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Armfield D, Boxwell S, McNamara L, Cook S, Conway S, Celikin M, Cardiff P. Effect of bioprosthetic leaflet anisotropy on stent dynamics of Transcatheter Aortic Valve Replacement devices. J Mech Behav Biomed Mater 2024; 157:106650. [PMID: 39018917 DOI: 10.1016/j.jmbbm.2024.106650] [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: 06/22/2023] [Revised: 06/28/2024] [Accepted: 07/01/2024] [Indexed: 07/19/2024]
Abstract
The assessment of stent fatigue in Transcatheter Aortic Valve Replacement (TAVR) systems is critical for the design of next-generation devices, both in vitro and in vivo. The mechanical properties of the bioprosthetic heart valves (BHVs) have a significant impact on the fatigue life of the metallic stent and thus must be taken into consideration when evaluating new TAVR device designs. This study aims to investigate the relationship between BHV anisotropic behaviour and the asymmetric deflections of the stent frame observed during in vitro testing. An explicit dynamics finite element model of the nitinol stent with attached bioprosthetic valve leaflets was developed to evaluate the deflections of the TAVR device under haemodynamic loading. Our results demonstrate that pericardium behaviour plays a dominant role in determining stent frame deflection. The anisotropic behaviour of the leaflets, resulting from collagen fibre orientation, affects the extent of deflection encountered by each commissure of the frame. This leads to asymmetric variation in frame deflection that can influence the overall fatigue life of the nitinol stent. This study highlights the importance of considering both the flexible nature of the metallic stent as well as the leaflet anisotropic behaviour in the design and fatigue assessment of TAVR systems.
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Affiliation(s)
- Dylan Armfield
- School of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland; SFI I-Form Centre, University College Dublin, Dublin, Ireland.
| | - Sam Boxwell
- School of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland; Mechanobiology and Medical Device Research Group, Department of Biomedical Engineering, University of Galway, Galway, Ireland
| | - Laoise McNamara
- Mechanobiology and Medical Device Research Group, Department of Biomedical Engineering, University of Galway, Galway, Ireland
| | - Scott Cook
- Structural Heart Division, Boston Scientific Corporation, Galway, Ireland
| | - Shane Conway
- Structural Heart Division, Boston Scientific Corporation, Galway, Ireland
| | - Mert Celikin
- School of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland; SFI I-Form Centre, University College Dublin, Dublin, Ireland
| | - Philip Cardiff
- School of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland; SFI I-Form Centre, University College Dublin, Dublin, Ireland.
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2
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Donmazov S, Saruhan EN, Pekkan K, Piskin S. Review of Machine Learning Techniques in Soft Tissue Biomechanics and Biomaterials. Cardiovasc Eng Technol 2024:10.1007/s13239-024-00737-y. [PMID: 38956008 DOI: 10.1007/s13239-024-00737-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 05/28/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND AND OBJECTIVE Advanced material models and material characterization of soft biological tissues play an essential role in pre-surgical planning for vascular surgeries and transcatheter interventions. Recent advances in heart valve engineering, medical device and patch design are built upon these models. Furthermore, understanding vascular growth and remodeling in native and tissue-engineered vascular biomaterials, as well as designing and testing drugs on soft tissue, are crucial aspects of predictive regenerative medicine. Traditional nonlinear optimization methods and finite element (FE) simulations have served as biomaterial characterization tools combined with soft tissue mechanics and tensile testing for decades. However, results obtained through nonlinear optimization methods are reliable only to a certain extent due to mathematical limitations, and FE simulations may require substantial computing time and resources, which might not be justified for patient-specific simulations. To a significant extent, machine learning (ML) techniques have gained increasing prominence in the field of soft tissue mechanics in recent years, offering notable advantages over conventional methods. This review article presents an in-depth examination of emerging ML algorithms utilized for estimating the mechanical characteristics of soft biological tissues and biomaterials. These algorithms are employed to analyze crucial properties such as stress-strain curves and pressure-volume loops. The focus of the review is on applications in cardiovascular engineering, and the fundamental mathematical basis of each approach is also discussed. METHODS The review effort employed two strategies. First, the recent studies of major research groups actively engaged in cardiovascular soft tissue mechanics are compiled, and research papers utilizing ML and deep learning (DL) techniques were included in our review. The second strategy involved a standard keyword search across major databases. This approach provided 11 relevant ML articles, meticulously selected from reputable sources including ScienceDirect, Springer, PubMed, and Google Scholar. The selection process involved using specific keywords such as "machine learning" or "deep learning" in conjunction with "soft biological tissues", "cardiovascular", "patient-specific," "strain energy", "vascular" or "biomaterials". Initially, a total of 25 articles were selected. However, 14 of these articles were excluded as they did not align with the criteria of focusing on biomaterials specifically employed for soft tissue repair and regeneration. As a result, the remaining 11 articles were categorized based on the ML techniques employed and the training data utilized. RESULTS ML techniques utilized for assessing the mechanical characteristics of soft biological tissues and biomaterials are broadly classified into two categories: standard ML algorithms and physics-informed ML algorithms. The standard ML models are then organized based on their tasks, being grouped into Regression and Classification subcategories. Within these categories, studies employ various supervised learning models, including support vector machines (SVMs), bagged decision trees (BDTs), artificial neural networks (ANNs) or deep neural networks (DNNs), and convolutional neural networks (CNNs). Additionally, the utilization of unsupervised learning approaches, such as autoencoders incorporating principal component analysis (PCA) and/or low-rank approximation (LRA), is based on the specific characteristics of the training data. The training data predominantly consists of three types: experimental mechanical data, including uniaxial or biaxial stress-strain data; synthetic mechanical data generated through non-linear fitting and/or FE simulations; and image data such as 3D second harmonic generation (SHG) images or computed tomography (CT) images. The evaluation of performance for physics-informed ML models primarily relies on the coefficient of determinationR 2 . In contrast, various metrics and error measures are utilized to assess the performance of standard ML models. Furthermore, our review includes an extensive examination of prevalent biomaterial models that can serve as physical laws for physics-informed ML models. CONCLUSION ML models offer an accurate, fast, and reliable approach for evaluating the mechanical characteristics of diseased soft tissue segments and selecting optimal biomaterials for time-critical soft tissue surgeries. Among the various ML models examined in this review, physics-informed neural network models exhibit the capability to forecast the mechanical response of soft biological tissues accurately, even with limited training samples. These models achieve highR 2 values ranging from 0.90 to 1.00. This is particularly significant considering the challenges associated with obtaining a large number of living tissue samples for experimental purposes, which can be time-consuming and impractical. Additionally, the review not only discusses the advantages identified in the current literature but also sheds light on the limitations and offers insights into future perspectives.
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Affiliation(s)
- Samir Donmazov
- Department of Mathematics, University of Kentucky, Lexington, KY, 40506, USA
| | - Eda Nur Saruhan
- Department of Computer Science and Engineering, Koc University, Sariyer, Istanbul, Turkey
| | - Kerem Pekkan
- Department of Mechanical Engineering, Koc University, Sariyer, Istanbul, Turkey
| | - Senol Piskin
- Department of Mechanical Engineering, Faculty of Engineering and Natural Sciences, Istinye University, Vadi Kampusu, Sariyer, 34396, Istanbul, Turkey.
- Modeling, Simulation and Extended Reality Laboratory, Faculty of Engineering and Natural Sciences, Istinye University, Vadi Kampusu, Sariyer, 34396, Istanbul, Turkey.
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Shi S, Hu M, Peng X, Cheng C, Feng S, Pu X, Yu X. Double crosslinking decellularized bovine pericardium of dialdehyde chondroitin sulfate and zwitterionic copolymer for bioprosthetic heart valves with enhanced antithrombogenic, anti-inflammatory and anti-calcification properties. J Mater Chem B 2024; 12:3417-3435. [PMID: 38525920 DOI: 10.1039/d4tb00074a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Due to the increasing aging population and the advancements in transcatheter aortic valve replacement (TAVR), the use of bioprosthetic heart valves (BHVs) in patients diagnosed with valvular disease has increased substantially. Commercially available glutaraldehyde (GA) cross-linked biological valves suffer from reduced durability due to a combination of factors, including the high cell toxicity of GA, subacute thrombus, inflammation and calcification. In this study, oxidized chondroitin sulfate (OCS), a natural polysaccharide derivative, was used to replace GA to cross-link decellularized bovine pericardium (DBP), carrying out the first crosslinking of DBP to obtain OCS-BP. Subsequently, the zwitterion radical copolymerization system was introduced in situ to perform double cross-linking to obtain double crosslinked BHVs with biomimetic modification (P(APM/MPC)-OCS-BP). P(APM/MPC)-OCS-BP presented enhanced mechanical properties, collagen stability and enzymatic degradation resistance due to double crosslinking. The ex vivo AV-shunt assay and coagulation factors test suggested that P(APM/MPC)-OCS-BP exhibited excellent anticoagulant and antithrombotic properties due to the introduction of P(APM/MPC). P(APM/MPC)-OCS-BP also showed good HUVEC-cytocompatibility due to the substantial reduction of its residual aldehyde group. The subcutaneous implantation also demonstrated that P(APM/MPC)-OCS-BP showed a weak inflammatory response due to the anti-inflammatory effect of OCS. Finally, in vivo and in vitro results revealed that P(APM/MPC)-OCS-BP exhibited an excellent anti-calcification property. In a word, this simple cooperative crosslinking strategy provides a novel solution to obtain BHVs with good mechanical properties, and HUVEC-cytocompatibility, anti-coagulation, anti-inflammatory and anti-calcification properties. It might be a promising alternative to GA-fixed BP and exhibited good prospects in clinical applications.
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Affiliation(s)
- Shubin Shi
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, P. R. China
| | - Mengyue Hu
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, P. R. China
| | - Xu Peng
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, P. R. China
- Experimental and Research Animal Institute, Sichuan University, Chengdu 610065, P. R. China
| | - Can Cheng
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, P. R. China
| | - Shaoxiong Feng
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, P. R. China
| | - Xinyun Pu
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, P. R. China
| | - Xixun Yu
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, P. R. China
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Ramella A, Lissoni V, Bridio S, Rodriguez Matas JF, Trimarchi S, Grossi B, Stefanini GG, Migliavacca F, Luraghi G. On the necessity to include arterial pre-stress in patient-specific simulations of minimally invasive procedures. Biomech Model Mechanobiol 2024; 23:525-537. [PMID: 38063955 DOI: 10.1007/s10237-023-01789-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/27/2023] [Indexed: 03/26/2024]
Abstract
Transcatheter aortic valve implantation (TAVI) and thoracic endovascular aortic repair (TEVAR) are minimally invasive procedures for treating aortic valves and diseases. Finite element simulations have proven to be valuable tools in predicting device-related complications. In the literature, the inclusion of aortic pre-stress has not been widely investigated. It plays a crucial role in determining the biomechanical response of the vessel and the device-tissue interaction. This study aims at demonstrating how and when to include the aortic pre-stress in patient-specific TAVI and TEVAR simulations. A percutaneous aortic valve and a stent-graft were implanted in aortic models reconstructed from patient-specific CT scans. Two scenarios for each patient were compared, i.e., including and neglecting the wall pre-stress. The neglection of pre-stress underestimates the contact pressure of 48% and 55%, the aorta stresses of 162% and 157%, the aorta strains of 77% and 21% for TAVI and TEVAR models, respectively. The stent stresses are higher than 48% with the pre-stressed aorta in TAVI simulations; while, similar results are obtained in TEVAR cases. The distance between the device and the aorta is similar with and without pre-stress. The inclusion of the aortic wall pre-stress has the capability to give a better representation of the biomechanical behavior of the arterial tissues and the implanted device. It is suggested to include this effect in patient-specific simulations replicating the procedures.
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Affiliation(s)
- Anna Ramella
- Computational Biomechanics Laboratory - LaBS, Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Piazza L. da Vinci 32, 20133, Milan, Italy
| | - Vittorio Lissoni
- Computational Biomechanics Laboratory - LaBS, Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Piazza L. da Vinci 32, 20133, Milan, Italy
| | - Sara Bridio
- Computational Biomechanics Laboratory - LaBS, Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Piazza L. da Vinci 32, 20133, Milan, Italy
| | - Jose Felix Rodriguez Matas
- Computational Biomechanics Laboratory - LaBS, Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Piazza L. da Vinci 32, 20133, Milan, Italy
| | - Santi Trimarchi
- Section of Vascular Surgery, Cardio Thoracic Vascular Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Via Della Commenda 19, 20122, Milan, Italy
| | - Benedetta Grossi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
| | - Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Francesco Migliavacca
- Computational Biomechanics Laboratory - LaBS, Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Piazza L. da Vinci 32, 20133, Milan, Italy
| | - Giulia Luraghi
- Computational Biomechanics Laboratory - LaBS, Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Piazza L. da Vinci 32, 20133, Milan, Italy.
