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Schweiger M, Krüger B, Malbon A, Fleischmann T, Weisskopf M, Frauenfelder T, Lemme F, Cesarovic N, Knirsch W, Hübler M. One-Year Outcome of an Ongoing Pre-Clinical Growing Animal Model for a Tissue-Engineered Valved Pulmonary Conduit. J Cardiovasc Dev Dis 2024; 11:179. [PMID: 38921679 DOI: 10.3390/jcdd11060179] [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: 01/20/2024] [Revised: 03/16/2024] [Accepted: 05/28/2024] [Indexed: 06/27/2024] Open
Abstract
Objectives: A self-constructed valved pulmonary conduit made out of a de-cellularized porcine small intestinal submucosal extracellular matrix biological scaffold was tested in a chronic growing lamb model. Methods: The conduit was implanted in pulmonary valve position in 19 lambs. We monitored clinical, laboratory, and echocardiographic findings until 12 months after surgery. In two animals, euthanasia was planned at nine and twelve months. Pre-mortem chest computed tomography and post-mortem pathologic work up were performed. Data are presented as frequency and percentage, median and range, or mean and standard deviation. Results: Twelve (63.2%) animals survived the perioperative period. Three unexpected deaths occurred during the follow-up period: one due to aspiration pneumonia at 23 days after surgery, and two due to early and late infective endocarditis of the conduit at 18 and 256 days. In the two animals with planned scarification, the pre-mortem CT scan revealed mild or no calcification within the conduit or valve leaflets. In the echocardiographic examination at 12 months, peak and mean systolic pressure gradients across the conduit valve were 6.5 (3-21) mmHg and 3 (2-12) mmHg, while valve regurgitation was none (n = 2), trivial (n = 5), moderate (n = 1), or severe (n = 1). No clinical or laboratory signs of hemolysis were seen. After 12 months of follow-up, the animals' body weights had increased from 33 (27-38) kg to 53 (38-66) kg (p = 0.010). Conclusions: Implantation of a valved pulmonary conduit in our growing lamb model was feasible. Infective endocarditis of the implanted valved conduit remained a significant complication.
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Affiliation(s)
- Martin Schweiger
- Department of Congenital Cardiovascular Surgery, Pediatric Heart Center, University Children's Hospital Zurich, 8032 Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, 8032 Zurich, Switzerland
| | - Bernard Krüger
- Division of Cardiac Anesthesia, Institute of Anesthesiology, University Hospital Zurich, 8091 Zurich, Switzerland
- Department of Anesthesia, University Children's Hospital, 8032 Zurich, Switzerland
| | - Alexandra Malbon
- The Royal (Dick) School of Veterinary Studies and the Roslin Institute, University of Edinburgh, Easter Bush Campus, Midlothian EH8 9YL, UK
| | - Thea Fleischmann
- Division of Surgical Research, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Miriam Weisskopf
- Division of Surgical Research, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Thomas Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University Zurich, 8091 Zurich, Switzerland
| | - Frithjof Lemme
- Congenital and Pediatric Heart Surgery, Children's Heart Clinic, University Heart Center, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | | | - Walter Knirsch
- Children's Research Center, University Children's Hospital Zurich, 8032 Zurich, Switzerland
- Division of Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, 8032 Zurich, Switzerland
| | - Michael Hübler
- Congenital and Pediatric Heart Surgery, Children's Heart Clinic, University Heart Center, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
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2
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Guo W, Liu H, Zhang J, Zhang J, Wang F, Zhang P, Yang Y. Preparation and characterization of a novel composite acellular matrix/hyaluronic acid thermosensitive hydrogel for interstitial cystitis/bladder pain syndrome. J Biomed Mater Res A 2024; 112:449-462. [PMID: 37975156 DOI: 10.1002/jbm.a.37643] [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: 02/13/2023] [Revised: 10/14/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023]
Abstract
Bladder mucosa damage that causes harm to the interstitium is a recognized pathogenesis of interstitial cystitis/bladder pain syndrome (IC/BPS). The intravesical instillation of drugs is an important second-line therapy, but it is often necessary to use drugs repeatedly in the clinic because of their short residence time in the bladder cavity, which alters the therapeutic effect. To overcome this drawback, this study developed a novel composite acellular matrix/hyaluronic acid (HA) thermosensitive hydrogel (HA-Gel) using rabbit small intestinal submucosa extracellular matrix (ECM) as the thermosensitive material and HA as the drug component and examined its composition, microstructure, thermodynamic properties, temperature sensitivity, rheological properties, biocompatibility, drug release, hydrogel residue, and bacteriostatic properties. The study showed HA-Gel was liquid at temperatures of 15-37.5°C and solid at 37.5-50°C, its swelling rate decreased with increasing temperature, and its lower critical solution temperature occurred at approximately 37.5°C. This property made the hydrogel liquid at room temperature convenient for intravesical perfusion and turned into a solid about 1 min after entering the body and rising to body temperature to increase its residence time. Subsequent experiments also proved that the gel residue time of HA-Gel in vivo and the drug release time of HA in vivo could reach more than 5 days, which was significantly higher than that of HA alone, and it had good biocompatibility and antibacterial properties. Therefore, this hydrogel possesses the proper characteristics to possibly make it an ideal dosage form for IC/BPS intravesical instillation therapy.
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Affiliation(s)
- Wei Guo
- Department of Urology, Beijing Chao-Yang Hospital, Beijing, China
| | - Haichao Liu
- Department of Urology, Hebei Yanda Hospital, West of SiPuLan Road, Langfang, China
| | - Jiaxing Zhang
- Department of Urology, Hebei Yanda Hospital, West of SiPuLan Road, Langfang, China
| | - Jianzhong Zhang
- Department of Urology, Beijing Chao-Yang Hospital, Beijing, China
| | - Fei Wang
- Department of Urology, Beijing Chao-Yang Hospital, Beijing, China
| | - Peng Zhang
- Department of Urology, Beijing Chao-Yang Hospital, Beijing, China
| | - Yunbo Yang
- Department of Urology, Hebei Yanda Hospital, West of SiPuLan Road, Langfang, China
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3
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Gonzalez BA, Herrera A, Ponce C, Gonzalez Perez M, Hsu CPD, Mirza A, Perez M, Ramaswamy S. Stem Cell-Secreted Allogeneic Elastin-Rich Matrix with Subsequent Decellularization for the Treatment of Critical Valve Diseases in the Young. Bioengineering (Basel) 2022; 9:bioengineering9100587. [PMID: 36290556 PMCID: PMC9598163 DOI: 10.3390/bioengineering9100587] [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: 09/05/2022] [Revised: 10/07/2022] [Accepted: 10/12/2022] [Indexed: 11/30/2022] Open
Abstract
Critical valve diseases in infants have a very poor prognosis for survival. Particularly challenging is for the valve replacement to support somatic growth. From a valve regenerative standpoint, bio-scaffolds have been extensively investigated recently. While bio-scaffold valves facilitate acute valve functionality, their xenogeneic properties eventually induce a hostile immune response. Our goal was to investigate if a bio-scaffold valve could be deposited with tissues derived from allogeneic stem cells, with a specific dynamic culture protocol to enhance the extracellular matrix (ECM) constituents, with subsequent stem cell removal. Porcine small intestinal submucosa (PSIS) tubular-shaped bio-scaffold valves were seeded with human bone marrow-derived mesenchymal stem cells (hBMMSCs), cultured statically for 8 days, and then exposed to oscillatory fluid-induced shear stresses for two weeks. The valves were then safely decellularized to remove the hBMMSCs while retaining their secreted ECM. This de novo ECM was found to include significantly higher (p < 0.05) levels of elastin compared to the ECM produced by the hBMMSCs under standard rotisserie culture. The elastin-rich valves consisted of ~8% elastin compared to the ~10% elastin composition of native heart valves. Allogeneic elastin promotes chemotaxis thereby accelerating regeneration and can support somatic growth by rapidly integrating with the host following implantation. As a proof-of-concept of accelerated regeneration, we found that valve interstitial cells (VICs) secreted significantly more (p < 0.05) collagen on the elastin-rich matrix compared to the raw PSIS bio-scaffold.
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4
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Weis J, Geiger R, Kilo J, Zimpfer D. Cormatrix® for vessel reconstruction in paediatric cardiac surgery-a word of caution. Interact Cardiovasc Thorac Surg 2021; 34:597-603. [PMID: 34687545 PMCID: PMC8972283 DOI: 10.1093/icvts/ivab264] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 04/19/2021] [Accepted: 08/27/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this retrospective study was to determine if Cormatrix® (CM) represents a safe alternative to conventional patch materials used in congenital heart surgery. METHODS A total of 57 paediatric patients who underwent cardiac surgery using an Extracellular Matrix Bioscaffold (CM) were categorized into 4 groups according to the patch implant location. Patch-related complications and reintervention rates were analysed. A subgroup of 18 patients was subsequently compared to a matched group of 36 patients who underwent similar surgical procedures with autologous pericardium as patch material. RESULTS No patient died during hospitalization. There were 2 late deaths, not related to the implanted CM patch. Fourteen (66.7%) out of 21 patients with arterial patch plasty developed progressive vessel/right ventricular outflow tract stenosis or aneurysm. All 3 patients with a valved CM conduit developed haemodynamically relevant valve stenosis or regurgitation. A total of 18 (31.5%) patients needed reintervention and 12 (21.1%) related to CM. Four (7%) patients needed surgical treatment with operative removal of the stenosis. Redo valve replacement was performed on 2 (3.5%) patients. Six (10.5%) patients required an interventional cardiology procedure at a median interval of 5 months from surgery. The subgroup analysis revealed a significantly lower patch-related reintervention rate in patients treated with autologous pericardium when compared to CM (P = 0.006). CONCLUSIONS CM is safe for atrial and ventricular defect closure. The use of CM for arterial vessel reconstruction is associated with higher reintervention rates when compared to autologous pericardium.
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Affiliation(s)
- Johanna Weis
- Pediatrics III (Cardiopulmonary Unit), Department of Child and Adolescent Health, Medical University Innsbruck, Innsbruck, Austria
| | - Ralf Geiger
- Pediatrics III (Cardiopulmonary Unit), Department of Child and Adolescent Health, Medical University Innsbruck, Innsbruck, Austria
| | - Juliane Kilo
- Division of Cardiac Surgery, Department of Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel Zimpfer
- Division of Cardiac Surgery, Department of Surgery, Pediatric Heart Center Vienna, Medical University Vienna, Vienna, Austria
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De Novo Valve Tissue Morphology Following Bioscaffold Mitral Valve Replacement in a Juvenile Non-Human Primate Model. Bioengineering (Basel) 2021; 8:bioengineering8070100. [PMID: 34356207 PMCID: PMC8301182 DOI: 10.3390/bioengineering8070100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 12/04/2022] Open
Abstract
The utility of implanting a bioscaffold mitral valve consisting of porcine small intestinal submucosa (PSIS) in a juvenile baboon model (12 to 14 months old at the time of implant; n = 3) to assess their in vivo tissue remodeling responses was investigated. Our findings demonstrated that the PSIS mitral valve exhibited the robust presence of de novo extracellular matrix (ECM) at all explantation time points (at 3-, 11-, and 20-months). Apart from a significantly lower level of proteoglycans in the implanted valve’s annulus region (p < 0.05) at 3 months compared to the 11- and 20-month explants, there were no other significant differences (p > 0.05) found between any of the other principal valve ECM components (collagen and elastin) at the leaflet, annulus, or chordae tendinea locations, across these time points. In particular, neochordae tissue had formed, which seamlessly integrated with the native papillary muscles. However, additional processing will be required to trigger accelerated, uniform and complete valve ECM formation in the recipient. Regardless of the specific processing done to the bioscaffold valve, in this proof-of-concept study, we estimate that a 3-month window following bioscaffold valve replacement is the timeline in which complete regeneration of the valve and integration with the host needs to occur.
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6
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Schlachtenberger G, Doerr F, Brezina A, Menghesha H, Heldwein MB, Bennink G, Menger MD, Moussavian M, Hekmat K, Wahlers T. Perigraft reaction and incorporation of porcine and bovine pericardial patches. Interact Cardiovasc Thorac Surg 2020; 32:638-647. [PMID: 33313856 DOI: 10.1093/icvts/ivaa308] [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: 06/13/2020] [Revised: 09/21/2020] [Accepted: 11/06/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Bovine and porcine pericardial patches are frequently used in cardiothoracic and vascular surgery. There are no guidelines recommending the usage of these patches for particular surgical approaches. However, these 2 materials supposedly possess different properties. The clinical advantage of porcine compared with bovine patches remains controversial. In this experimental study, we analysed the incorporation and vascularization of bovine and porcine pericardial patches during the initial phase after implantation. METHODS Bovine and porcine pericardial patches were implanted into the dorsal skinfold chamber of C57BL/6 mice (n = 8 per group) to study vascularization and inflammation at the implantation site using repetitive intravital fluorescence microscopy over a 14-day period. At the end of the in vivo experiments, CD-31-positive cells were determined to evaluate the vascularization by immunohistochemistry. Furthermore, cell proliferation and apoptosis were analysed immunohistochemically. RESULTS Implanted bovine patches exhibited an enhanced vascularization, as indicated by a significantly higher number of CD-31-positive cells and micro-vessels (23.2 ± 4.3 vs 16.5 ± 5.8 mm-2; P = 0.001). Furthermore, bovine patches showed a slightly but not significantly higher functional capillary density. Both patches induced a moderate leukocytic inflammatory host tissue response, and neither bovine nor porcine patches significantly affected apoptosis and cell proliferation at the implantation site. CONCLUSIONS Bovine and porcine pericardial patches are similarly suitable for surgery. Bovine patches exhibited an improved vascularization during the first 14 days after implantation. This may result in a quicker and improved incorporation into the surrounding tissue compared with porcine pericardial patches.
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Affiliation(s)
| | - Fabian Doerr
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Annamaria Brezina
- Department of Anesthesiology and Intensive Care Medicine, Kerpenerstr 62, 50937 Cologne, Germany.,Institute for Clinical and Experimental Surgery, Saarland University Kirberger Strasse, 66421 Homburg/Saar, Germany
| | - Hruy Menghesha
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Matthias B Heldwein
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Gerardus Bennink
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Michael D Menger
- Institute for Clinical and Experimental Surgery, Saarland University Kirberger Strasse, 66421 Homburg/Saar, Germany
| | - Mohammed Moussavian
- Department of Surgery, Centre Hospitalier Emile Mayrisch (CHEM), Esch-sur-Alzette, Luxembourg
| | - Khosro Hekmat
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
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7
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Zhao P, Li X, Fang Q, Wang F, Ao Q, Wang X, Tian X, Tong H, Bai S, Fan J. Surface modification of small intestine submucosa in tissue engineering. Regen Biomater 2020; 7:339-348. [PMID: 32793379 PMCID: PMC7414999 DOI: 10.1093/rb/rbaa014] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/25/2020] [Accepted: 03/10/2020] [Indexed: 12/11/2022] Open
Abstract
With the development of tissue engineering, the required biomaterials need to have the ability to promote cell adhesion and proliferation in vitro and in vivo. Especially, surface modification of the scaffold material has a great influence on biocompatibility and functionality of materials. The small intestine submucosa (SIS) is an extracellular matrix isolated from the submucosal layer of porcine jejunum, which has good tissue mechanical properties and regenerative activity, and is suitable for cell adhesion, proliferation and differentiation. In recent years, SIS is widely used in different areas of tissue reconstruction, such as blood vessels, bone, cartilage, bladder and ureter, etc. This paper discusses the main methods for surface modification of SIS to improve and optimize the performance of SIS bioscaffolds, including functional group bonding, protein adsorption, mineral coating, topography and formatting modification and drug combination. In addition, the reasonable combination of these methods also offers great improvement on SIS surface modification. This article makes a shallow review of the surface modification of SIS and its application in tissue engineering.
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Affiliation(s)
- Pan Zhao
- Department of Tissue Engineering, School of Fundamental Sciences, China Medical University, 77 Puhe Avenue, Shenbei New District, Shenyang 110122, China
| | - Xiang Li
- Department of Cell Biology, School of Life Sciences, China Medical University, 77 Puhe Avenue, Shenbei New District, Shenyang 110122, China
| | - Qin Fang
- Cardiac Surgery, Liaoning First Hospital of China Medical University, No. 155 Nanjing Street, Heping District, Shenyang, Liaoning 110122, China
| | - Fanglin Wang
- Department of Tissue Engineering, School of Fundamental Sciences, China Medical University, 77 Puhe Avenue, Shenbei New District, Shenyang 110122, China
| | - Qiang Ao
- Department of Tissue Engineering, School of Fundamental Sciences, China Medical University, 77 Puhe Avenue, Shenbei New District, Shenyang 110122, China
| | - Xiaohong Wang
- Department of Tissue Engineering, School of Fundamental Sciences, China Medical University, 77 Puhe Avenue, Shenbei New District, Shenyang 110122, China
| | - Xiaohong Tian
- Department of Tissue Engineering, School of Fundamental Sciences, China Medical University, 77 Puhe Avenue, Shenbei New District, Shenyang 110122, China
| | - Hao Tong
- Department of Tissue Engineering, School of Fundamental Sciences, China Medical University, 77 Puhe Avenue, Shenbei New District, Shenyang 110122, China
| | - Shuling Bai
- Department of Tissue Engineering, School of Fundamental Sciences, China Medical University, 77 Puhe Avenue, Shenbei New District, Shenyang 110122, China
| | - Jun Fan
- Department of Tissue Engineering, School of Fundamental Sciences, China Medical University, 77 Puhe Avenue, Shenbei New District, Shenyang 110122, China
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8
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Knirsch W, Krüger B, Fleischmann T, Malbon A, Lipiski M, Lemme F, Sauer M, Cesarovic N, Dave H, Hübler M, Schweiger M. Establishing a pre-clinical growing animal model to test a tissue engineered valved pulmonary conduit. J Thorac Dis 2020; 12:1070-1078. [PMID: 32274175 PMCID: PMC7138975 DOI: 10.21037/jtd.2019.12.70] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Many valvular pathologies of the heart may be only sufficiently treated by replacement of the valve if a reconstruction is not feasible. However, structural deterioration, thrombosis with thromboembolic events and infective endocarditis are commonly encountered complications over time and often demand a re-operation. In congenital heart disease the lack of small diameter valves with the potential to grow poses additional challenges and limits treatment options to homo- or xenograft implants. Methods In this study, a chronic sheep model (24 months follow-up), a self-constructed valved conduit was created out of a tissue engineered (TE) patch (CorMatrix® Cardiovascular, Inc, USA) and implanted in orthotopic right ventricular (RV)-pulmonary artery (PA) position. Thereafter, the sheep were regularly monitored by clinical, laboratory and echocardiographic examinations to evaluate cardiac function and the implanted RV-PA-conduit. Discussion Here, we summarize the study protocol and our experiences during the perioperative phase and the follow up period and explain how we constructed a valved conduit out of a commercially available TE patch. Trial registration License number: ZH 284/14.
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Affiliation(s)
- Walter Knirsch
- Division of Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Bernard Krüger
- Division of Cardiac Anesthesia, Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland.,Department of Anesthesia, University Children's Hospital, Zurich, Switzerland
| | - Thea Fleischmann
- Division of Surgical Research, University Hospital Zurich, Zurich, Switzerland
| | - Alexandra Malbon
- Institute for Veterinary Pathology Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Miriam Lipiski
- Division of Surgical Research, University Hospital Zurich, Zurich, Switzerland
| | - Frithjof Lemme
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Congenital Cardiovascular Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Switzerland
| | - Mareike Sauer
- Division of Surgical Research, University Hospital Zurich, Zurich, Switzerland
| | - Niko Cesarovic
- Division of Surgical Research, University Hospital Zurich, Zurich, Switzerland
| | - Hitendu Dave
- Department of Congenital Cardiovascular Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Switzerland
| | - Michael Hübler
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Congenital Cardiovascular Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Switzerland
| | - Martin Schweiger
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Congenital Cardiovascular Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Switzerland
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9
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Gonzalez BA, Pour Issa E, Mankame OV, Bustillos J, Cuellar A, Rodriguez AJ, Scholl F, Bibevski S, Hernandez L, Brehier V, Casares M, Rivas-Wagner K, Morales P, Lopez J, Wagner J, Bibevski J, Agarwal A, George F, Ramaswamy S. Porcine Small Intestinal Submucosa Mitral Valve Material Responses Support Acute Somatic Growth. Tissue Eng Part A 2020; 26:475-489. [PMID: 31802695 DOI: 10.1089/ten.tea.2019.0220] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: Conceptually, a tissue engineered heart valve would be especially appealing in the pediatric setting since small size and somatic growth constraints would be alleviated. In this study, we utilized porcine small intestinal submucosa (PSIS) for valve replacement. Of note, we evaluated the material responses of PSIS and subsequently its acute function and somatic growth potential in the mitral position. Methods and Results: Material and mechanical assessment demonstrated that both fatigued 2ply (∼65 μm) and 4ply (∼110 μm) PSIS specimens exhibited similar failure mechanisms, but at an accelerated rate in the former. Specifically, the fatigued 2ply PSIS samples underwent noticeable fiber pullout and recruitment on the bioscaffold surface, leading to higher yield strength (p < 0.05) and yield strain (p < 0.05) compared to its fatigued 4ply counterparts. Consequently, 2ply PSIS mitral valve constructs were subsequently implanted in juvenile baboons (n = 3). Valve function was longitudinally monitored for 90 days postvalve implantation and was found to be robust in all animals. Histology at 90 days in one of the animals revealed the presence of residual porcine cells, fibrin matrix, and host baboon immune cells but an absence of tissue regeneration. Conclusions: Our findings suggest that the altered structural responses of PSIS, postfatigue, rather than de novo tissue formation, are primarily responsible for the valve's ability to accommodate somatic growth during the acute phase (90 days) following mitral valve replacement. Impact Statement Tissue engineered heart valves (TEHVs) offer the potential of supporting somatic growth. In this study, we investigated a porcine small intestinal submucosa bioscaffold for pediatric mitral heart valve replacement. The novelty of the study lies in identifying material responses under mechanical loading conditions and its effectiveness in being able to function as a TEHV. In addition, the ability of the scaffold valve to support acute somatic growth was evaluated in the Baboon model. The current study contributes toward finding a solution for critical valve diseases in children, whose current prognosis for survival is poor.
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Affiliation(s)
- Brittany A Gonzalez
- Department of Biomedical Engineering and Florida International University, Miami, Florida, USA
| | - Elnaz Pour Issa
- Department of Biomedical Engineering and Florida International University, Miami, Florida, USA
| | - Omkar V Mankame
- Department of Biomedical Engineering and Florida International University, Miami, Florida, USA
| | - Jenniffer Bustillos
- Department of Mechanical and Material Engineering, Florida International University, Miami, Florida, USA
| | - Antonio Cuellar
- Department of Biomedical Engineering and Florida International University, Miami, Florida, USA
| | - Andres J Rodriguez
- Department of Biomedical Engineering and Florida International University, Miami, Florida, USA
| | - Frank Scholl
- Joe DiMaggio Children's Hospital, Memorial Regional Hospital, Hollywood, Florida, USA
| | - Steven Bibevski
- Department of Biomedical Engineering and Florida International University, Miami, Florida, USA.,Joe DiMaggio Children's Hospital, Memorial Regional Hospital, Hollywood, Florida, USA
| | - Lazaro Hernandez
- Joe DiMaggio Children's Hospital, Memorial Regional Hospital, Hollywood, Florida, USA
| | - Vincent Brehier
- Joe DiMaggio Children's Hospital, Memorial Regional Hospital, Hollywood, Florida, USA
| | - Mike Casares
- Joe DiMaggio Children's Hospital, Memorial Regional Hospital, Hollywood, Florida, USA
| | | | - Pablo Morales
- Mannheimer Foundation, Inc., Homestead, Florida, USA
| | - Jesus Lopez
- Mannheimer Foundation, Inc., Homestead, Florida, USA
| | - Joseph Wagner
- Mannheimer Foundation, Inc., Homestead, Florida, USA
| | | | - Arvind Agarwal
- Department of Mechanical and Material Engineering, Florida International University, Miami, Florida, USA
| | - Florence George
- Department of Mathematics and Statistics, Florida International University, Miami, Florida, USA
| | - Sharan Ramaswamy
- Department of Biomedical Engineering and Florida International University, Miami, Florida, USA
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Design and Evaluation of a Structural Reinforced Small Intestinal Submucosa Vascular Graft for Hemodialysis Access in a Porcine Model. ASAIO J 2018; 64:270-277. [DOI: 10.1097/mat.0000000000000618] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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11
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Nemoto S, Konishi H, Shimada R, Suzuki T, Katsumata T, Yamada H, Sakurai J, Sakamoto Y, Kohno K, Onishi A, Ito M. In situ tissue regeneration using a warp-knitted fabric in the canine aorta and inferior vena cava†. Eur J Cardiothorac Surg 2018; 54:318-327. [DOI: 10.1093/ejcts/ezy045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/19/2018] [Indexed: 12/31/2022] Open
Affiliation(s)
- Shintaro Nemoto
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Hayato Konishi
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Ryo Shimada
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Tatsuya Suzuki
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Hideaki Yamada
- Production Development Section, Fukui Tateami Co., Ltd, Fukui, Japan
| | - Jun Sakurai
- Production Development Section, Fukui Tateami Co., Ltd, Fukui, Japan
| | - Yohei Sakamoto
- Toxicology Research Department, Teijin Institute for Biomedical Research, Teijin Pharma Limited, Hino, Tokyo, Japan
| | - Kazuteru Kohno
- Healthcare Business Development, Teijin Limited, Hino, Tokyo, Japan
| | - Atsuko Onishi
- Healthcare Business Development, Teijin Limited, Hino, Tokyo, Japan
| | - Masaya Ito
- Healthcare Business Development, Teijin Limited, Hino, Tokyo, Japan
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Mosala Nezhad Z, Poncelet A, de Kerchove L, Fervaille C, Banse X, Bollen X, Dehoux JP, El Khoury G, Gianello P. CorMatrix valved conduit in a porcine model: long-term remodelling and biomechanical characterization. Interact Cardiovasc Thorac Surg 2016; 24:90-98. [PMID: 27659148 DOI: 10.1093/icvts/ivw314] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/29/2016] [Accepted: 08/17/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Porcine small intestinal submucosa extracellular matrix (CorMatrix; CorMatrix Cardiovascular, Rosewell, GA) is a relatively novel tissue substitute used in cardiovascular applications. We investigated the biological reaction and remodelling of CorMatrix as a tri-leaflet valved conduit in a pig model. We hypothesized that CorMatrix maintains a durable architecture as a valved conduit and remodels to resemble surrounding tissues. METHODS We fashioned the valved conduit using a 7 × 10 cm 4-ply CorMatrix sheet and placed it in the thoracic aorta of seven landrace pigs for 3, 4, 5 and 6 months. Biodegradation, replacement by native tissue, strength and durability were examined by histology, immunohistochemistry and mechanical testing. RESULTS Four pigs, one per time frame, completed the study. The conduit lost its original architecture as a tri-leaflet valve due to cusp immobility, subsequent attachment to the wall segment and consequent maintenance of a thick arterial wall-like structure. Scaffold resorption was incomplete, with disorganized inconsistent spatial and temporal degradation even at 6 months. Fibrosis, scarring and calcification started at 4 months and chronic inflammation persisted. The partially remodelled scaffold did not resemble the aortic wall, suggesting impaired remodelling. Mechanical testing showed progressive weakening of the tissues over time, which were liable to breakage. CONCLUSIONS CorMatrix is biodegradable; however, it failed to remodel in a structured and anatomical fashion in an arterial environment. Progressive mechanical and remodelling failure in this scenario might be explained by the complexity of the conduit design and the host's chronic inflammatory response, leading to early fibrosis and calcification.
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Affiliation(s)
- Zahra Mosala Nezhad
- Cardiovascular and Thoracic Surgery Department, Saint-Luc University Hospital, Université catholique de Louvain, Brussels, Belgium
| | - Alain Poncelet
- Cardiovascular and Thoracic Surgery Department, Saint-Luc University Hospital, Université catholique de Louvain, Brussels, Belgium
| | - Laurent de Kerchove
- Cardiovascular and Thoracic Surgery Department, Saint-Luc University Hospital, Université catholique de Louvain, Brussels, Belgium
| | - Caroline Fervaille
- Mont-Godinne Hospital-CHU, Laboratory of Anatomy Pathology, Université catholique de Louvain, Mont-Godinne, Belgium, Belgium
| | - Xavier Banse
- Orthopedics and Trauma Surgery, Saint-Luc University Hospital, Université catholique de Louvain, Brussels, Belgium
| | - Xavier Bollen
- Institute of Mechanics, Materials and Civil Engineering, Center for Research in Energy and Mechatronics, Université catholique de Louvain, Louvain-La-Neuve, Belgium
| | - Jean-Paul Dehoux
- Institute of Experimental and Clinical Research (IREC), Laboratory of Experimental Surgery and Transplantation (CHEX), Université catholique de Louvain, Brussels, Belgium
| | - Gebrine El Khoury
- Cardiovascular and Thoracic Surgery Department, Saint-Luc University Hospital, Université catholique de Louvain, Brussels, Belgium
| | - Pierre Gianello
- Institute of Experimental and Clinical Research (IREC), Laboratory of Experimental Surgery and Transplantation (CHEX), Université catholique de Louvain, Brussels, Belgium
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Mosala Nezhad Z, Poncelet A, de Kerchove L, Gianello P, Fervaille C, El Khoury G. Small intestinal submucosa extracellular matrix (CorMatrix®) in cardiovascular surgery: a systematic review. Interact Cardiovasc Thorac Surg 2016; 22:839-50. [PMID: 26912574 DOI: 10.1093/icvts/ivw020] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 01/08/2016] [Indexed: 11/12/2022] Open
Abstract
Extracellular matrix (ECM) derived from small intestinal submucosa (SIS) is widely used in clinical applications as a scaffold for tissue repair. Recently, CorMatrix® porcine SIS-ECM (CorMatrix Cardiovascular, Inc., Roswell, GA, USA) has gained popularity for 'next-generation' cardiovascular tissue engineering due to its ease of use, remodelling properties, lack of immunogenicity, absorbability and potential to promote native tissue growth. Here, we provide an overview of the biology of porcine SIS-ECM and systematically review the preclinical and clinical literature on its use in cardiovascular surgery. CorMatrix® has been used in a variety of cardiovascular surgical applications, and since it is the most widely used SIS-ECM, this material is the focus of this review. Since CorMatrix® is a relatively new product for cardiovascular surgery, some clinical and preclinical studies published lack systematic reporting of functional and pathological findings in sufficient numbers of subjects. There are also emerging reports to suggest that, contrary to expectations, an undesirable inflammatory response may occur in CorMatrix® implants in humans and longer-term outcomes at particular sites, such as the heart valves, may be suboptimal. Large-scale clinical studies are needed driven by robust protocols that aim to quantify the pathological process of tissue repair.
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Affiliation(s)
- Zahra Mosala Nezhad
- Institute of Experimental and Clinical Research (IREC), Division of Cardiovascular Research (CARD), Université catholique de Louvain, Brussels, Belgium Department of Cardiovascular and Thoracic Surgery, Université catholique de Louvain, Saint-Luc University Hospital, Brussels, Belgium
| | - Alain Poncelet
- Institute of Experimental and Clinical Research (IREC), Division of Cardiovascular Research (CARD), Université catholique de Louvain, Brussels, Belgium Department of Cardiovascular and Thoracic Surgery, Université catholique de Louvain, Saint-Luc University Hospital, Brussels, Belgium
| | - Laurent de Kerchove
- Institute of Experimental and Clinical Research (IREC), Division of Cardiovascular Research (CARD), Université catholique de Louvain, Brussels, Belgium Department of Cardiovascular and Thoracic Surgery, Université catholique de Louvain, Saint-Luc University Hospital, Brussels, Belgium
| | - Pierre Gianello
- Institute of Experimental and Clinical Research (IREC), Division of Experimental Surgery and Transplantation (CHEX), Université catholique de Louvain, Brussels, Belgium
| | - Caroline Fervaille
- Laboratory of Anatomy Pathology, Université catholique de Louvain, Godinne University Hospital-CHU, Yvoir, Belgium
| | - Gebrine El Khoury
- Institute of Experimental and Clinical Research (IREC), Division of Cardiovascular Research (CARD), Université catholique de Louvain, Brussels, Belgium Department of Cardiovascular and Thoracic Surgery, Université catholique de Louvain, Saint-Luc University Hospital, Brussels, Belgium
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Erek E, Aydin S, Suzan D, Yildiz O, Demir IH, Odemis E. Early Degeneration of Extracellular Matrix Used for Aortic Reconstruction During the Norwood Operation. Ann Thorac Surg 2016; 101:758-60. [DOI: 10.1016/j.athoracsur.2015.04.051] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 03/27/2015] [Accepted: 04/08/2015] [Indexed: 10/22/2022]
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Maeda K, Ruel M. The clinical application potential of extracellular matrix in cardiac tissue engineering. J Thorac Cardiovasc Surg 2015; 150:1290-1. [PMID: 26323619 DOI: 10.1016/j.jtcvs.2015.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 08/03/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Kay Maeda
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
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Row S, Peng H, Schlaich EM, Koenigsknecht C, Andreadis ST, Swartz DD. Arterial grafts exhibiting unprecedented cellular infiltration and remodeling in vivo: the role of cells in the vascular wall. Biomaterials 2015; 50:115-26. [PMID: 25736502 DOI: 10.1016/j.biomaterials.2015.01.045] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 01/13/2015] [Accepted: 01/20/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To engineer and implant vascular grafts in the arterial circulation of a pre-clinical animal model and assess the role of donor medial cells in graft remodeling and function. APPROACH AND RESULTS Vascular grafts were engineered using Small Intestinal Submucosa (SIS)-fibrin hybrid scaffold and implanted interpositionally into the arterial circulation of an ovine model. We sought to demonstrate implantability of SIS-Fibrin based grafts; examine the remodeling; and determine whether the presence of vascular cells in the medial wall was necessary for cellular infiltration from the host and successful remodeling of the implants. We observed no occlusions or anastomotic complications in 18 animals that received these grafts. Notably, the grafts exhibited unprecedented levels of host cell infiltration that was not limited to the anastomotic sites but occurred through the lumen as well as the extramural side, leading to uniform cell distribution. Incoming cells remodeled the extracellular matrix and matured into functional smooth muscle cells as evidenced by expression of myogenic markers and development of vascular reactivity. Interestingly, tracking the donor cells revealed that their presence was beneficial but not necessary for successful grafting. Indeed, the proliferation rate and number of donor cells decreased over time as the vascular wall was dominated by host cells leading to significant remodeling and development of contractile function. CONCLUSIONS These results demonstrate that SIS-Fibrin grafts can be successfully implanted into the arterial circulation of a clinically relevant animal model, improve our understanding of vascular graft remodeling and raise the possibility of engineering mural cell-free arterial grafts.
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Affiliation(s)
- Sindhu Row
- Department of Chemical and Biological Engineering, University at Buffalo, State University of New York, Amherst, NY 14260-4200, USA
| | - Haofan Peng
- Department of Chemical and Biological Engineering, University at Buffalo, State University of New York, Amherst, NY 14260-4200, USA
| | - Evan M Schlaich
- Department of Chemical and Biological Engineering, University at Buffalo, State University of New York, Amherst, NY 14260-4200, USA
| | - Carmon Koenigsknecht
- Department of Pediatrics, Women and Children's Hospital of Buffalo, University at Buffalo, State University of New York, Amherst, NY 14260-4200, USA
| | - Stelios T Andreadis
- Department of Chemical and Biological Engineering, University at Buffalo, State University of New York, Amherst, NY 14260-4200, USA; Department of Biomedical Engineering, University at Buffalo, State University of New York, Amherst, NY 14260-4200, USA; Center of Excellence in Bioinformatics and Life Sciences, University at Buffalo, State University of New York, Amherst, NY 14260-4200, USA.
| | - Daniel D Swartz
- Department of Pediatrics, Women and Children's Hospital of Buffalo, University at Buffalo, State University of New York, Amherst, NY 14260-4200, USA; Center of Excellence in Bioinformatics and Life Sciences, University at Buffalo, State University of New York, Amherst, NY 14260-4200, USA.
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Hibino N, McConnell P, Shinoka T, Malik M, Galantowicz M. Preliminary Experience in the Use of an Extracellular Matrix (CorMatrix) as a Tube Graft: Word of Caution. Semin Thorac Cardiovasc Surg 2015; 27:288-95. [DOI: 10.1053/j.semtcvs.2015.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2015] [Indexed: 11/11/2022]
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Holubec T, Caliskan E, Sündermann SH, Starck CT, Plass A, Bettex D, Falk V, Maisano F. Use of extracellular matrix patches in cardiac surgery. J Card Surg 2014; 30:145-8. [PMID: 25533356 DOI: 10.1111/jocs.12494] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A noncellular xenogeneic extracellular matrix derived from the porcine small intestinal submucosa can be used as a new patch material with potential advantages. We review the literature on the use of this material in cardiac surgery.
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Affiliation(s)
- Tomas Holubec
- Division of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
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Sündermann SH, Müggler O, Caliskan E, Reser D, Manka R, Holubec T, Czerny M, Falk V. Extracellular matrix for reconstruction of cardiac structures after tumour resections. Interact Cardiovasc Thorac Surg 2014; 20:10-4. [DOI: 10.1093/icvts/ivu310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Babczyk P, Conzendorf C, Klose J, Schulze M, Harre K, Tobiasch E. Stem Cells on Biomaterials for Synthetic Grafts to Promote Vascular Healing. J Clin Med 2014; 3:39-87. [PMID: 26237251 PMCID: PMC4449663 DOI: 10.3390/jcm3010039] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 10/28/2013] [Accepted: 11/16/2013] [Indexed: 12/25/2022] Open
Abstract
This review is divided into two interconnected parts, namely a biological and a chemical one. The focus of the first part is on the biological background for constructing tissue-engineered vascular grafts to promote vascular healing. Various cell types, such as embryonic, mesenchymal and induced pluripotent stem cells, progenitor cells and endothelial- and smooth muscle cells will be discussed with respect to their specific markers. The in vitro and in vivo models and their potential to treat vascular diseases are also introduced. The chemical part focuses on strategies using either artificial or natural polymers for scaffold fabrication, including decellularized cardiovascular tissue. An overview will be given on scaffold fabrication including conventional methods and nanotechnologies. Special attention is given to 3D network formation via different chemical and physical cross-linking methods. In particular, electron beam treatment is introduced as a method to combine 3D network formation and surface modification. The review includes recently published scientific data and patents which have been registered within the last decade.
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Affiliation(s)
- Patrick Babczyk
- Department of Natural Science, Bonn-Rhein-Sieg University of Applied Science, Von-Liebig-Street 20, Rheinbach 53359, Germany.
| | - Clelia Conzendorf
- Faculty of Mechanical Engineering/Process Engineering, University of Applied Science Dresden, Friedrich-List-Platz 1, Dresden 01069, Germany.
| | - Jens Klose
- Faculty of Mechanical Engineering/Process Engineering, University of Applied Science Dresden, Friedrich-List-Platz 1, Dresden 01069, Germany.
| | - Margit Schulze
- Department of Natural Science, