Patologica, AULSS2 Marca Trevigiana, Ospedale Di Treviso, Treviso, Italy
| | - Vladimiro L Vida
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Massimo A Padalino
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Diletta Trojan
- Fondazione Banca Dei Tessuti del Veneto Onlus, Treviso, Italy
| |
Collapse
|
2
|
Eildermann K, Durashov M, Kuschnerus K, Poppe A, Weixler V, Photiadis J, Sigler M, Murin P. Tissue-engineered and autologous pericardium in congenital heart surgery: comparative histopathological study of human vascular explants. Eur J Cardiothorac Surg 2024; 65:ezae027. [PMID: 38290761 PMCID: PMC10924714 DOI: 10.1093/ejcts/ezae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/06/2024] [Accepted: 01/26/2024] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVES The goal of this histological study was to assess the biocompatibility of vascular patches used in the repair of congenital heart defects. METHODS We examined tissue-engineered bovine (n = 7) and equine (n = 7) patches and autologous human pericardium (n = 7), all explanted due to functional issues or follow-up procedures. Techniques like Movat-Verhoeff, von Kossa and immunohistochemical staining were used to analyse tissue composition, detect calcifications and identify immune cells. A semi-quantitative scoring system was implemented to evaluate the biocompatibility aspects, thrombus formation, extent of pannus, inflammation of pannus, cellular response to patch material, patch degradation, calcification and neoadventitial inflammation. RESULTS We observed distinct material degradation patterns among types of patches. Bovine patches showed collagen disintegration and exudate accumulation, whereas equine patches displayed edematous swelling and material dissolution. Biocompatibility scores were lower in terms of cellular response, degradation and overall score for human autologous pericardial patches compared to tissue-engineered types. The extent of pannus formation was not influenced by the type of patch. Bovine patches had notable calcifications causing tissue hardening, and foreign body giant cells were more frequently seen in equine patches. Plasma cells were frequently detected in the neointimal tissue of engineered patches. CONCLUSIONS Our results confirm the superior biocompatibility of human autologous patches and highlight discernible variations in the changes of patch material and the cellular response to patch material between bovine and equine patches. Our approach implements the semi-quantitative scoring of various aspects of biocompatibility, facilitating a comparative quantitative analysis across all types of patches, despite their inherent differences.
Collapse
Affiliation(s)
- Katja Eildermann
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August University Göttingen, Göttingen, Germany
| | - Maksim Durashov
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August University Göttingen, Göttingen, Germany
| | - Kira Kuschnerus
- Department of Congenital Heart Surgery—Pediatric Heart Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
| | - Andrea Poppe
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August University Göttingen, Göttingen, Germany
| | - Viktoria Weixler
- Department of Congenital Heart Surgery—Pediatric Heart Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
| | - Joachim Photiadis
- Department of Congenital Heart Surgery—Pediatric Heart Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
| | - Matthias Sigler
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August University Göttingen, Göttingen, Germany
| | - Peter Murin
- Department of Congenital Heart Surgery—Pediatric Heart Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
| |
Collapse
|
3
|
Birbach M, Fedorowicz M, Gałkowska EM, Powirska A, Kozłowski M, Mozol K, Wasiak A, Maruszewski B, Kansy A. Using cryopreserved allogeneic pericardium to repair congenital heart defects in children. Cell Tissue Bank 2024; 25:99-109. [PMID: 37792171 PMCID: PMC10902029 DOI: 10.1007/s10561-023-10089-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/01/2023] [Indexed: 10/05/2023]
Abstract
Patches prepared from autologous, allogeneic, or xenogeneic tissues are widely used in the repair of congenital heart defects in children. Since 2002, cryopreserved allogeneic pericardial patches have been prepared in our institution as an alternative to commercially available patches. This study retrospectively reviewed donor and patient data concerning cryopreservation time and the clinical use of the pericardium in 382 children who were operated on at a single center between 2004 and 2021. There were 177 donors: 98 males and 79 females. The median donor age was 13 years (range: 1 month to 53 years) and the median cryopreservation time was 72 days (range: 3-685). There were 382 pediatric patients: 224 males and 158 females. The median patient age was 1 month (range: 3 days to 17.8 years). The patches were used for primary surgeries in 228 patients and for reoperations in 154. The patches were implanted into the right heart or venous circulation in 209 patients, the left heart or arterial circulation in 246 patients, and both sides of the circulatory system in 73. Extracardiac patch implantation was performed in 339 patients, intracardiac in 79 patients, and both intracardiac and extracardiac in 36 patients. Our study presents a single-center experience in the use of cryopreserved allogeneic pericardium. The pericardium can be used on the systemic and pulmonary sides of the circulatory system, in either extracardiac or intracardiac positions. However, there is no uniform strategy for selecting the "patch of choice" for correcting congenital heart defects in children, especially since there are few studies comparing several types of patches.
Collapse
Affiliation(s)
- Mariusz Birbach
- Department of Pediatric Cardiothoracic Surgery, The Children's Memorial Health Institute, Aleja Dzieci Polskich 20, 04-730, Warsaw, Poland.
- Allograft Heart Valve Cryobank, The Children's Memorial Health Institute, Aleja Dzieci Polskich 20, 04-730, Warsaw, Poland.
| | - Maciej Fedorowicz
- Allograft Heart Valve Cryobank, The Children's Memorial Health Institute, Aleja Dzieci Polskich 20, 04-730, Warsaw, Poland
| | - Ewa M Gałkowska
- Allograft Heart Valve Cryobank, The Children's Memorial Health Institute, Aleja Dzieci Polskich 20, 04-730, Warsaw, Poland
| | - Agnieszka Powirska
- Allograft Heart Valve Cryobank, The Children's Memorial Health Institute, Aleja Dzieci Polskich 20, 04-730, Warsaw, Poland
| | - Michał Kozłowski
- Department of Pediatric Cardiothoracic Surgery, The Children's Memorial Health Institute, Aleja Dzieci Polskich 20, 04-730, Warsaw, Poland
| | - Krzysztof Mozol
- Department of Pediatric Cardiothoracic Surgery, The Children's Memorial Health Institute, Aleja Dzieci Polskich 20, 04-730, Warsaw, Poland
| | - Aleksandra Wasiak
- Department of Pediatric Cardiothoracic Surgery, The Children's Memorial Health Institute, Aleja Dzieci Polskich 20, 04-730, Warsaw, Poland
| | - Bohdan Maruszewski
- Department of Pediatric Cardiothoracic Surgery, The Children's Memorial Health Institute, Aleja Dzieci Polskich 20, 04-730, Warsaw, Poland
| | - Andrzej Kansy
- Department of Pediatric Cardiothoracic Surgery, The Children's Memorial Health Institute, Aleja Dzieci Polskich 20, 04-730, Warsaw, Poland
| |
Collapse
|
4
|
Bhende VV, Sharma TS, Krishnakumar M, Ramaswamy AS, Bilgi K, Pathan SR. The Utility of Invengenx® Bovine Patch for Right Ventricular Outflow Tract (RVOT) Reconstruction and Augmentation in the Surgical Management of Tetralogy of Fallot (TOF): A Contemporary Study and Review of the Literature. Cureus 2023; 15:e46882. [PMID: 37841993 PMCID: PMC10568359 DOI: 10.7759/cureus.46882] [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: 10/12/2023] [Indexed: 10/17/2023] Open
Abstract
Background and objective Complex congenital heart diseases (CHDs), such as the tetralogy of Fallot (TOF), often warrant reconstruction and augmentation of the right ventricular outflow tract (RVOT). This procedure requires the use of both synthetic and natural materials. However, finding the ideal material for tissue implants can be challenging. Biological materials often face issues such as tissue degeneration, calcium deposition, antigenicity, rejection, shrinkage, and fibrosis. These issues can lead to complications such as stenosis and insufficiency, potentially requiring early reoperations. In light of this, this study aimed to investigate the effectiveness of the Invengenx® bovine patch for RVOT reconstruction and augmentation. Methods This was a retrospective observational study conducted among eight children who underwent TOF correction cardiac surgery. Their demographic and clinical characteristics, intraoperative findings, and postoperative follow-up results at six months were collected from the hospital patient database. Results There were no deaths or complications in this study. We observed a significant reduction in the gradient across the pulmonary valve and the outflow tract at six months post-procedure. The analysis demonstrated that the Invengenx® bovine patch was successful and did not lead to any complications. Conclusions This study demonstrates the safety and efficacy of this engineered bovine pericardial patch (Invengenx®) as a cardiovascular substitute for surgical repair of both simple and more complex congenital cardiac defects.
Collapse
Affiliation(s)
- Vishal V Bhende
- Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna Hospital, Bhaikaka University, Gokal Nagar, Karamsad, IND
| | - Tanishq S Sharma
- Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna Hospital, Bhaikaka University, Gokal Nagar, Karamsad, IND
- Community Medicine, SAL Institute of Medical Sciences, Ahmedabad, IND
| | | | | | - Kanchan Bilgi
- Neuroanaesthesiology, People Tree Hospitals, Bengaluru, IND
| | - Sohilkhan R Pathan
- Clinical Research Services, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna Hospital, Bhaikaka University, Gokal Nagar, Karamsad, IND
| |
Collapse
|
5
|
Schwartzman WE, Jimenez M, Yates AR, Armstrong AK, Salavitabar A, Hor KK, Hoerstrup S, Emmert MY, Shinoka T, Carrillo SA, Breuer CK, Kelly JM. Patch Materials for Pulmonary Artery Arterioplasty and Right Ventricular Outflow Tract Augmentation: A Review. Pediatr Cardiol 2023; 44:973-995. [PMID: 37149833 PMCID: PMC10224813 DOI: 10.1007/s00246-023-03152-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/20/2023] [Indexed: 05/08/2023]
Abstract
Patch augmentation of the right ventricular outflow tract (RVOT) and pulmonary artery (PA) arterioplasty are relatively common procedures in the surgical treatment of patients with congenital heart disease. To date, several patch materials have been applied with no agreed upon clinical standard. Each patch type has unique performance characteristics, cost, and availability. There are limited data describing the various advantages and disadvantages of different patch materials. We performed a review of studies describing the clinical performance of various RVOT and PA patch materials and found a limited but growing body of literature. Short-term clinical performance has been reported for a multitude of patch types, but comparisons are limited by inconsistent study design and scarce histologic data. Standard clinical criteria for assessment of patch efficacy and criteria for intervention need to be applied across patch types. The field is progressing with improvements in outcomes due to newer patch technologies focused on reducing antigenicity and promoting neotissue formation which may have the ability to grow, remodel, and repair.
Collapse
Affiliation(s)
| | - Michael Jimenez
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Andrew R Yates
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Aimee K Armstrong
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Arash Salavitabar
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Kan K Hor
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Simon Hoerstrup
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
| | - Maximilian Y Emmert
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Toshiharu Shinoka
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Sergio A Carrillo
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Christopher K Breuer
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - John M Kelly
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA.
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
| |
Collapse
|
6
|
Dear colleagues, we need to know your results…. Ann Thorac Surg 2021; 113:190-191. [PMID: 33675709 DOI: 10.1016/j.athoracsur.2021.01.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 11/23/2022]
|