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Suárez S, López-Campos JA, Fernández JR, Segade A. Nonlocal damage evaluation of a sigmoid-based damage model for fibrous biological soft tissues. Biomech Model Mechanobiol 2024; 23:655-674. [PMID: 38158483 DOI: 10.1007/s10237-023-01798-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/22/2023] [Indexed: 01/03/2024]
Abstract
The comprehension and modeling of the mechanical behavior of soft biological tissues are essential due to their clinical applications. This knowledge is essential for predicting tissue responses accurately and enhancing our ability to compute the behavior of biological structures and bio-prosthetic devices under specific loading conditions. The current research is centered on modeling the initiation and progression of soft tissues damage, which typically exhibit intricate anisotropic and nonlinear elastic characteristics. For this purpose, the following study presents a comparative analysis of the computational performance of two distinct damage modeling techniques. The first technique employs a well-established damage model, based on a piece-wise exponential damage function as proposed by Calvo et al. (Int J Numer Methods Eng 69:2036-2057, 2007. https://doi.org/10.1002/nme.1825 ). The second approach adopts a sigmoid function, as proposed by López-Campos et al. (Comput Methods Biomech Biomed Eng 23(6):213-223. https://doi.org/10.1080/10255842.2019.1710742 ). The aim of this study is to verify the validity of the López-Campos sigmoid-based damage model to be used in finite element simulation, the implementation of which is unknown. For this proposal, both models were implemented within a commercial Finite Element software package, and their responses to local and non-local damage algorithms were assessed in depth through two standard benchmark tests: a plate with a hole and a ball burst. The results of this study indicate that, for a wide range of cases, such as in-plane stresses, out-plane stresses, stress concentration and contact, all over large displacement conditions, the López-Campos damage model shows a good response to non-local algorithms achieving mesh independence and convergence in all these cases. The results obtained are in line with those obtained for the Calvo's damage model, showing, in addition, larger deformations under in-plane stress and stress concentration conditions and a lower number of iterations under out-plane stress and contact conditions. Consequently, the López-Campos' damage model emerges as a valuable and useful tool in the field of mechanical damage research in biological systems.
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Affiliation(s)
- Sofía Suárez
- CINTECX, Department of Mechanical Engineering, Universidade de Vigo, Campus As Lagoas, Marcosende, 36310, Vigo, Pontevedra, Spain.
- Design and Numerical Simulation Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Hospital Álvaro Cunqueiro, Carretera Clara Campoamor 341, Tecnical Building 2º Floor, 36312, Vigo, Pontevedra, Spain.
| | - Jose A López-Campos
- CINTECX, Department of Mechanical Engineering, Universidade de Vigo, Campus As Lagoas, Marcosende, 36310, Vigo, Pontevedra, Spain
- Design and Numerical Simulation Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Hospital Álvaro Cunqueiro, Carretera Clara Campoamor 341, Tecnical Building 2º Floor, 36312, Vigo, Pontevedra, Spain
| | - Jose R Fernández
- Design and Numerical Simulation Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Hospital Álvaro Cunqueiro, Carretera Clara Campoamor 341, Tecnical Building 2º Floor, 36312, Vigo, Pontevedra, Spain
- Department of Applied Mathematics I, Industrial Engineering School, Universidade de Vigo, Campus As Lagoas, Marcosende, 36310, Vigo, Pontevedra, Spain
| | - Abraham Segade
- CINTECX, Department of Mechanical Engineering, Universidade de Vigo, Campus As Lagoas, Marcosende, 36310, Vigo, Pontevedra, Spain
- Design and Numerical Simulation Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Hospital Álvaro Cunqueiro, Carretera Clara Campoamor 341, Tecnical Building 2º Floor, 36312, Vigo, Pontevedra, Spain
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Kim Y, Pyo WK, Kim WK, Suh GY, Kang K, Lee SH. A parametric study regarding structural design of a bioprosthetic aortic valve by 3D fluid-structure interaction simulations. Heliyon 2024; 10:e27310. [PMID: 38509976 PMCID: PMC10951528 DOI: 10.1016/j.heliyon.2024.e27310] [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: 11/30/2023] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/22/2024] Open
Abstract
Since the introduction of transcatheter aortic valve (AV) implantation as a viable option, surgical bioprosthetic AVs have recently started incorporating shorter struts considering future valve-in-valve procedures. However, the effect of leaflet coaptation geometry on the longevity of these valves remains unexplored. To address this gap, we performed a finite element analysis on bioprosthetic AVs with varying strut heights using a two-way fluid-structure interaction method. To establish a baseline, we used a standard height based on a rendered platform image of the CE PERIMOUNT Magna Ease valve from Edward Lifesciences in Irvine, CA. Bovine pericardium properties were assigned to the leaflets, while normal saline properties were used as the recirculating fluid in hemodynamic simulations. The physiological pressure profile of the cardiac cycle was applied between the aorta and left ventricle. We calculated blood flow velocity, effective orifice area (EOA), and mechanical stress on the leaflets. The results reveal that as the strut height increases, the stroke volume increases, leakage volume decreases, and EOA improves. Additionally, the maximum mechanical stress experienced by the leaflet decreases by 62% as the strut height increases to 1.2 times the standard height. This research highlights that a low-strut design in bioprosthetic AVs may negatively affect their durability, which can be useful in design of next-generation bioprosthetic AVs.
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Affiliation(s)
- Yongwoo Kim
- Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
| | - Won Kyung Pyo
- Department of Thoracic Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Wan Kee Kim
- Department of Thoracic and Cariovascular Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Gyeonggi-do, Republic of Korea
| | - Ga-Young Suh
- Department of Biomedical Engineering, California State University, Long Beach, CA, USA
| | - Keonwook Kang
- Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
| | - Seung Hyun Lee
- Department of Thoracic Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Morany A, Bardon RG, Lavon K, Hamdan A, Bluestein D, Haj-Ali R. Analysis of fibrocalcific aortic valve stenosis: computational pre-and-post TAVR haemodynamics behaviours. ROYAL SOCIETY OPEN SCIENCE 2024; 11:230905. [PMID: 38384780 PMCID: PMC10878817 DOI: 10.1098/rsos.230905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 01/22/2024] [Indexed: 02/23/2024]
Abstract
Fibro-calcific aortic valve (AV) diseases are characterized by calcium growth or accumulation of fibrosis in the AV tissues. Fibrocalcific aortic stenosis (FAS) rises specifically in females, like calcification-induced aortic stenosis (CAS), may eventually necessitate valve replacement. Fluid-structure-interaction (FSI) computational models for severe CAS and FAS patients were developed using lattice Boltzmann method and multi-scale finite elements (FE). Three parametric AV models were introduced: pathology-free of non-calcified tri-and-bicuspid AVs with healthy collagen fibre network (CFN), a FAS model incorporated a thickened CFN with embedded small calcification volumes, and a CAS model employs healthy CFN with embedded high calcification volumes. The results indicate that the interaction between calcium deposits, adjacent tissue and fibres crucially influences haemodynamics and structural reactions. A fourth model of transcatheter aortic valve replacement (TAVR) post-procedure outcomes was created to study both CAS and FAS. TAVR-CAS had a higher maximum contact pressure and lower anchoring area than TAVR-FAS, making it prone to aortic tissue damage and migration. Finally, although the TAVR-CAS offered a larger opening area, its paravalvular leakage was higher. This may be attributed to a similar thrombogenicity potential characterizing both models. The computational framework emphasizes the significance of mechanobiology in FAS and underscores the requirement for tissue modelling at multiple scales.
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Affiliation(s)
- Adi Morany
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv, Israel
| | | | - Karin Lavon
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Ashraf Hamdan
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Danny Bluestein
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Rami Haj-Ali
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv, Israel
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
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Sadipour M, Azadani AN. The Measurement of Bovine Pericardium Density and Its Implications on Leaflet Stress Distribution in Bioprosthetic Heart Valves. Cardiovasc Eng Technol 2023; 14:853-861. [PMID: 37932655 DOI: 10.1007/s13239-023-00692-0] [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: 01/01/2023] [Accepted: 10/18/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE Bioprosthetic Heart Valves (BHVs) are widely used in clinical practice, showing promising outcomes. Computational modeling offers a valuable tool for quantitatively characterizing BHVs. To ensure the accuracy of computational models, it is crucial to consider precise leaflet properties, including mechanical properties and density. Bovine pericardium (BP) serves as a common material for BHV leaflets. Previous computational studies often assume BP density to approximate that of water or blood. Given that BP leaflets undergo various treatments, such as tissue fixation and anti-calcification, this study aims to measure the density of BP used in BHVs and assess its impact on leaflet stress distribution. METHODS Eight square BP samples were laser cut from Edwards BP patches and their density was determined. Specimen weight was measured using an A&D Analytical Balance, while volume was assessed through high-resolution imaging. Additionally, finite element models resembling a BHV, like the Carpentier-Edwards PERIMOUNT Magna, were constructed in ABAQUS. RESULTS The average density of the BP samples was found to be 1,410 kg/m3. During the acceleration phase of a cardiac cycle, the maximum stress reached 1.89 MPa for a density of 1,410 kg/m3 and 2.47 MPa for a density of 1,000 kg/m3 (a 30.7% difference). In the deceleration phase, the maximum stress reached 713 kPa and 669 kPa, respectively. CONCLUSION Leaflet stress distribution and motion in BHVs are influenced by density variations. Establishing an accurate density value for BHV leaflets is imperative for enhancing the computational models, which can ultimately contribute to improved BHV design and outcomes.
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Affiliation(s)
- Masod Sadipour
- Department of Mechanical and Materials Engineering, University of Denver, 2155 E. Wesley Ave #439, Denver, CO, 80208, USA
| | - Ali N Azadani
- Department of Mechanical and Materials Engineering, University of Denver, 2155 E. Wesley Ave #439, Denver, CO, 80208, USA.
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Hu M, Shi S, Peng X, Pu X, Yu X. A synergistic strategy of dual-crosslinking and loading intelligent nanogels for enhancing anti-coagulation, pro-endothelialization and anti-calcification properties in bioprosthetic heart valves. Acta Biomater 2023; 171:466-481. [PMID: 37793601 DOI: 10.1016/j.actbio.2023.09.045] [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: 05/04/2023] [Revised: 09/07/2023] [Accepted: 09/26/2023] [Indexed: 10/06/2023]
Abstract
Currently, glutaraldehyde (GA)-crosslinked bioprosthetic heart valves (BHVs) still do not guarantee good biocompatibility and long-term effective durability for clinical application due to their subacute thrombus, inflammation, calcification, tearing and limited durability. In this study, double-modified xanthan gum (oxidized/vinylated xanthan gum (O2CXG)) was acquired from xanthan gum for subsequent double crosslinking and modification platform construction. Sulfonic acid groups with anticoagulant properties were also introduced through the free radical polymerization of vinyl sulfonate (VS) and vinyl on O2CXG. Taking advantage of the drug-loading function of xanthan gum, the treated pericardium was further loaded with inflammation-triggered dual drug-loaded nanogel (heparin (Hep) and atorvastatin (Ator)). Mechanical properties of O2CXG-crosslinked porcine pericardium (O2CXG-PP) were significantly improved via the first network formed by Schiff base bonds and the second C-C bonds network. Due to the presence of sulfonic acid groups as well as the dual drug release from nanogels under the stimulation of H2O2, the hemocompatibility, anti-inflammatory, pro-endothelialization and anti-calcification properties of the crosslinked pericardium modified with nanogels loaded with Hep and Ator (O2CXG+VS+(Hep+Ator) nanogel-PP) was significantly better than that of GA-crosslinked PP (GA-PP). The collaborative strategy of double crosslinking and sequential release of anticoagulant/endothelium-promoting drugs triggered by inflammation could effectively meet the requirement of enhanced multiple performance and long-term durability of bioprosthetic heart valves and provide a valuable pattern for multi-functionalization of blood contacting materials. STATEMENT OF SIGNIFICANCE: Currently, glutaraldehyde-crosslinked bioprosthetic heart valves (BHVs) are subject to subacute thrombus, inflammation, calcification and tearing, which would not guarantee good biocompatibility and long-term effective durability. We developed a cooperative strategy of double crosslinking and surface modification in which double-modified xanthan gum plays a cornerstone. The mechanical properties of this BHV were significantly improved via the first network formed by Schiff base bonds and the second C-C bonds network. Inflammation-triggered combination delivery of heparin and atorvastatin has been demonstrated to enhance anticoagulation, anti-inflammatory and pro-endothelialization of BHVs by utilizing local inflammatory response. The collaborative strategy could effectively meet the requirement of enhanced multiple performance and long-term durability of BHVs and provide a valuable pattern for the multi-functionalization of blood-contacting materials.
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Affiliation(s)
- Mengyue Hu
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, PR China
| | - Shubin Shi
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, PR China
| | - Xu Peng
- Experimental and Research Animal Institute, Sichuan University, Chengdu 610065, PR China
| | - Xinyun Pu
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, PR China
| | - Xixun Yu
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, PR China.
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10
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Kafili G, Kabir H, Jalali Kandeloos A, Golafshan E, Ghasemi S, Mashayekhan S, Taebnia N. Recent advances in soluble decellularized extracellular matrix for heart tissue engineering and organ modeling. J Biomater Appl 2023; 38:577-604. [PMID: 38006224 PMCID: PMC10676626 DOI: 10.1177/08853282231207216] [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] [Indexed: 11/26/2023]
Abstract
Despite the advent of tissue engineering (TE) for the remodeling, restoring, and replacing damaged cardiovascular tissues, the progress is hindered by the optimal mechanical and chemical properties required to induce cardiac tissue-specific cellular behaviors including migration, adhesion, proliferation, and differentiation. Cardiac extracellular matrix (ECM) consists of numerous structural and functional molecules and tissue-specific cells, therefore it plays an important role in stimulating cell proliferation and differentiation, guiding cell migration, and activating regulatory signaling pathways. With the improvement and modification of cell removal methods, decellularized ECM (dECM) preserves biochemical complexity, and bio-inductive properties of the native matrix and improves the process of generating functional tissue. In this review, we first provide an overview of the latest advancements in the utilization of dECM in in vitro model systems for disease and tissue modeling, as well as drug screening. Then, we explore the role of dECM-based biomaterials in cardiovascular regenerative medicine (RM), including both invasive and non-invasive methods. In the next step, we elucidate the engineering and material considerations in the preparation of dECM-based biomaterials, namely various decellularization techniques, dECM sources, modulation, characterizations, and fabrication approaches. Finally, we discuss the limitations and future directions in fabrication of dECM-based biomaterials for cardiovascular modeling, RM, and clinical translation.
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Affiliation(s)
- Golara Kafili
- Institute for Nanoscience and Nanotechnology, Sharif University of Technology, Tehran, Iran
| | - Hannaneh Kabir
- Molecular Cell Biomechanics Laboratory, Departments of Bioengineering and Mechanical Engineering, University of California, Berkeley, CA, USA
| | | | - Elham Golafshan
- Institute for Nanoscience and Nanotechnology, Sharif University of Technology, Tehran, Iran
| | - Sara Ghasemi
- Department of Chemical and Petroleum Engineering, Sharif University of Technology, Tehran, Iran
| | - Shohreh Mashayekhan
- Institute for Nanoscience and Nanotechnology, Sharif University of Technology, Tehran, Iran
- Department of Chemical and Petroleum Engineering, Sharif University of Technology, Tehran, Iran
| | - Nayere Taebnia
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
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11
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Zhuravleva IY, Karpova EV, Dokuchaeva AA, Titov AT, Timchenko TP, Vasilieva MB. Calcification of Various Bioprosthetic Materials in Rats: Is It Really Different? Int J Mol Sci 2023; 24:ijms24087274. [PMID: 37108443 PMCID: PMC10139218 DOI: 10.3390/ijms24087274] [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: 03/17/2023] [Revised: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
The causes of heart valve bioprosthetic calcification are still not clear. In this paper, we compared the calcification in the porcine aorta (Ao) and the bovine jugular vein (Ve) walls, as well as the bovine pericardium (Pe). Biomaterials were crosslinked with glutaraldehyde (GA) and diepoxide (DE), after which they were implanted subcutaneously in young rats for 10, 20, and 30 days. Collagen, elastin, and fibrillin were visualized in non-implanted samples. Atomic absorption spectroscopy, histological methods, scanning electron microscopy, and Fourier-transform infrared spectroscopy were used to study the dynamics of calcification. By the 30th day, calcium accumulated most intensively in the collagen fibers of the GA-Pe. In elastin-rich materials, calcium deposits were associated with elastin fibers and localized differences in the walls of Ao and Ve. The DE-Pe did not calcify at all for 30 days. Alkaline phosphatase does not affect calcification since it was not found in the implant tissue. Fibrillin surrounds elastin fibers in the Ao and Ve, but its involvement in calcification is questionable. In the subcutaneous space of young rats, which are used to model the implants' calcification, the content of phosphorus was five times higher than in aging animals. We hypothesize that the centers of calcium phosphate nucleation are the positively charged nitrogen of the pyridinium rings, which is the main one in fresh elastin and appears in collagen as a result of GA preservation. Nucleation can be significantly accelerated at high concentrations of phosphorus in biological fluids. The hypothesis needs further experimental confirmation.
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Affiliation(s)
- Irina Y Zhuravleva
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, 15 Rechkunovskaya St., 630055 Novosibirsk, Russia
| | - Elena V Karpova
- N. Vorozhtsov Novosibirsk Institute of Organic Chemistry SB RAS, 9 Lavrentiev Avenue, 630090 Novosibirsk, Russia
| | - Anna A Dokuchaeva
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, 15 Rechkunovskaya St., 630055 Novosibirsk, Russia
| | - Anatoly T Titov
- V. Sobolev Institute of Geology and Mineralogy SB RAS, 3 Academician Koptyug Avenue, 630090 Novosibirsk, Russia
| | - Tatiana P Timchenko
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, 15 Rechkunovskaya St., 630055 Novosibirsk, Russia
| | - Maria B Vasilieva
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, 15 Rechkunovskaya St., 630055 Novosibirsk, Russia
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12
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Chen X, Yu T, Kong Q, Xu H, Zhao Z, Li G, Fan H, Wang Y. A chlorogenic acid functional strategy of anti-inflammation, anti-coagulation and promoted endothelial proliferation for bioprosthetic artificial heart valves. J Mater Chem B 2023; 11:2663-2673. [PMID: 36883900 DOI: 10.1039/d2tb02407a] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Heart valve replacement has become an optimal choice for the treatment of severe heart valve disease. At present, most commercial bioprosthetic heart valves (BHVs) are made from porcine pericardium or bovine pericardium treated with glutaraldehyde. Nevertheless, due to the toxicity of residual aldehyde groups left after glutaraldehyde cross-linking, these commercial BHVs exhibit poor biocompatibility, calcification, risk of coagulation and endothelialization difficulty, which greatly affects the durability of the BHVs and shortens their service life. In this work, based on a chlorogenic acid functional anti-inflammation, anti-coagulation and endothelialization strategy and dual-functional non-glutaraldehyde cross-linking reagent OX-CO, a kind of functional BHV material OX-CA-PP has been developed from OX-CO cross-linked porcine pericardium (OX-CO-PP) followed by the convenient modification of chlorogenic acid through a reactive oxygen species (ROS) sensitive borate ester bond. The functionalization of chlorogenic acid can reduce the risk of valve leaf thrombosis and promote endothelial cell proliferation, which is beneficial to the formation of a long-term interface with good blood compatibility. Meanwhile, such a ROS responsive behavior can trigger intelligent release of chlorogenic acid on-demand to achieve the inhibition of acute inflammation at the early stage of implantation. The in vivo and in vitro experimental results show that the functional BHV material OX-CA-PP exhibits superior anti-inflammation, improved anti-coagulation, minimal calcification and promoted proliferation of endothelial cells, showing that this non-glutaraldehyde functional strategy has great potential for the application of BHVs and providing a promising reference for other implanted biomaterials.
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Affiliation(s)
- Xiaotong Chen
- National Engineering Research Center of Clean Technology in Leather Industry, Sichuan University, Chengdu 610065, China
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610065, China.
| | - Tao Yu
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610065, China.
| | - Qunshou Kong
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610065, China.
| | - Hong Xu
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610065, China.
| | - Zhiyu Zhao
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610065, China.
| | - Gaocan Li
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610065, China.
| | - Haojun Fan
- National Engineering Research Center of Clean Technology in Leather Industry, Sichuan University, Chengdu 610065, China
| | - Yunbing Wang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610065, China.
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13
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Helbock RT, Anam SB, Kovarovic BJ, Slepian MJ, Hamdan A, Haj-Ali R, Bluestein D. Designing a Novel Asymmetric Transcatheter Aortic Valve for Stenotic Bicuspid Aortic Valves Using Patient-Specific Computational Modeling. Ann Biomed Eng 2023; 51:58-70. [PMID: 36042099 DOI: 10.1007/s10439-022-03039-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/25/2022] [Indexed: 01/13/2023]
Abstract
Bicuspid aortic valve (BAV), the most common congenital heart malformation, is characterized by the presence of only two valve leaflets with asymmetrical geometry, resulting in elliptical systolic opening. BAV often leads to early onset of calcific aortic stenosis (AS). Following the rapid expansion of transcatheter aortic valve replacement (TAVR), designed specifically for treating conventional tricuspid AS, BAV patients with AS were initially treated "off-label" with TAVR, which recently gained FDA and CE regulatory approval. Despite its increasing use in BAV, pathological BAV anatomy often leads to complications stemming from mismatched anatomical features. To mitigate these complications, a novel eccentric polymeric TAVR valve incorporating asymmetrical leaflets was designed specifically for BAV anatomies. Computational modeling was used to optimize its asymmetric leaflets for lower functional stresses and improved hemodynamic performance. Deployment and flow were simulated in patient-specific BAV models (n = 6) and compared to a current commercial TAVR valve (Evolut R 29 mm), to assess deployment and flow parameters. The novel eccentric BAV-dedicated valve demonstrated significant improvements in peak systolic orifice area, along with lower jet velocity and wall shear stress (WSS). This feasibility study demonstrates the clinical potential of the first known BAV-dedicated TAVR design, which will foster advancement of patient-dedicated valvular devices.
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Affiliation(s)
- Ryan T Helbock
- Biofluids Research Group, Department of Biomedical Engineering, T8-050 Health Sciences Center, Stony Brook University, Stony Brook, NY11794-8084, USA
| | - Salwa B Anam
- Biofluids Research Group, Department of Biomedical Engineering, T8-050 Health Sciences Center, Stony Brook University, Stony Brook, NY11794-8084, USA
| | - Brandon J Kovarovic
- Biofluids Research Group, Department of Biomedical Engineering, T8-050 Health Sciences Center, Stony Brook University, Stony Brook, NY11794-8084, USA
| | - Marvin J Slepian
- Department of Medicine and Biomedical Engineering Sarver Heart Center, University of Arizona, Tucson, AZ, 85721, USA
| | - Ashraf Hamdan
- Department of Cardiology, Rabin Medical Center, 4941492, Petah Tikva, Israel
| | - Rami Haj-Ali
- School of Mechanical Engineering, Faculty of Engineering, Tel Aviv University, 69978, Tel Aviv, Ramat Aviv, Israel
| | - Danny Bluestein
- Biofluids Research Group, Department of Biomedical Engineering, T8-050 Health Sciences Center, Stony Brook University, Stony Brook, NY11794-8084, USA.
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14
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Steblovnik K, Bunc M. Technical Aspects and Development of Transcatheter Aortic Valve Implantation. J Cardiovasc Dev Dis 2022; 9:jcdd9080282. [PMID: 36005446 PMCID: PMC9409777 DOI: 10.3390/jcdd9080282] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
Aortic stenosis is the most common valve disease requiring surgery or percutaneous treatment. Since the first-in-man implantation in 2002 we have witnessed incredible progress in transcatheter aortic valve implantation (TAVI). In this article, we review the technical aspects of TAVI development with a look at the future. Durability, low thrombogenicity, good hydrodynamics, biocompatibility, low catheter profile, and deployment stability are the attributes of an ideal TAVI device. Two main design types exist-balloon-expandable and self-expanding prostheses. Balloon-expandable prostheses use a cobalt-chromium alloy frame providing high radial strength and radiopacity, while the self-expanding prostheses use a nickel-titanium (Nitinol) alloy frame, which expands to its original shape once unsheathed and heated to the body temperature. The valve is sewn onto the frame and consists of the porcine or bovine pericardium, which is specially treated to prevent calcinations and prolong durability. The lower part of the frame can be covered by polyethylene terephthalate fabric or a pericardial skirt, providing better sealing between the frame and aortic annulus. The main future challenges lie in achieving lower rates of paravalvular leaks and new pacemaker implantations following the procedure, lower delivery system profiles, more precise positioning, longer durability, and a good hemodynamic profile. Patient-specific design and the use of autologous tissue might solve these issues.
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15
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Rudziński PN, Mach M, Gross C, Russo M, Werner P, Coti I, Scherzer S, Andreas M. Current Prostheses for Transcatheter Heart Valve Replacement: A Technical and Clinical Review. Rev Cardiovasc Med 2022; 23:257. [PMID: 39076633 PMCID: PMC11266972 DOI: 10.31083/j.rcm2308257] [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: 03/23/2022] [Revised: 05/04/2022] [Accepted: 06/21/2022] [Indexed: 07/31/2024] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has become a cornerstone in today's treatment of aortic stenosis. Modern transcatheter prostheses are continuously evolving and each one features different design traits. In this review, the authors provide insight in the technical differences of current prostheses and TAVR related clinical decision pathways, preferably useful for the beginners but also for advanced operators. Additionally, procedural considerations and comparative outcomes of the prostheses are discussed. In doing so, the authors aim to facilitate the choice of the ideal transcatheter valve procedure for each individual.
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Affiliation(s)
- Piotr Nikodem Rudziński
- Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, 04-628 Warsaw, Poland
| | - Markus Mach
- Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Christoph Gross
- Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Marco Russo
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, 00152 Rome, Italy
| | - Paul Werner
- Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Iuliana Coti
- Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Sabine Scherzer
- Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria
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16
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Huang X, Zheng C, Ding K, Li M, Zhang S, Wu B, Wei Q, Lei Y, Wang Y. Hyaluronic Acid-Grafted Bioprosthetic Heart Valves Achieved by Copolymerization Exhibited Improved Anticalcification and Antithrombogenicity. ACS Biomater Sci Eng 2022; 8:3399-3410. [PMID: 35839344 DOI: 10.1021/acsbiomaterials.2c00367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Bioprosthetic heart valves (BHVs) are widely used in clinic, but they still have problems of calcification, thrombogenicity, and cytotoxicity. The reported techniques based on glutaraldehyde (Glut) crosslinking have difficulty in solving these problems simultaneously. In this study, we grafted Glut-crosslinked porcine pericardium (GA) with hyaluronic acid (HA) by radical copolymerization to improve its anticalcification and antithrombotic properties. Partially methacrylated poly-ε-lysine was used to introduce methacryl groups into GA. Then, HA-grafted porcine pericardium (GA-HA) was obtained by radical copolymerization. Rat's subcutaneous implantation results showed that the calcium content of GA-HA was significantly lower than that of GA (37 ± 29 μg/mg vs 188 ± 7 μg/mg), and the platelets adhering to the surface of GA-HA decreased by approximately 41% compared with GA. In conclusion, grafting porcine pericardium with HA by copolymerization might be feasible to improve the anticalcification and antithrombotic properties of BHVs.
