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Dittfeld C, Bähring S, Welzel C, Jannasch A, Matschke K, Tugtekin SM, Alexiou K. Tissue requirements for the application of aortic valve neocuspidization - appropriate pericardium properties and homogeneity? JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2024; 35:26. [PMID: 38683259 PMCID: PMC11058761 DOI: 10.1007/s10856-024-06790-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 03/05/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE Aortic valve neocuspidization (AVNeo) using autologous pericardium is a promising technique. Expected advantages are reduced immune response, appropriate biomechanics and lower treatment expenses. Nevertheless, autologous pericardium can be affected by patient's age and comorbidities. Usually, glutaraldehyde (GA) - fixed bovine pericardium is the basic material for aortic valve prostheses, easy available and carefully pre-examined in a standardized fabrication process. Aim of the study is the verification of autologous pericardial tissue homogeneity by analysing tissue thickness, biomechanics and extracellular matrix (ECM) composition. METHODS Segments of human GA-fixed pericardium selected by the surgeon based on visual criteria for cusp pre-cut and remaining after surgical AV replacement were investigated in comparison to bovine standard tissue treated equivalently. Pericardium sampling was performed at up to three positions of each sutured cusp for histological or biomechanical analysis, according to tissue availability. RESULTS AND CONCLUSIONS Human pericardia exhibited a higher heterogeneity in collagen content, density of vessel structures and elastic moduli. Thickness, vessel density and collagen and elastin content differed significantly between the species. In contrast, significant interindividual differences were detected in most properties investigated for human pericardial samples but only for tissue thickness in bovine tissues. Higher heterogeneity of human pericardium, differing vessel and collagen content compared to bovine state-of-the-art material might be detrimental for long term AV functionality or deterioration and have to be intensely investigated in patients follow up after autologous cusp replacement.
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Affiliation(s)
- Claudia Dittfeld
- Department of Cardiac Surgery, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Heart Centre Dresden, Dresden, Germany.
| | - Sophia Bähring
- Department of Cardiac Surgery, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Heart Centre Dresden, Dresden, Germany
| | - Cindy Welzel
- Department of Cardiac Surgery, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Heart Centre Dresden, Dresden, Germany
| | - Anett Jannasch
- Department of Cardiac Surgery, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Heart Centre Dresden, Dresden, Germany
| | - Klaus Matschke
- Department of Cardiac Surgery, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Heart Centre Dresden, Dresden, Germany
| | - Sems-Malte Tugtekin
- Department of Cardiac Surgery, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Heart Centre Dresden, Dresden, Germany
| | - Konstantin Alexiou
- Department of Cardiac Surgery, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Heart Centre Dresden, Dresden, Germany
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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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Fauzi AA, Fauza J, Suroto H, Parenrengi MA, Suryaningtyas W, Widiyanti P, Suroto NS, Utomo B, Wahid BDJ, Bella FR, Firda Y. An In Vitro Study of Chitosan-Coated Bovine Pericardium as a Dural Substitute Candidate. J Funct Biomater 2023; 14:488. [PMID: 37888153 PMCID: PMC10607121 DOI: 10.3390/jfb14100488] [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: 08/30/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 10/28/2023] Open
Abstract
Defects in the dura matter can be caused by head injury, and many cases require neurosurgeons to use artificial dura matter. Bovine pericardium is an option due to its abundant availability, adjustable size and characteristics, and because it has more collagen than porcine or equine pericardia. Nevertheless, the drawback of bovine pericardium is that it has a higher inflammatory effect than other synthetic dura matters. Chitosan has been shown to have a strong anti-inflammatory effect and has good tensile strength; thus, the idea was formulated to use chitosan as a coating for bovine pericardium. This study used decellularized bovine pericardial membranes with 0.5% sodium dodecyl sulphate and coatings containing chitosan at concentrations of 0.25%, 0.5%, 0.75%, and 1%. An FTIR test showed the presence of a C=N functional group as a bovine pericardium-chitosan bond. Morphological tests of the 0.25% and 0.5% chitosan concentrations showed standard pore sizes. The highest tensile strength percentage was shown by the membrane with a chitosan concentration of 1%. The highest degradation rate of the membrane was observed on the 7th and 14th days for 0.75% and 1% concentrations, and the lowest swelling ratio was observed for the 0.25% concentration. The highest level of cell viability was found for 0.75% chitosan. The bovine pericardium membrane with a 0.75% concentration chitosan coating was considered the optimal sample for use as artificial dura matter.
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Affiliation(s)
- Asra Al Fauzi
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya 60131, Indonesia; (J.F.); (M.A.P.); (W.S.); (N.S.S.); (B.D.J.W.); (F.R.B.)
| | - Joandre Fauza
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya 60131, Indonesia; (J.F.); (M.A.P.); (W.S.); (N.S.S.); (B.D.J.W.); (F.R.B.)
| | - Heri Suroto
- Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya 60131, Indonesia;
| | - Muhammad Arifin Parenrengi
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya 60131, Indonesia; (J.F.); (M.A.P.); (W.S.); (N.S.S.); (B.D.J.W.); (F.R.B.)
| | - Wihasto Suryaningtyas
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya 60131, Indonesia; (J.F.); (M.A.P.); (W.S.); (N.S.S.); (B.D.J.W.); (F.R.B.)
| | - Prihartini Widiyanti
- Biomedical Engineering Study Program, Department of Physic, Faculty of Science and Technology, Universitas Airlangga, Surabaya 60115, Indonesia; (P.W.); (Y.F.)
| | - Nur Setiawan Suroto
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya 60131, Indonesia; (J.F.); (M.A.P.); (W.S.); (N.S.S.); (B.D.J.W.); (F.R.B.)
| | - Budi Utomo
- Department of Public Health, Faculty of Medicine, Universitas Airlangga, Surabaya 60115, Indonesia;
| | - Billy Dema Justia Wahid
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya 60131, Indonesia; (J.F.); (M.A.P.); (W.S.); (N.S.S.); (B.D.J.W.); (F.R.B.)
| | - Fitria Renata Bella
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya 60131, Indonesia; (J.F.); (M.A.P.); (W.S.); (N.S.S.); (B.D.J.W.); (F.R.B.)
| | - Yurituna Firda
- Biomedical Engineering Study Program, Department of Physic, Faculty of Science and Technology, Universitas Airlangga, Surabaya 60115, Indonesia; (P.W.); (Y.F.)
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Di Francesco D, Pigliafreddo A, Casarella S, Di Nunno L, Mantovani D, Boccafoschi F. Biological Materials for Tissue-Engineered Vascular Grafts: Overview of Recent Advancements. Biomolecules 2023; 13:1389. [PMID: 37759789 PMCID: PMC10526356 DOI: 10.3390/biom13091389] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
The clinical demand for tissue-engineered vascular grafts is still rising, and there are many challenges that need to be overcome, in particular, to obtain functional small-diameter grafts. The many advances made in cell culture, biomaterials, manufacturing techniques, and tissue engineering methods have led to various promising solutions for vascular graft production, with available options able to recapitulate both biological and mechanical properties of native blood vessels. Due to the rising interest in materials with bioactive potentials, materials from natural sources have also recently gained more attention for vascular tissue engineering, and new strategies have been developed to solve the disadvantages related to their use. In this review, the progress made in tissue-engineered vascular graft production is discussed. We highlight, in particular, the use of natural materials as scaffolds for vascular tissue engineering.
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Affiliation(s)
- Dalila Di Francesco
- Department of Health Sciences, University of Piemonte Orientale “A. Avogadro”, 28100 Novara, Italy; (D.D.F.); (S.C.); (L.D.N.)
- Laboratory for Biomaterials and Bioengineering, CRC-I, Department of Min-Met-Materials Engineering, University Hospital Research Center, Regenerative Medicine, Laval University, Quebec City, QC G1V 0A6, Canada;
| | - Alexa Pigliafreddo
- Department of Health Sciences, University of Piemonte Orientale “A. Avogadro”, 28100 Novara, Italy; (D.D.F.); (S.C.); (L.D.N.)
| | - Simona Casarella
- Department of Health Sciences, University of Piemonte Orientale “A. Avogadro”, 28100 Novara, Italy; (D.D.F.); (S.C.); (L.D.N.)
| | - Luca Di Nunno
- Department of Health Sciences, University of Piemonte Orientale “A. Avogadro”, 28100 Novara, Italy; (D.D.F.); (S.C.); (L.D.N.)
| | - Diego Mantovani
- Laboratory for Biomaterials and Bioengineering, CRC-I, Department of Min-Met-Materials Engineering, University Hospital Research Center, Regenerative Medicine, Laval University, Quebec City, QC G1V 0A6, Canada;
| | - Francesca Boccafoschi
- Department of Health Sciences, University of Piemonte Orientale “A. Avogadro”, 28100 Novara, Italy; (D.D.F.); (S.C.); (L.D.N.)
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Jing W, Huang Y, Feng J, Li H, Yu X, Zhao B, Wei P. The clinical effectiveness of staple line reinforcement with different matrix used in surgery. Front Bioeng Biotechnol 2023; 11:1178619. [PMID: 37351469 PMCID: PMC10282759 DOI: 10.3389/fbioe.2023.1178619] [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: 03/03/2023] [Accepted: 05/24/2023] [Indexed: 06/24/2023] Open
Abstract
Staplers are widely used in clinics; however, complications such as bleeding and leakage remain a challenge for surgeons. To tackle this issue, buttress materials are recommended to reinforce the staple line. This Review provides a systematic summary of the characteristics and applications of the buttress materials. First, the physical and chemical properties of synthetic polymer materials and extracellular matrix used for the buttress materials are introduced, as well as their pros and cons in clinical applications. Second, we review the clinical effects of reinforcement mesh in pneumonectomy, sleeve gastrectomy, pancreatectomy, and colorectal resection. Based on the analysis of numerous research data, we believe that buttress materials play a crucial role in increasing staple line strength and reducing the probability of complications, such as bleeding and leakage. However, considering the requirements of bioactivity, degradability, and biosafety, non-crosslinked small intestinal submucosa (SIS) matrix material is the preferred candidate. It has high research and application value, but further studies are required to confirm this. The aim of this Review is to provide comprehensive guidance on the selection of materials for staple line reinforcement.
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Affiliation(s)
| | | | | | | | | | - Bo Zhao
- *Correspondence: Bo Zhao, ; Pengfei Wei,
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Mechanical reinforcement of amniotic membranes for vesicovaginal fistula repair. J Mech Behav Biomed Mater 2023; 139:105680. [PMID: 36701851 DOI: 10.1016/j.jmbbm.2023.105680] [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: 09/02/2022] [Revised: 11/23/2022] [Accepted: 01/11/2023] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Amniotic membranes (AM) have shown its great potential in reconstructive surgery due to their regenerative capacity. However, AM is regarded to be relatively weak when applied for load-bearing purposes. This study aims to produce an AM-based scaffold that can withstand the mechanical loads applied in vesicovaginal fistula repair. Different strategies are investigated to improve the mechanical characteristics of AM. METHODS Single and multilayered AM, and composite constructs of AM with electrospun poly-4-hydroxybutyrate (P4HB) or bovine pericardial tissue combined with the use of fibrin glue, were mechanically tested in this study. Suture retention strength and mechanical characteristics (tensile stress, elongation, tangent modulus and maximum load) were assessed by uniaxial testing. The effect of degradation of the composite constructs on the mechanical characteristics was determined by uniaxial testing after 4 and 8 weeks. RESULTS Single and multilayered AM could not provide the mechanical requirements needed for surgical implantation (>2N load). AM was combined successfully with electrospun P4HB and bovine pericardium with the use of fibrin glue and were able to exceed the 2N load. CONCLUSION The composite constructs with AM showed sufficient mechanical characteristics for surgical implantation. Electrospun P4HB combined with AM seemed the most promising candidate since the mechanical characteristics of P4HB can be further modified to meet the requirements of the application site and the degradation of the P4HB allows a gradual transfer of load. Eventhough the scaffold is intended for fistula repair, it can potentially be applied in surgical reconstruction of other hollow organs by modifying the mechanical characteristics.
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Grab M, Stieglmeier F, Emrich J, Grefen L, Leone A, König F, Hagl C, Thierfelder N. Customized 3D printed bioreactors for decellularization-High efficiency and quality on a budget. Artif Organs 2021; 45:1477-1490. [PMID: 34219220 DOI: 10.1111/aor.14034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 01/07/2023]
Abstract
Decellularization (DC) of biomaterials with bioreactors is widely used to produce scaffolds for tissue engineering. This study uses 3D printing to develop efficient but low-cost DC bioreactors. Two bioreactors were developed to decellularize pericardial patches and vascular grafts. Flow profiles and pressure distribution inside the bioreactors were optimized by steady-state computational fluid dynamics (CFD) analysis. Printing materials were evaluated by cytotoxicity assessment. Following evaluation, all parts of the bioreactors were 3D printed in a commercial fused deposition modeling printer. Samples of bovine pericardia and porcine aortae were decellularized using established protocols. An immersion and agitation setup was used as a control. With histological assessment, DNA quantification and biomechanical testing treatment effects were evaluated. CFD analysis of the pericardial bioreactor revealed even flow and pressure distribution in between all pericardia. The CFD analysis of the vessel bioreactor showed increased intraluminal flow rate and pressure compared to the vessel's outside. Cytotoxicity assessment of the used printing material revealed no adverse effect on the tissue. Complete DC was achieved for all samples using the 3D printed bioreactors while DAPI staining revealed residual cells in aortic vessels of the control group. Histological analysis showed no structural changes in the decellularized samples. Additionally, biomechanical properties exhibited no significant change compared to native samples. This study presents a novel approach to manufacturing highly efficient and low budget 3D printed bioreactors for the DC of biomaterials. When compared to standard protocols, the bioreactors offer a cost effective, fast, and reproducible approach, which vastly improves the DC results.
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Affiliation(s)
- Maximilian Grab
- Department of Cardiac Surgery, Ludwig-Maximilian University, Munich, Germany.,Chair of Medical Materials and Implants, Technical University, Munich, Germany
| | - Felix Stieglmeier
- Department of Cardiac Surgery, Ludwig-Maximilian University, Munich, Germany
| | - Jessica Emrich
- Department of Cardiac Surgery, Ludwig-Maximilian University, Munich, Germany
| | - Linda Grefen
- Department of Cardiac Surgery, Ludwig-Maximilian University, Munich, Germany
| | - Ariane Leone
- Department of Cardiac Surgery, Ludwig-Maximilian University, Munich, Germany
| | - Fabian König
- Department of Cardiac Surgery, Ludwig-Maximilian University, Munich, Germany.,Chair of Medical Materials and Implants, Technical University, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig-Maximilian University, Munich, Germany
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