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Affiliation(s)
- Xueyu Huang
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, P. R. China
| | - Cheng Zheng
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, P. R. China
| | - Kailei Ding
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, P. R. China
| | - Meiling Li
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, P. R. China
| | - Shumang Zhang
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, P. R. China
| | - Binggang Wu
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, P. R. China.,Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu 610041 P.R. China
| | - Qingrong Wei
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, P. R. China
| | - Yang Lei
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, P. R. China
| | - Yunbing Wang
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, P. R. China
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17
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Qi X, Jiang Z, Song M, Tang Z, Xie X, Liu Y, Wu Q, Wu Z. A Novel Crosslinking Method for Improving the Anti-Calcification Ability and Extracellular Matrix Stability in Transcatheter Heart Valves. Front Bioeng Biotechnol 2022; 10:909771. [PMID: 35903798 PMCID: PMC9315440 DOI: 10.3389/fbioe.2022.909771] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/08/2022] [Indexed: 12/12/2022] Open
Abstract
More than 200,000 patients with aortic diseases worldwide undergo surgical valve replacement each year, and transcatheter heart valves (THV) have been more widely used than ever before. However, THV made by the glutaraldehyde (Glut) crosslinking method has the disadvantage of being prone to calcification, which significantly reduces the durability of biomaterials. In this study, we applied a novel crosslinking method using ribose in THV for the first time, which can decrease calcification and increase the stability of the extracellular matrix (ECM). We incubated the bovine pericardium (BP) in ribose solution at 37°C by shaking for 12 days and confirmed that the structure of the BP was more compact than that of the Glut group. Moreover, the ribose method remarkably enhanced the biomechanical properties and provided reliable resistance to enzymatic degradation and satisfactory cellular compatibility in THV. When the BP was implanted subcutaneously in vivo, we demonstrated that ECM components were preserved more completely, especially in elastin, and the immune-inflammatory response was more moderate than that in the Glut treatment group. Finally, the ribose-cross-linked materials showed better anti-calcification potential and improved durability of THV than Glut-cross-linked materials.
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18
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左 一, 康 珂, 尚 大, 杨 夏, 吴 尧, 虞 奇, 温 贤. [Comparative study on Sichuan yak pericardium and Australian cattle pericardium]. SHENG WU YI XUE GONG CHENG XUE ZA ZHI = JOURNAL OF BIOMEDICAL ENGINEERING = SHENGWU YIXUE GONGCHENGXUE ZAZHI 2022; 39:537-543. [PMID: 35788523 PMCID: PMC10950777 DOI: 10.7507/1001-5515.202202044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/24/2022] [Indexed: 06/15/2023]
Abstract
Currently, as the key raw material of artificial biological heart valve, bovine pericardium is mainly depend on import and has become a "bottleneck" challenge, greatly limiting the development of domestic biological heart valve. Therefore, the localization of bovine pericardium is extremely urgent. In this study, the pericardium of Sichuan yak was compared with that of Australian cattle in terms of fundamental properties and anti-calcification performance. The results demonstrated that the appearance and thickness of yak pericardium were more advantageous than the Australian one. Sichuan yak pericardium and Australian cattle pericardium had comparable performance in shrinkage temperature, mechanical test and anti-calcification test. This study preliminarily verifies the feasibility of substitution of Australian cattle pericardium by Sichuan yak pericardium and promotes the progression of bovine pericardium localization with data support.
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Affiliation(s)
- 一聪 左
- 成都纽脉生物科技有限公司(成都 611139)Chengdu NewMed Biotechnology Co., Ltd, Chengdu 611139, P. R. China
| | - 珂 康
- 成都纽脉生物科技有限公司(成都 611139)Chengdu NewMed Biotechnology Co., Ltd, Chengdu 611139, P. R. China
| | - 大鹏 尚
- 成都纽脉生物科技有限公司(成都 611139)Chengdu NewMed Biotechnology Co., Ltd, Chengdu 611139, P. R. China
| | - 夏燕 杨
- 成都纽脉生物科技有限公司(成都 611139)Chengdu NewMed Biotechnology Co., Ltd, Chengdu 611139, P. R. China
| | - 尧 吴
- 成都纽脉生物科技有限公司(成都 611139)Chengdu NewMed Biotechnology Co., Ltd, Chengdu 611139, P. R. China
| | - 奇峰 虞
- 成都纽脉生物科技有限公司(成都 611139)Chengdu NewMed Biotechnology Co., Ltd, Chengdu 611139, P. R. China
| | - 贤涛 温
- 成都纽脉生物科技有限公司(成都 611139)Chengdu NewMed Biotechnology Co., Ltd, Chengdu 611139, P. R. China
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19
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Ding K, Zheng C, Huang X, Zhang S, Li M, Lei Y, Wang Y. A PEGylation method of fabricating bioprosthetic heart valves based on glutaraldehyde and 2-amino-4-pentenoic acid co-crosslinking with improved antithrombogenicity and cytocompatibility. Acta Biomater 2022; 144:279-291. [PMID: 35365404 DOI: 10.1016/j.actbio.2022.03.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 02/04/2022] [Accepted: 03/10/2022] [Indexed: 12/13/2022]
Abstract
With the development of diagnostic techniques, the incidence of bioprosthetic heart valve thrombosis (BHVT) is found to be seriously underestimated. Developing bioprosthetic heart valves (BHVs) that have good hemocompatibility without sacrificing other properties such as hydrodynamics and durability will be an effective strategy to alleviate BHVT. In this study, we developed a PEGylation method by co-crosslinking and subsequent radical polymerization. 2-amino-4-pentenoic acid was used to introduce carbon-carbon double bonds for glutaraldehyde crosslinked pericardia. Then poly (ethylene glycol) diacrylate (PEGDA) was immobilized on pericardia by radical polymerization. A comprehensive evaluation of the modified pericardia was performed including structural characterization, hemocompatibility, cytocompatibility, mechanical properties, component stability, hydrodynamic performance and durability of the BHVs. The modified pericardia significantly reduced platelet adhesion by more than 75% compared with traditional glutaraldehyde crosslinked pericardia. Cell viability in the modified pericardia group was nearly 5-fold higher than that in glutaraldehyde crosslinked pericardia. The hydrodynamic performance met the requirements of ISO 5840-3 under physiological aortic valve conditions and its durability was proved after 200 million cycles of accelerated fatigue test. In conclusion, PEGDA modified pericardia exhibited improved antithrombogenicity and cytocompatibility properties compared with glutaraldehyde crosslinked pericardia. STATEMENT OF SIGNIFICANCE: Bioprosthetic valve (BHV) implantation requires BHV to be structurally stable as well as biocompatible in vivo. Traditional glutaraldehyde crosslinking method prepared BHV suffers from severe cytotoxicity, thrombosis, and calcification. BHV modification methods that have simultaneously improved structural stability and biocompatibility were rarely reported. Here, we proposed a PEGylation method for BHV based on co-crosslinking strategy that could improve its structural stability as well as hemocompatibility. We take the advantage of high efficiency of glutaraldehyde crosslinking and demonstrate the feasibility and superiority of the PEGylated strategy, offering a promising option in glutaraldehyde-based BHV fabrication in the future.
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Affiliation(s)
- Kailei Ding
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, China
| | - Cheng Zheng
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, China
| | - Xueyu Huang
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, China
| | - Shumang Zhang
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, China
| | - Meiling Li
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, China
| | - Yang Lei
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, China
| | - Yunbing Wang
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, China.
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20
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Mudigonda J, Xu D, Amedi A, Lane BA, Corporan D, Wang V, Padala M. A Biohybrid Material With Extracellular Matrix Core and Polymeric Coating as a Cell Honing Cardiovascular Tissue Substitute. Front Cardiovasc Med 2022; 9:807255. [PMID: 35402573 PMCID: PMC8987446 DOI: 10.3389/fcvm.2022.807255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/20/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo investigate the feasibility of a hybrid material in which decellularized pericardial extracellular matrix is functionalized with polymeric nanofibers, for use as a cardiovascular tissue substitute.BackgroundA cardiovascular tissue substitute, which is gradually resorbed and is replaced by host's native tissue, has several advantages. Especially in children and young adults, a resorbable material can be useful in accommodating growth, but also enable rapid endothelialization that is necessary to avoid thrombotic complications. In this study, we report a hybrid material, wherein decellularized pericardial matrix is functionalized with a layer of polymeric nanofibers, to achieve the mechanical strength for implantation in the cardiovascular system, but also have enhanced cell honing capacity.MethodsPericardial sacs were decellularized with sodium deoxycholate, and polycaprolactone-chitosan fibers were electrospun onto the matrix. Tissue-polymer interaction was evaluated using spectroscopic methods, and the mechanical properties of the individual components and the hybrid material were quantified. In-vitro blood flow loop studies were conducted to assess hemocompatibility and cell culture methods were used to assess biocompatibility.ResultsEncapsulation of the decellularized matrix with 70 μm thick matrix of polycaprolactone-chitosan nanofibers, was feasible and reproducible. Spectroscopy of the cross-section depicted new amide bond formation and C–O–C stretch at the interface. An average peel strength of 56.13 ± 11.87 mN/mm2 was measured, that is sufficient to withstand a high shear of 15 dynes/cm2 without delamination. Mechanical strength and extensibility ratio of the decellularized matrix alone were 18,000 ± 4,200 KPa and 0.18 ± 0.03% whereas that of the hybrid was higher at 20,000 ± 6,600 KPa and 0.35 ± 0.20%. Anisotropy index and stiffness of the biohybrid were increased as well. Neither thrombus formation, nor platelet adhesion or hemolysis was measured in the in-vitro blood flow loop studies. Cellular adhesion and survival were adequate in the material.ConclusionEncapsulating a decellularized matrix with a polymeric nanofiber coating, has favorable attributes for use as a cardiovascular tissue substitute.
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Affiliation(s)
- Jahnavi Mudigonda
- Structural Heart Research & Innovation Laboratory, Carlyle Fraser Heart Center, Emory University Hospital Midtown, Atlanta, GA, United States
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Dongyang Xu
- Structural Heart Research & Innovation Laboratory, Carlyle Fraser Heart Center, Emory University Hospital Midtown, Atlanta, GA, United States
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Alan Amedi
- Structural Heart Research & Innovation Laboratory, Carlyle Fraser Heart Center, Emory University Hospital Midtown, Atlanta, GA, United States
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Brooks A. Lane
- Structural Heart Research & Innovation Laboratory, Carlyle Fraser Heart Center, Emory University Hospital Midtown, Atlanta, GA, United States
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Daniella Corporan
- Structural Heart Research & Innovation Laboratory, Carlyle Fraser Heart Center, Emory University Hospital Midtown, Atlanta, GA, United States
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Vivian Wang
- Structural Heart Research & Innovation Laboratory, Carlyle Fraser Heart Center, Emory University Hospital Midtown, Atlanta, GA, United States
| | - Muralidhar Padala
- Structural Heart Research & Innovation Laboratory, Carlyle Fraser Heart Center, Emory University Hospital Midtown, Atlanta, GA, United States
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States
- *Correspondence: Muralidhar Padala
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21
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Johnson EL, Rajanna MR, Yang CH, Hsu MC. Effects of membrane and flexural stiffnesses on aortic valve dynamics: identifying the mechanics of leaflet flutter in thinner biological tissues. FORCES IN MECHANICS 2022; 6:100053. [PMID: 36278140 PMCID: PMC9583650 DOI: 10.1016/j.finmec.2021.100053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Valvular pathologies that induce deterioration in the aortic valve are a common cause of heart disease among aging populations. Although there are numerous available technologies to treat valvular conditions and replicate normal aortic function by replacing the diseased valve with a bioprosthetic implant, many of these devices face challenges in terms of long-term durability. One such phenomenon that may exacerbate valve deterioration and induce undesirable hemodynamic effects in the aorta is leaflet flutter, which is characterized by oscillatory motion in the biological tissues. While this behavior has been observed for thinner bioprosthetic valves, the specific underlying mechanics that lead to leaflet flutter have not previously been identified. This work proposes a computational approach to isolate the fundamental mechanics that induce leaflet flutter in thinner biological tissues during the cardiac cycle. The simulations in this work identify reduced flexural stiffness as the primary factor that contributes to increased leaflet flutter in thinner biological tissues, while decreased membrane stiffness and mass of the thinner tissues do not directly induce flutter in these valves. The results of this study provide an improved understanding of the mechanical tissue properties that contribute to flutter and offer significant insights into possible developments in the design of bioprosthetic tissues to account for and reduce the incidence of flutter.
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Affiliation(s)
- Emily L. Johnson
- Department of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - Manoj R. Rajanna
- Department of Mechanical Engineering, Iowa State University, Ames, Iowa 50011, USA
| | - Cheng-Hau Yang
- Department of Mechanical Engineering, Iowa State University, Ames, Iowa 50011, USA
| | - Ming-Chen Hsu
- Department of Mechanical Engineering, Iowa State University, Ames, Iowa 50011, USA
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22
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Stracuzzi A, Britt BR, Mazza E, Ehret AE. Risky interpretations across the length scales: continuum vs. discrete models for soft tissue mechanobiology. Biomech Model Mechanobiol 2022; 21:433-454. [PMID: 34985590 PMCID: PMC8940853 DOI: 10.1007/s10237-021-01543-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/28/2021] [Indexed: 11/29/2022]
Abstract
Modelling and simulation in mechanobiology play an increasingly important role to unravel the complex mechanisms that allow resident cells to sense and respond to mechanical cues. Many of the in vivo mechanical loads occur on the tissue length scale, thus raising the essential question how the resulting macroscopic strains and stresses are transferred across the scales down to the cellular and subcellular levels. Since cells anchor to the collagen fibres within the extracellular matrix, the reliable representation of fibre deformation is a prerequisite for models that aim at linking tissue biomechanics and cell mechanobiology. In this paper, we consider the two-scale mechanical response of an affine structural model as an example of a continuum mechanical approach and compare it with the results of a discrete fibre network model. In particular, we shed light on the crucially different mechanical properties of the 'fibres' in these two approaches. While assessing the capability of the affine structural approach to capture the fibre kinematics in real tissues is beyond the scope of our study, our results clearly show that neither the macroscopic tissue response nor the microscopic fibre orientation statistics can clarify the question of affinity.
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Affiliation(s)
- Alberto Stracuzzi
- Empa, Swiss Federal Laboratories for Materials Science and Technology, Überlandstrasse 129, 8600, Dübendorf, Switzerland. .,ETH Zurich, Institute for Mechanical Systems, Leonhardstrasse 21, 8092, Zürich, Switzerland.
| | - Ben R Britt
- Empa, Swiss Federal Laboratories for Materials Science and Technology, Überlandstrasse 129, 8600, Dübendorf, Switzerland.,ETH Zurich, Institute for Mechanical Systems, Leonhardstrasse 21, 8092, Zürich, Switzerland
| | - Edoardo Mazza
- Empa, Swiss Federal Laboratories for Materials Science and Technology, Überlandstrasse 129, 8600, Dübendorf, Switzerland.,ETH Zurich, Institute for Mechanical Systems, Leonhardstrasse 21, 8092, Zürich, Switzerland
| | - Alexander E Ehret
- Empa, Swiss Federal Laboratories for Materials Science and Technology, Überlandstrasse 129, 8600, Dübendorf, Switzerland. .,ETH Zurich, Institute for Mechanical Systems, Leonhardstrasse 21, 8092, Zürich, Switzerland.
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23
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Song M, Tang Z, Liu Y, Xie X, Qi X, Wu Q, Jiang Z, Wu Z, Qian T. Yak Pericardium as an Alternative Biomaterial for Transcatheter Heart Valves. Front Bioeng Biotechnol 2021; 9:766991. [PMID: 34820366 PMCID: PMC8607193 DOI: 10.3389/fbioe.2021.766991] [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: 08/30/2021] [Accepted: 10/20/2021] [Indexed: 11/13/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has received much attention and development in the past decade due to its lower risk of complication and infections compared to a traditional open thoracotomy. However, the current commercial transcatheter heart valve does not fully meet clinical needs; therefore, new biological materials must be found in order to meet these requirements. We have discovered a new type of biological material, the yak pericardium. This current research studied its extracellular matrix structure, composition, mechanical properties, and amino acid content. Folding experiment was carried out to analyze the structure and mechanics after folding. We also conducted a subcutaneous embedding experiment to analyze the inflammatory response and calcification after implantation. Australian bovine pericardium, local bovine pericardium, and porcine pericardium were used as controls. The overall structure of the yak pericardium is flat, the collagen runs regularly, it has superior mechanical properties, and the average thickness is significantly lower than that of the Australian bovine and the local bovine pericardium control groups. The yak pericardium has a higher content of elastic fibers, showing that it has a better compression resistance effect during the folding experiment as well as having less expression of transplantation-related antigens. We conducted in vivo experiments and found that the yak pericardium has less inflammation and a lower degree of calcification. In summary, the yak pericardium, which is thin and strong, has lower immunogenicity and outstanding anti-calcification effects may be an excellent candidate valve leaflet material for TAVI.
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Affiliation(s)
- Mingzhe Song
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Zhenjie Tang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Yuhong Liu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Xinlong Xie
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Xiaoke Qi
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Qiying Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Zhenlin Jiang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Zhongshi Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Tao Qian
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
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24
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McGregor C, Salmonsmith J, Burriesci G, Byrne G. Biological Equivalence of GGTA-1 Glycosyltransferase Knockout and Standard Porcine Pericardial Tissue Using 90-Day Mitral Valve Implantation in Adolescent Sheep. Cardiovasc Eng Technol 2021; 13:363-372. [PMID: 34820778 PMCID: PMC9197892 DOI: 10.1007/s13239-021-00585-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 10/19/2021] [Indexed: 11/26/2022]
Abstract
Objective There is growing interest in the application of genetically engineered reduced antigenicity animal tissue for manufacture of bioprosthetic heart valves (BHVs) to reduce antibody induced tissue calcification and accelerated structural valve degeneration (SVD). This study tested biological equivalence of valves made from Gal-knockout (GalKO) and standard porcine pericardium after 90-day mitral valve implantation in sheep. Methods GalKO (n = 5) and standard (n = 5) porcine pericardial BHVs were implanted in a randomized and blind fashion into sheep for 90-days. Valve haemodynamic function was measured at 30-day intervals. After explantation, valves were examined for pannus, vegetation, inflammation, thrombus, and tissue calcification. Results Nine of 10 recipients completed the study. There was no difference between study groups for haemodynamic performance and no adverse valve-related events. Explanted BHVs showed mild pannus integration and minimal thrombus, with no difference between the groups. Limited focal mineral deposits were detected by x-ray. Atomic spectroscopy analysis detected tissue calcium levels of 1.0 µg/mg ± 0.2 for GalKO BHVs and 1.9 µg/mg ± 0.9 for standard tissue BHVs (p = 0.4), considered to be both low and equivalent. Conclusions This is the first demonstration of biological equivalence between GalKO and standard pig pericardium. The GalKO mutation causes neither intrinsic detrimental biological nor functional impact on BHV performance. Commercial adaptation of GalKO tissue for surgical or transcatheter BHVs would remove the clinical disparity between patients producing anti-Gal antibody and BHVs containing the Gal antigen. GalKO BHVs may reduce accelerated tissue calcification and SVD, enhancing patient choices, especially for younger patients. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s13239-021-00585-0.
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Affiliation(s)
- Christopher McGregor
- Institute of Cardiovascular Science, University College London, London, UK.
- Department of Surgery, University of Minnesota, 8195B, MMC 195 Mayo, Minneapolis, MN, 55455, USA.
| | - Jacob Salmonsmith
- Department of Surgery, University of Minnesota, 8195B, MMC 195 Mayo, Minneapolis, MN, 55455, USA
- Department of Mechanical Engineering, University College London, London, UK
| | - Gaetano Burriesci
- Department of Mechanical Engineering, University College London, London, UK
- Ri.MED Foundation, Bioengineering Group, Palermo, Italy
| | - Guerard Byrne
- Institute of Cardiovascular Science, University College London, London, UK
- Department of Surgery, University of Minnesota, 8195B, MMC 195 Mayo, Minneapolis, MN, 55455, USA
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25
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An study on the influence of collagen fiber directions in TAVs performance using FEM. J Mech Behav Biomed Mater 2021; 126:104969. [PMID: 34844877 DOI: 10.1016/j.jmbbm.2021.104969] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/21/2021] [Accepted: 11/06/2021] [Indexed: 11/23/2022]
Abstract
Transcatheter Aortic Valve Implantation (TAVI) or Replacement (TAVR) is a promising treatment for aortic valve stenosis, consisting of a procedure to replace a damaged native aortic valve by a bioprosthetic one. This replacement valve control the flow of blood using leaflets that are similar to the ones of a native aortic valve. Commonly manufactured using bovine or porcine pericardium, it is a tissue histologically composed of collagen fibers embedded into a nearly-isotropic matrix, where their distribution makes the pericardium behave as an anisotropic hyperelastic material. Because of such complicated behavior, bioprosthetic pericardium valves are, as expected, sensitive to the distribution and orientation of these fibers in such device. Therefore, the objective of this work is a thorough systematic study on the influence of these fibers' distribution. First, a Finite Element model of a bioprosthetic valve is generated; then, a material routine to accurately describe the behavior of pericardium is implemented in a commercial software package; in addition, a dedicated algorithm to specify the direction of fibers is developed. Finally, a systematic study on the influence that fiber orientations have on the overall behavior of the TAV is performed. As a result of this study, two extreme behaviors are highlighted depending on the preferential orientation of collagen fibers; namely, one with fibers in circumferential direction and the opposite with fibers in an axial orientation. Then, it is concluded that the behavior of fibers in circumferential direction is very sensitive to small variations of the orientation angle, whereas such orientation is not as determining when the aim is to achieve a behavior near to the one corresponding with axial orientation.
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26
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Jin C, Zhao L, Wu Z, Li B, Liu R, He H, Wang L, Wang W. Comparison on the properties of bovine pericardium and porcine pericardium used as leaflet materials of transcatheter heart valve. Artif Organs 2021; 46:427-438. [PMID: 34545589 DOI: 10.1111/aor.14074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/06/2021] [Accepted: 09/13/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND In order to obtain the smaller delivery diameter, porcine pericardium had been used as a substitute material of bovine pericardium for the leaflet materials of transcatheter heart valve (THV). However, the differences between them had not been fully studied. Therefore, this study compared the microstructure, biochemical and mechanical properties of two materials and hydrodynamics of THV made by the two materials in detail. METHODS In this study, firstly, the microstructure of pericardium was analyzed by staining and scanning electron microscope; secondly, the biochemical properties of pericardium after different processes were compared by heat shrinkage temperature test, free amino and carboxyl concentration test, enzyme degradation test, subcutaneous implantation calcification analysis in rats; finally, the mechanical properties were evaluated by uniaxial tensile test before and after the pericardium being crimped, and then, the hydrodynamics of THV was studied according to the ISO5840 standard. RESULTS Compared with bovine pericardium, after the same process, porcine pericardium showed a looser and tinier fiber bundle, a similar free carboxyl concentration, a lower resistance to enzyme degradation, a significantly lower calcification, bearing capacity and damage after being crimped, a better hydrodynamic and adaption with lower cardiac output and deformation of implantation position. Meanwhile the dehydration process of pericardium almost had preserved all the biochemical advantages of two materials. CONCLUSION In this study, porcine and bovine pericardium showed some significant differences in biochemical, mechanical properties and hydrodynamics. According to the results, it was presumed that the thinner porcine pericardium might be more suitable for THV of right heart system. Meanwhile, more attention should be taken for the calcification of THV made by the bovine pericardium.
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Affiliation(s)
- Chang Jin
- Research Center for Biomedical Engineering, Medical Innovation & Research Division, Chinese PLA General Hospital, Beijing, China.,Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Chinese PLA General Hospital, Beijing, China
| | - Li Zhao
- Research Center for Biomedical Engineering, Medical Innovation & Research Division, Chinese PLA General Hospital, Beijing, China.,Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Chinese PLA General Hospital, Beijing, China
| | - Zebin Wu
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beihang University, Beijing, China
| | - Bin Li
- Research Center for Biomedical Engineering, Medical Innovation & Research Division, Chinese PLA General Hospital, Beijing, China.,Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Chinese PLA General Hospital, Beijing, China
| | - Ronghui Liu
- Research Center for Biomedical Engineering, Medical Innovation & Research Division, Chinese PLA General Hospital, Beijing, China.,Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Chinese PLA General Hospital, Beijing, China
| | - Hongping He
- Research Center for Biomedical Engineering, Medical Innovation & Research Division, Chinese PLA General Hospital, Beijing, China.,Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Chinese PLA General Hospital, Beijing, China
| | - Lizhen Wang
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beihang University, Beijing, China
| | - Weidong Wang
- Research Center for Biomedical Engineering, Medical Innovation & Research Division, Chinese PLA General Hospital, Beijing, China.,Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Chinese PLA General Hospital, Beijing, China
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27
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Campion G, Hershberger K, Whelan A, Conroy J, Lally C, Murphy BP. A Biomechanical and Microstructural Analysis of Bovine and Porcine Pericardium for Use in Bioprosthetic Heart Valves. STRUCTURAL HEART 2021. [DOI: 10.1080/24748706.2021.1938317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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28
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Russo G, Gennari M, Gavazzoni M, Pedicino D, Pozzoli A, Taramasso M, Maisano F. Transcatheter Mitral Valve Implantation: Current Status and Future Perspectives. Circ Cardiovasc Interv 2021; 14:e010628. [PMID: 34407621 DOI: 10.1161/circinterventions.121.010628] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mitral transcatheter therapies represent the treatment of choice for all patients deemed unsuitable for cardiac surgery. So far, the largest clinical experience has been limited to percutaneous repair techniques. However, given the complexity and heterogeneity of mitral valve anatomy and pathology, transcatheter mitral valve implantation will widen the mitral valve therapies horizon, toward a patient-tailored approach. Current data about transcatheter mitral valve implantation is still limited and, although some data are promising, there are still some issues to be addressed. This review provides a comprehensive insight into the available devices and describes potential advantages and limitations of transcatheter mitral valve implantation.
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Affiliation(s)
- Giulio Russo
- University of Zurich, Switzerland (G.R., M. Gennari,. M.G., A.P., M.T.).,Fondazione Policlinico Universitario A. Gemelli, IRCSS, Roma, Italy (G.R., D.P.).,Università Cattolica del Sacro Cuore, Roma, Italy (G.R., D.P.)
| | - Marco Gennari
- University of Zurich, Switzerland (G.R., M. Gennari,. M.G., A.P., M.T.).,IRCCS Centro Cardiologico Monzino, Milan, Italy (M. Gennari)
| | - Mara Gavazzoni
- University of Zurich, Switzerland (G.R., M. Gennari,. M.G., A.P., M.T.)
| | - Daniela Pedicino
- Fondazione Policlinico Universitario A. Gemelli, IRCSS, Roma, Italy (G.R., D.P.).,Università Cattolica del Sacro Cuore, Roma, Italy (G.R., D.P.)
| | - Alberto Pozzoli
- University of Zurich, Switzerland (G.R., M. Gennari,. M.G., A.P., M.T.).,Heart Surgery Unit, Cardiocentro Ticino, Lugano, Switzerland (A.P.)
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29
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Zhuravleva IY, Karpova EV, Dokuchaeva AA, Kuznetsova EV, Vladimirov SV, Ksenofontov AL, Nichay NR. Bovine jugular vein conduit: What affects its elastomechanical properties and thermostability? J Biomed Mater Res A 2021; 110:394-408. [PMID: 34390309 DOI: 10.1002/jbm.a.37296] [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: 05/03/2021] [Revised: 07/23/2021] [Accepted: 08/03/2021] [Indexed: 12/12/2022]
Abstract
The aim of this study was to compare the mechanical properties and thermal stability of the venous wall depending on the treatment method used, and, accordingly, on those structural changes in the tissue that this treatment causes. Bovine jugular vein walls (BJVWs) cross-linked with glutaraldehyde (GA), ethylene glycol diglycidyl ether (DE), and Contegra commercial conduit were evaluated using uniaxial stretching [with and without pre-conditioning (PreC)], differential scanning calorimetry, amino acid analysis, and attenuated total reflection infrared spectroscopy. Fresh BJVW was used as a control. It was shown that failure stress in non-PreC GA-treated and DE-treated materials was lower than that in fresh and Contegra counterparts. Contegra samples were the stiffest among the tested materials. Cyclic preloading leads to distortion of the mechanical behavior of this material, which is heterogeneous in composition and structure. The denaturation temperatures (Td ) of all cross-linked BJVWs were higher than the Td of the fresh vein. The microstructures of the tested BJVWs did not exhibit any differences, but the cross-linking density and hydration of the DE-vein were the highest. GA-cross-linking or DE-cross-linking and isopropanol exposure (Contegra) changed the protein secondary structures of the tested materials in different ways. We hypothesized that the protein secondary structure and hydration degree are the main causes of differences in the mechanical properties and thermal stability of BJVW.
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Affiliation(s)
- Irina Yu Zhuravleva
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, Novosibirsk, Russian Federation
| | - Elena V Karpova
- N.N. Vorozhtsov Novosibirsk Institute of Organic Chemistry SB RAS, Novosibirsk, Russian Federation
| | - Anna A Dokuchaeva
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, Novosibirsk, Russian Federation
| | - Elena V Kuznetsova
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, Novosibirsk, Russian Federation
| | - Sergei V Vladimirov
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, Novosibirsk, Russian Federation
| | - Alexander L Ksenofontov
- A. Belozersky Research Institute of Physico-Chemical Biology MSU, Moscow, Russian Federation
| | - Natalia R Nichay
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, Novosibirsk, Russian Federation
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30
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Bui HT, Khair N, Yeats B, Gooden S, James SP, Dasi LP. Transcatheter Heart Valves: A Biomaterials Perspective. Adv Healthc Mater 2021; 10:e2100115. [PMID: 34038627 DOI: 10.1002/adhm.202100115] [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: 01/18/2021] [Revised: 04/23/2021] [Indexed: 11/11/2022]
Abstract
Heart valve disease is prevalent throughout the world, and the number of heart valve replacements is expected to increase rapidly in the coming years. Transcatheter heart valve replacement (THVR) provides a safe and minimally invasive means for heart valve replacement in high-risk patients. The latest clinical data demonstrates that THVR is a practical solution for low-risk patients. Despite these promising results, there is no long-term (>20 years) durability data on transcatheter heart valves (THVs), raising concerns about material degeneration and long-term performance. This review presents a detailed account of the materials development for THVRs. It provides a brief overview of THVR, the native valve properties, the criteria for an ideal THV, and how these devices are tested. A comprehensive review of materials and their applications in THVR, including how these materials are fabricated, prepared, and assembled into THVs is presented, followed by a discussion of current and future THVR biomaterial trends. The field of THVR is proliferating, and this review serves as a guide for understanding the development of THVs from a materials science and engineering perspective.
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Affiliation(s)
- Hieu T. Bui
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
| | - Nipa Khair
- School of Advanced Materials Discovery Colorado State University 700 Meridian Ave Fort Collins CO 80523 USA
| | - Breandan Yeats
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
| | - Shelley Gooden
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
| | - Susan P. James
- School of Advanced Materials Discovery Colorado State University 700 Meridian Ave Fort Collins CO 80523 USA
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
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31
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Yang F, Xu L, Guo G, Wang Y. Visible light-induced cross-linking of porcine pericardium for the improvement of endothelialization, anti-tearing, and anticalcification properties. J Biomed Mater Res A 2021; 110:31-42. [PMID: 34245103 DOI: 10.1002/jbm.a.37263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/28/2021] [Accepted: 06/29/2021] [Indexed: 12/18/2022]
Abstract
Population aging and the development of transcatheter aortic valve replacement boost the implantation of bioprosthetic heart valves (BHVs) in patients worldwide. However, the traditional glutaraldehyde cross-linked BHVs fail within 12-15 years mainly due to leaflet tear and calcification defects. In this study, a novel visible light-induced cross-linking of the porcine pericardium (PP) was realized by the photo-oxidation of the furfuryl-modified PP in the presence of Rose Bengal. The resulting material showed comparable collagen stability with the glutaraldehyde cross-linked PP and appropriate biomechanical properties such as tensile strength, modulus, and elongation, suggesting that this material could meet the general requirement for BHVs. Besides, this cross-linked PP showed significantly improved cytocompatibility compared with the Glut-cross-linked PP, with no cytotoxicity to L929 cells and the ability to support HUVECgrowth. Meanwhile, this material showed superior anti-tearing performance and much less calcification than the Glut-cross-linked PP in hope of reducing the risk of BHV failure. Considering these results, the visible light-induced cross-linking method proposed in this study could provide a promising way to construct a biocompatible and robust biomaterial for the fabrication of the BHV.
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Affiliation(s)
- Fan Yang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
| | - Liangpeng Xu
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
| | - Gaoyang Guo
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
| | - Yunbing Wang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
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Obrist D, Carrel TP. Commentary: Leaflet fluttering of bioprosthetic valve—Does it matter? JTCVS OPEN 2021; 6:82-83. [PMID: 36003581 PMCID: PMC9390657 DOI: 10.1016/j.xjon.2020.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 10/12/2020] [Accepted: 10/23/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Dominik Obrist
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Thierry P. Carrel
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Address for reprints: Thierry P. Carrel, MD, Department for Cardiovascular Surgery, University Hospital, Freiburgstrasse, CH-3010 Bern, Switzerland.
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Hinchliffe JD, Parassini Madappura A, Syed Mohamed SMD, Roy I. Biomedical Applications of Bacteria-Derived Polymers. Polymers (Basel) 2021; 13:1081. [PMID: 33805506 PMCID: PMC8036740 DOI: 10.3390/polym13071081] [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: 03/01/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 12/12/2022] Open
Abstract
Plastics have found widespread use in the fields of cosmetic, engineering, and medical sciences due to their wide-ranging mechanical and physical properties, as well as suitability in biomedical applications. However, in the light of the environmental cost of further upscaling current methods of synthesizing many plastics, work has recently focused on the manufacture of these polymers using biological methods (often bacterial fermentation), which brings with them the advantages of both low temperature synthesis and a reduced reliance on potentially toxic and non-eco-friendly compounds. This can be seen as a boon in the biomaterials industry, where there is a need for highly bespoke, biocompatible, processable polymers with unique biological properties, for the regeneration and replacement of a large number of tissue types, following disease. However, barriers still remain to the mass-production of some of these polymers, necessitating new research. This review attempts a critical analysis of the contemporary literature concerning the use of a number of bacteria-derived polymers in the context of biomedical applications, including the biosynthetic pathways and organisms involved, as well as the challenges surrounding their mass production. This review will also consider the unique properties of these bacteria-derived polymers, contributing to bioactivity, including antibacterial properties, oxygen permittivity, and properties pertaining to cell adhesion, proliferation, and differentiation. Finally, the review will select notable examples in literature to indicate future directions, should the aforementioned barriers be addressed, as well as improvements to current bacterial fermentation methods that could help to address these barriers.
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Affiliation(s)
| | | | | | - Ipsita Roy
- Department of Materials Science and Engineering, Faculty of Engineering, University of Sheffield, Sheffield S1 3JD, UK; (J.D.H.); (A.P.M.); (S.M.D.S.M.)
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Xu F, Johnson EL, Wang C, Jafari A, Yang CH, Sacks MS, Krishnamurthy A, Hsu MC. Computational investigation of left ventricular hemodynamics following bioprosthetic aortic and mitral valve replacement. MECHANICS RESEARCH COMMUNICATIONS 2021; 112:103604. [PMID: 34305195 PMCID: PMC8301225 DOI: 10.1016/j.mechrescom.2020.103604] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The left ventricle of the heart is a fundamental structure in the human cardiac system that pumps oxygenated blood into the systemic circulation. Several valvular conditions can cause the aortic and mitral valves associated with the left ventricle to become severely diseased and require replacement. However, the clinical outcomes of such operations, specifically the postoperative ventricular hemodynamics of replacing both valves, are not well understood. This work uses computational fluid-structure interaction (FSI) to develop an improved understanding of this effect by modeling a left ventricle with the aortic and mitral valves replaced with bioprostheses. We use a hybrid Arbitrary Lagrangian-Eulerian/immersogeometric framework to accommodate the analysis of cardiac hemodynamics and heart valve structural mechanics in a moving fluid domain. The motion of the endocardium is obtained from a cardiac biomechanics simulation and provided as an input to the proposed numerical framework. The results from the simulations in this work indicate that the replacement of the native mitral valve with a tri-radially symmetric bioprosthesis dramatically changes the ventricular hemodynamics. Most significantly, the vortical motion in the left ventricle is found to reverse direction after mitral valve replacement. This study demonstrates that the proposed computational FSI framework is capable of simulating complex multiphysics problems and can provide an in-depth understanding of the cardiac mechanics.
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Affiliation(s)
- Fei Xu
- Ansys Inc., Austin, TX 78746, USA
| | - Emily L. Johnson
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011, USA
| | | | - Arian Jafari
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011, USA
| | - Cheng-Hau Yang
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011, USA
| | - Michael S. Sacks
- Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, Austin, TX 78712, USA
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712, USA
| | - Adarsh Krishnamurthy
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011, USA
| | - Ming-Chen Hsu
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011, USA
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Yang L, Xie S, Ding K, Lei Y, Wang Y. The study of dry biological valve crosslinked with a combination of carbodiimide and polyphenol. Regen Biomater 2021; 8:rbaa049. [PMID: 33732495 PMCID: PMC7947589 DOI: 10.1093/rb/rbaa049] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/11/2020] [Accepted: 09/23/2020] [Indexed: 12/18/2022] Open
Abstract
The glutaraldehyde crosslinked pericardium has been used in bioprosthetic valves for about 50 years. However, problems such as glutaraldehyde residue and calcification still exist in current commercial products. Non-glutaraldehyde crosslinked dry valve is an important strategy to solve those problems. In this study, a non-glutaraldehyde crosslinked dry biological valve material was obtained by the combined crosslinking of carbodiimide (EDC) and polyphenol. The results showed that the comprehensive properties of EDC and curcumin crosslinked pericardium were superior to glutaraldehyde crosslinked pericardium, including unfolding property, anti-calcification, cytotoxicity, anticoagulant properties, mechanical properties, enzyme degradation resistance and thermal shrinkage temperature. EDC and curcumin crosslinked dry pericardium could flatten after being folded at 40°C for 3 days while glutaraldehyde crosslinked pericardium could not. The calcification of pericardium treated with EDC and curcumin was 1.21 ± 0.36 mg/g in rats after 60 days’ subdermal implantation, much lower than that of glutaraldehyde treated control group (22.06 ± 3.17 mg/g).
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Affiliation(s)
- Li Yang
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, China
| | - Shuang Xie
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, China
| | - Kailei Ding
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, China
| | - Yang Lei
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, China
| | - Yunbing Wang
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, China
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Lan X, Zhao Q, Zhang J, Lei Y, Wang Y. A combination of hydrogen bonding and chemical covalent crosslinking to fabricate a novel swim-bladder-derived dry heart valve material yields advantageous mechanical and biological properties. Biomed Mater 2020; 16:015014. [DOI: 10.1088/1748-605x/abb616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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37
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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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Liu M, Dong H, Lou X, Iannucci G, Chen EP, Leshnower BG, Sun W. A Novel Anisotropic Failure Criterion With Dispersed Fiber Orientations for Aortic Tissues. J Biomech Eng 2020; 142:111002. [PMID: 32766773 DOI: 10.1115/1.4048029] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Indexed: 12/14/2022]
Abstract
Accurate failure criteria play a fundamental role in biomechanical analyses of aortic wall rupture and dissection. Experimental investigations have demonstrated a significant difference of aortic wall strengths in the circumferential and axial directions. Therefore, the isotropic von Mises stress and maximum principal stress, commonly used in computational analysis of the aortic wall, are inadequate for modeling of anisotropic failure properties. In this study, we propose a novel stress-based anisotropic failure criterion with dispersed fiber orientations. In the new failure criterion, the overall failure metric is computed by using angular integration (AI) of failure metrics in all directions. Affine rotations of fiber orientations due to finite deformation are taken into account in an anisotropic hyperelastic constitutive model. To examine fitting capability of the failure criterion, a set of off-axis uniaxial tension tests were performed on aortic tissues of four porcine individuals and 18 human ascending thoracic aortic aneurysm (ATAA) patients. The dispersed fiber failure criterion demonstrates a good fitting capability with the off-axis testing data. Under simulated biaxial stress conditions, the dispersed fiber failure criterion predicts a smaller failure envelope comparing to those predicted by the traditional anisotropic criteria without fiber dispersion, which highlights the potentially important role of fiber dispersion in the failure of the aortic wall. Our results suggest that the deformation-dependent fiber orientations need to be considered when wall strength determined from uniaxial tests are used for in vivo biomechanical analysis. More investigations are needed to determine biaxial failure properties of the aortic wall.
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Affiliation(s)
- Minliang Liu
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30313
| | - Hai Dong
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30313
| | - Xiaoying Lou
- Emory University School of Medicine, Atlanta, GA 30332
| | - Glen Iannucci
- Emory University School of Medicine, Atlanta, GA 30332
| | - Edward P Chen
- Emory University School of Medicine, Atlanta, GA 30332
| | | | - Wei Sun
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Technology Enterprise Park, Room 206 387 Technology Circle, Atlanta, GA 30313
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In-Vitro Assessment of the Effects of Transcatheter Aortic Valve Leaflet Design on Neo-Sinus Geometry and Flow. Ann Biomed Eng 2020; 49:1046-1057. [PMID: 33098058 DOI: 10.1007/s10439-020-02664-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/16/2020] [Indexed: 10/23/2022]
Abstract
Transcatheter aortic valve (TAV) leaflet thrombosis is a clinical risk with potentially fatal consequences. Studies have identified neo-sinus flow stasis as a cause of leaflet thrombosis. Flow stasis is influenced by the TAV leaflets, which affect the local fluid dynamics in the aortic sinus and neo-sinus. This study evaluated the effects of TAV leaflet features on the neo-sinus flow as a measure of leaflet thrombosis risk. Five TAVs of varied leaflet length and insertion height were tested in a simulator. Hydrodynamics and leaflet kinematics through en-phase imaging were quantified. Velocity fields were assessed using high-speed particle image velocimetry. Regions of flow stasis and particle residence times (PRTs) were quantified. TAVs with shorter leaflet length exhibited larger orifice areas and lower transvalvular pressure gradients. Shorter leaflet length and increased leaflet insertion TAVs additionally exhibited lower neo-sinus PRTs (0.44 ± 0.21 vs 2.83 ± 0.48 cycles, p < 0.05) and higher neo-sinus peak velocities (0.15 ± 0.009 vs 0.07 ± 0.005 m/s, p < 0.05) than TAVs with longer leaflet length and lower leaflet insertion. The average neo-sinus volume positively correlated with PRT(r = 0.810, p < 0.001), and extent of flow stasis (r = 0.682, p < 0.05). These results suggest that a small neo-sinus volume may reduce flow stagnation and particle residence, potentially reducing the risk of leaflet thrombosis. We propose that leaflet design features might be proactively controlled in the design of future transcatheter aortic valves.
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40
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Whelan A, Williams E, Nolan DR, Murphy B, Gunning PS, O'Reilly D, Lally C. Bovine Pericardium of High Fibre Dispersion Has High Fatigue Life and Increased Collagen Content; Potentially an Untapped Source of Heart Valve Leaflet Tissue. Ann Biomed Eng 2020; 49:1022-1032. [PMID: 33063231 DOI: 10.1007/s10439-020-02644-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 09/30/2020] [Indexed: 02/07/2023]
Abstract
Bioprosthetic heart valves (BHVs) are implanted in aortic valve stenosis patients to replace the native, dysfunctional valve. Yet, the long-term performance of the glutaraldehyde-fixed bovine pericardium (GLBP) leaflets is known to reduce device durability. The aim of this study was to investigate a type of commercial-grade GLBP which has been over-looked in the literature to date; that of high collagen fibre dispersion (HD). Under uniaxial cyclic loading conditions, it was observed that the fatigue behaviour of HD GLBP was substantially equivalent to GLBP in which the fibres are highly aligned along the loading direction. It was also found that HD GLBP had a statistically significant 9.5% higher collagen content when compared to GLBP with highly aligned collagen fibres. The variability in diseased BHV delivery sites results in unpredictable and complex loading patterns across leaflets in vivo. This study presents the possibility of a shift from the traditional choice of circumferentially aligned GLBP leaflets, to that of high fibre dispersion arrangements. Characterised by its high fatigue life and increased collagen content, in addition to multiple fibre orientations, GLBP of high fibre dispersion may provide better patient outcomes under the multi-directional loading to which BHV leaflets are subjected in vivo.
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Affiliation(s)
- Alix Whelan
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.,Department of Mechanical, Manufacturing & Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin 2, Ireland.,Structural Heart Division, Boston Scientific Corporation, Galway, Ireland
| | - Elizabeth Williams
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.,Department of Mechanical, Manufacturing & Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin 2, Ireland
| | - David R Nolan
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.,Department of Mechanical, Manufacturing & Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin 2, Ireland
| | - Bruce Murphy
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.,Department of Mechanical, Manufacturing & Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin 2, Ireland.,Advanced Materials and Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland and Trinity College Dublin, Dublin, Ireland
| | - Paul S Gunning
- Structural Heart Division, Boston Scientific Corporation, Los Gatos, CA, 95032, USA
| | - David O'Reilly
- Structural Heart Division, Boston Scientific Corporation, Galway, Ireland
| | - Caitríona Lally
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland. .,Department of Mechanical, Manufacturing & Biomedical Engineering, School of Engineering, Trinity College Dublin, Dublin 2, Ireland. .,Advanced Materials and Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland and Trinity College Dublin, Dublin, Ireland.
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41
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Jin L, He H, Yang F, Xu L, Guo G, Wang Y. Tough pNAGA hydrogel hybridized porcine pericardium for the pre-mounted TAVI valve with improved anti-tearing properties and hemocompatibility. ACTA ACUST UNITED AC 2020; 15:065013. [PMID: 32615546 DOI: 10.1088/1748-605x/aba239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The rate of adoption of transcatheter aortic valve implantation (TAVI) is increasing rapidly, due to the procedure being less invasive. However, TAVI still faces problems relating to durability, the potential incidence of thrombosis, and the inconvenience of storage in glutaraldehyde (Glut) solution. In this work, a tough hydrogel poly(N-acryloyl glycinamide) (pNAGA) is hybridized with Glut-crosslinked porcine pericardium (Glut-PP) via in situ polymerization and glycerolization, so as to obtain dry leafet material for the fabrication of a pre-mounted bioprosthetic heart valve (BHV). The tensile strength, anti-shearing, and anti-tearing properties of the valve are significantly improved by the process of hydrogel hybridization. Following a period of dry-state compression as a simulation for the crimping process of pre-mounted TAV, pNAGA/Glut-PP showed full recovery without structural damage when fully rehydrated. The introduction of pNAGA also improved the blood compatibility of the tissue, with less clot formation and fewer blood cells adhering to the surface of pNAGA/Glut-PP than is found with Glut-PP. Subcutaneous implantation in rats showed that pNAGA/Glut-PP induced a decreased inflammatory response compared with Glut-PP. These results indicate that the strategy for hybridization with hydrogel could be a potential method for preparing pre-mounted TAVs with an improved performance.
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42
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Johnson EL, Wu MCH, Xu F, Wiese NM, Rajanna MR, Herrema AJ, Ganapathysubramanian B, Hughes TJR, Sacks MS, Hsu MC. Thinner biological tissues induce leaflet flutter in aortic heart valve replacements. Proc Natl Acad Sci U S A 2020; 117:19007-19016. [PMID: 32709744 PMCID: PMC7431095 DOI: 10.1073/pnas.2002821117] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Valvular heart disease has recently become an increasing public health concern due to the high prevalence of valve degeneration in aging populations. For patients with severely impacted aortic valves that require replacement, catheter-based bioprosthetic valve deployment offers a minimally invasive treatment option that eliminates many of the risks associated with surgical valve replacement. Although recent percutaneous device advancements have incorporated thinner, more flexible biological tissues to streamline safer deployment through catheters, the impact of such tissues in the complex, mechanically demanding, and highly dynamic valvular system remains poorly understood. The present work utilized a validated computational fluid-structure interaction approach to isolate the behavior of thinner, more compliant aortic valve tissues in a physiologically realistic system. This computational study identified and quantified significant leaflet flutter induced by the use of thinner tissues that initiated blood flow disturbances and oscillatory leaflet strains. The aortic flow and valvular dynamics associated with these thinner valvular tissues have not been previously identified and provide essential information that can significantly advance fundamental knowledge about the cardiac system and support future medical device innovation. Considering the risks associated with such observed flutter phenomena, including blood damage and accelerated leaflet deterioration, this study demonstrates the potentially serious impact of introducing thinner, more flexible tissues into the cardiac system.
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Affiliation(s)
- Emily L Johnson
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011
| | - Michael C H Wu
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011
| | - Fei Xu
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011
| | - Nelson M Wiese
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011
| | - Manoj R Rajanna
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011
| | - Austin J Herrema
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011
| | | | - Thomas J R Hughes
- Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, Austin, TX 78712;
| | - Michael S Sacks
- Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, Austin, TX 78712;
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712
| | - Ming-Chen Hsu
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50011;
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43
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Yang F, He H, Xu L, Jin L, Guo G, Wang Y. Inorganic-polymerization crosslinked tissue-siloxane hybrid as potential biomaterial for bioprosthetic heart valves. J Biomed Mater Res A 2020; 109:754-765. [PMID: 32681740 DOI: 10.1002/jbm.a.37061] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 06/21/2020] [Accepted: 07/01/2020] [Indexed: 12/17/2022]
Abstract
Bioprosthetic heart valve (BHV) replacement is increasingly used for treating valve-related diseases worldwide but the current commercially used BHVs treated with glutaraldehyde (Glut) often failed within 12-15 years due to degradation, thrombosis, inferior biocompatibility, and calcification. Herein, 3-glycidyloxypropyl trimethoxysilane (GPTMS) was used to crosslink porcine pericardium (PP) at the concentration (vol/vol) of 0.25%, 1%, 2%, and 4% and their performance for potential application in BHVs was evaluated. The crosslinking mechanism mainly involved the ring-opening of epoxide by amine attack and silanol poly-condensation. The stability of collagen in higher concentration (1%, 2%, and 4%) GPTMS crosslinked PPs (GPTMS-PPs) was clearly increased. GPTMS-PPs showed no cytotoxicity and supported the growth of endothelial cells while Glut-PP did not. GPTMS-PPs were less prothrombotic than Glut-PP. GPTMS-PP crosslinked at 1% concentration showed comparable mechanical properties to Glut-PP while had better anti-tearing performance. The subcutaneous implantation in rat for 30 days showed that GPTMS crosslinking was able to effectively inhibit the calcification of BHV.
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Affiliation(s)
- Fan Yang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
| | - Haiyang He
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
| | - Liangpeng Xu
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
| | - Linhe Jin
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
| | - Gaoyang Guo
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
| | - Yunbing Wang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
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You P, Liu Y, Wang X, Li B, Wu W, Tang L. Acellular pericardium: A naturally hierarchical, osteoconductive, and osteoinductive biomaterial for guided bone regeneration. J Biomed Mater Res A 2020; 109:132-145. [PMID: 32441432 DOI: 10.1002/jbm.a.37011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 04/15/2020] [Accepted: 04/19/2020] [Indexed: 01/04/2023]
Abstract
There is great demand for an improved barrier membrane with osteogenic potential for guided bone regeneration (GBR). Natural acellular porcine pericardium (APP) is increasingly used in regenerative medicine as a kind of common extracellular matrix materials. This study aimed to investigate its potential application in GBR, especially its osteoconductive and osteoinductive properties. Bio-Gide (BG), a commercial collagen membrane, was set as the control group. APP samples were characterized by physicochemical analyses and their biological effects on human bone mesenchymal stem cells (hBMSCs) and human gingival fibroblasts (hGFs) were also examined. Additionally, the osteogenic potential of APP was tested on a bilateral critical-sized calvarial defect model. We discovered that the smooth surface of APP tended to recruit more hBMSCs. Moreover, promoted proliferation and osteogenic differentiation of hBMSCs was detected on this side of APP, with increased alkaline phosphatase activity and upregulated expression of bone-specific genes. Besides, the rough side of APP showed good biocompatibility and barrier function with hGFs. Histologic observation and analysis of calvarial defect healing over 4 weeks revealed enhanced bone regeneration under APP compared with BG and the control group. The results of this study indicate that APP is a potential osteoconductive and osteoinductive biomaterial for GBR.
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Affiliation(s)
- Pengyue You
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, No.22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, P.R. China
| | - Yuhua Liu
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, No.22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, P.R. China
| | - Xinzhi Wang
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, No.22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, P.R. China
| | - Bowen Li
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, No.22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, P.R. China
| | - Weiyi Wu
- Department of Second Clinical Division, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, No.22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, P.R. China
| | - Lin Tang
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, No.22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, P.R. China
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Sun Z, Liu J, Wang X, Jing H, Li B, Kong D, Leng X, Wang Z. Epoxy Chitosan-Crosslinked Acellular Bovine Pericardium with Improved Anti-calcification and Biological Properties. ACS APPLIED BIO MATERIALS 2020; 3:2275-2283. [PMID: 35025279 DOI: 10.1021/acsabm.0c00067] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Glutaraldehyde (GA) was conventionally used to crosslink bovine pericardium to prepare bioprosthetic heart valves (BHVs), which usually fail within 10 years because of valve deterioration and calcification. To overcome the high cytotoxicity and severe calcification of GA-crosslinked BHVs, a quaternary ammonium salt of epoxy chitosan (epoxy group-modified 3-chlorine-2-hydroxypropyl trimethyl chitosan, abbreviated as "eHTCC") was developed to modify the acellular bovine pericardium to substitute GA and improve its anti-calcification and biocompatible properties. Mechanical test, enzymatic stability test, blood compatibility assay, and cytocompatibility assay were used to investigate its mechanical property and biocompatibility. The anti-calcification effect of the eHTCC-modified bovine pericardium (eHTCC-BP) was assessed by in vitro assay and rat subcutaneous implantation assay. The results showed that eHTCC-BP could improve the mechanical properties and anti-enzymolysis ability of BP, as well as retain the original three-dimensional structure, compared with the uncrosslinked-BP group. Moreover, the in vivo calcification level of the eHTCC-BP group was much lower than that of the GA-BP group, which was 5.1% (2 weeks), 2.3% (4 weeks), and 0.8% (8 weeks) of the GA-BP group. In summary, this study demonstrated that eHTCC could be a potential crosslinking agent for the extracellular matrix for its favorable crosslinking effects, anti-enzymolysis, anti-calcification, and biocompatibility.
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Affiliation(s)
- Zhiting Sun
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300192, China
| | - Jing Liu
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300192, China
| | - Xiaoxiao Wang
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300192, China
| | - Huimin Jing
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300192, China
| | - Binhan Li
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300192, China
| | - Deling Kong
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300192, China.,Key Laboratory of Bioactive Materials of Ministry of Education, State Key Laboratory of Medicinal Chemical Biology, College of Life Science, Nankai University, Tianjin 300071, China
| | - Xigang Leng
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300192, China
| | - Zhihong Wang
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300192, China
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Caballero A, Mao W, McKay R, Sun W. The Impact of Self-Expandable Transcatheter Aortic Valve Replacement on Concomitant Functional Mitral Regurgitation: A Comprehensive Engineering Analysis. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2020; 4:179-191. [PMID: 33728393 DOI: 10.1080/24748706.2020.1740365] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background Mitral regurgitation (MR) is present in a large proportion of patients who undergo transcatheter aortic valve replacement (TAVR). However, existing clinical data on the impact of TAVR on early post-procedural MR severity are contradictory. Using a comprehensive computational engineering methodology, this study aimed to evaluate quantitatively the structural and hemodynamic impact of TAVR on aortic-mitral continuity and MR severity in a rigorously developed and validated patient-specific left heart (LH) computer model with aortic stenosis and concomitant functional MR. Methods TAVR procedure was virtually simulated using a self-expandable valve (SEV) at three implantation heights. Pre- and post-TAVR LH dynamics as well as intra-operative biomechanics were analyzed. Results No significant differences in early MR improvement (<10%) were noted at the three implantation depths when compared to the pre-TAVR state. The high deployment model resulted in the highest stress in the native aortic leaflets, lowest stent-tissue contact force, highest aortic-mitral angle, and highest MR reduction for this patient case. When comparing SEV vs. balloon-expandable valve (BEV) performance at an optimal implantation height, the SEV gave a higher regurgitant volume ⋅ than the pre-TAVR model (40.49 vs 37.59 ml), while the BEV model gave the lowest regurgitant volume (33.84 vs 37.59 ml). Conclusions Contact force, aortic-mitral angle, and valve annuli compression were identified as possible mechanistic parameters that may suggest avenues for acute MR improvement. Albeit a single patient parametric study, it is our hope that such detailed engineering analysis could shed some light into the underlying biomechanical mechanisms of TAVR impact on MR.
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Affiliation(s)
- Andrés Caballero
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Wenbin Mao
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Raymond McKay
- Division of Cardiology, The Hartford Hospital, Hartford, Connecticut, USA
| | - Wei Sun
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
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Grebenik EA, Gafarova ER, Istranov LP, Istranova EV, Ma X, Xu J, Guo W, Atala A, Timashev PS. Mammalian Pericardium-Based Bioprosthetic Materials in Xenotransplantation and Tissue Engineering. Biotechnol J 2020; 15:e1900334. [PMID: 32077589 DOI: 10.1002/biot.201900334] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 01/29/2020] [Indexed: 12/13/2022]
Abstract
Bioprosthetic materials based on mammalian pericardium tissue are the gold standard in reconstructive surgery. Their application range covers repair of rectovaginal septum defects, abdominoplastics, urethroplasty, duraplastics, maxillofacial, ophthalmic, thoracic and cardiovascular reconstruction, etc. However, a number of factors contribute to the success of their integration into the host tissue including structural organization, mechanical strength, biocompatibility, immunogenicity, surface chemistry, and biodegradability. In order to improve the material's properties, various strategies are developed, such as decellularization, crosslinking, and detoxification. In this review, the existing issues and long-term achievements in the development of bioprosthetic materials based on the mammalian pericardium tissue, aimed at a wide-spectrum application in reconstructive surgery are analyzed. The basic technical approaches to preparation of biocompatible forms providing continuous functioning, optimization of biomechanical and functional properties, and clinical applicability are described.
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Affiliation(s)
- Ekaterina A Grebenik
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, 119991, Russia
| | - Elvira R Gafarova
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, 119991, Russia
| | - Leonid P Istranov
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, 119991, Russia
| | - Elena V Istranova
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, 119991, Russia
| | - Xiaowei Ma
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing, 100190, P. R. China
| | - Jing Xu
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing, 100190, P. R. China
| | - Weisheng Guo
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing, 100190, P. R. China
| | - Anthony Atala
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, 27101, USA
| | - Peter S Timashev
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, 119991, Russia.,Institute of Photonic Technologies, Research center "Crystallography and Photonics" RAS, Moscow, 142190, Russia.,N. N. Semenov Institute of Chemical Physics, Russian Academy of Sciences, Moscow, 119991, Russia
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48
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Walker S, Dittfeld C, Jakob A, Schönfelder J, König U, Tugtekin SM. Sterilization and Cross-Linking Combined with Ultraviolet Irradiation and Low-Energy Electron Irradiation Procedure: New Perspectives for Bovine Pericardial Implants in Cardiac Surgery. Thorac Cardiovasc Surg 2020; 70:33-42. [PMID: 32114687 DOI: 10.1055/s-0040-1705100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Bovine pericardium is the major natural source of patches and aortic valve substitutes in cardiac repair procedures. However, long-term tissue durability and biocompatibility issues lead to degeneration (e.g., calcification) that requires reoperation. Tissue preparation strategies, including glutaraldehyde fixation, are reasons for the deterioration of pericardial tissues. We describe a pretreatment procedure involving sterilization and cross-linking combined with ultraviolet (UV) irradiation and low-energy electron irradiation (SULEEI). This innovative, glutaraldehyde-free protocol improves the mechanical aspects and biocompatibility of porcine pericardium patches. METHODS We adopted the SULEEI protocol, which combines decellularization, sterilization, and cross-linking, along with UV irradiation and low-energy electron irradiation, to pretreat bovine pericardium. Biomechanics, such as ultimate tensile strength and elasticity, were investigated by comparing SULEEI-treated tissue with glutaraldehyde-fixed analogues, clinical patch materials, and an aortic valve substitute. Histomorphological and cellular aspects were investigated by histology, DNA content analysis, and degradability. RESULTS Mechanical parameters, including ultimate tensile strength, elasticity (Young's modulus), and suture retention strength, were similar for SULEEI-treated and clinically applied bovine pericardium. The SULEEI-treated tissues showed well-preserved histoarchitecture that resembled all pericardial tissues investigated. Fiber density did not differ significantly. DNA content after the SULEEI procedure was reduced to less than 10% of the original tissue material, and more than 50% of the SULEEI-treated pericardium was digested by collagenase. CONCLUSION The SULEEI procedure represents a new treatment protocol for the preparation of patches and aortic valve prostheses from bovine pericardial tissue. The avoidance of glutaraldehyde fixation may lessen the tissue degeneration processes in cardiac repair patches and valve prostheses.
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Affiliation(s)
- Simona Walker
- Department of Medical and Biotechnological Applications, Fraunhofer Institute for Organic Electronics, Electron Beam and Plasma Technology, Dresden, Germany
| | - Claudia Dittfeld
- Department of Cardiac Surgery, Faculty of Medicine Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Aline Jakob
- Department of Cardiac Surgery, Faculty of Medicine Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Jessy Schönfelder
- Department of Medical and Biotechnological Applications, Fraunhofer Institute for Organic Electronics, Electron Beam and Plasma Technology, Dresden, Germany
| | - Ulla König
- Department of Medical and Biotechnological Applications, Fraunhofer Institute for Organic Electronics, Electron Beam and Plasma Technology, Dresden, Germany
| | - Sems-Malte Tugtekin
- Department of Cardiac Surgery, Faculty of Medicine Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
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49
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Ghosh RP, Marom G, Bianchi M, D'souza K, Zietak W, Bluestein D. Numerical evaluation of transcatheter aortic valve performance during heart beating and its post-deployment fluid-structure interaction analysis. Biomech Model Mechanobiol 2020; 19:1725-1740. [PMID: 32095912 DOI: 10.1007/s10237-020-01304-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 02/02/2020] [Indexed: 01/11/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure that provides an effective alternative to open-heart surgical valve replacement for treating advanced calcific aortic valve disease patients. However, complications, such as valve durability, device migration, paravalvular leakage (PVL), and thrombogenicity may lead to increased overall post-TAVR morbidity and mortality. A series of numerical studies involving a self-expandable TAVR valve were performed to evaluate these complications. Structural studies were performed with finite element (FE) analysis, followed by computational fluid dynamics (CFD) simulations, and fluid-structure interaction (FSI) analysis. The FE analysis was utilized to study the effect of TAVR valve implantation depth on valve anchorage in the Living Heart Human Model, which is capable of simulating beating heart during repeated cardiac cycles. The TAVR deployment cases where no valve migration was observed were then used to calculate the post-deployment thrombogenic potential via CFD simulations. FSI analysis followed to further assess the post-deployment TAVR hemodynamic performance for different implantation depths. The deployed valves PVL, geometric and effective orifice areas, and the leaflets structural and flow stress magnitudes were compared to determine the device optimal landing zone. The combined structural and hemodynamic analysis indicated that with the TAVR valve deployed at an aft ventricle position an optimal performance was achieved in the specific anatomy studied. Given the TAVR's rapid expansion to younger lower-risk patients, the comprehensive numerical methodology proposed here can potentially be used as a predictive tool for both procedural planning and valve design optimization to minimize the reported complications.
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Affiliation(s)
- Ram P Ghosh
- Department of Biomedical Engineering, Health Sciences Center T08-050, Stony Brook University, Stony Brook, NY, 11794-8084, USA
| | - Gil Marom
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Matteo Bianchi
- Department of Biomedical Engineering, Health Sciences Center T08-050, Stony Brook University, Stony Brook, NY, 11794-8084, USA
| | - Karl D'souza
- Dassault Systèmes SIMULIA Corp, Johnston, RI, 02919, USA
| | - Wojtek Zietak
- Capvidia NV, Research Park Haasrode, Technologielaan 3, 3001, Leuven, Belgium
| | - Danny Bluestein
- Department of Biomedical Engineering, Health Sciences Center T08-050, Stony Brook University, Stony Brook, NY, 11794-8084, USA.
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50
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Yang L, Huang X, Deng L, Ma X, Jiang H, Ning Q, Liang Z, Lei Y, Wang Y. Pre-mounted dry TAVI valve with improved endothelialization potential using REDV-loaded PEGMA hydrogel hybrid pericardium. J Mater Chem B 2020; 8:2689-2701. [DOI: 10.1039/c9tb00879a] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Schematic diagram for the preparation of hydrogel hybrid dry valve.
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Affiliation(s)
- Li Yang
- National Engineering Research Center for Biomaterials
- Sichuan University
- Chengdu
- China
| | - Xueyu Huang
- National Engineering Research Center for Biomaterials
- Sichuan University
- Chengdu
- China
| | - Lu Deng
- National Engineering Research Center for Biomaterials
- Sichuan University
- Chengdu
- China
| | - Xiaoxiao Ma
- National Engineering Research Center for Biomaterials
- Sichuan University
- Chengdu
- China
| | - Honglin Jiang
- National Engineering Research Center for Biomaterials
- Sichuan University
- Chengdu
- China
| | - Qinggong Ning
- National Engineering Research Center for Biomaterials
- Sichuan University
- Chengdu
- China
| | - Zhen Liang
- National Engineering Research Center for Biomaterials
- Sichuan University
- Chengdu
- China
| | - Yang Lei
- National Engineering Research Center for Biomaterials
- Sichuan University
- Chengdu
- China
| | - Yunbing Wang
- National Engineering Research Center for Biomaterials
- Sichuan University
- Chengdu
- China
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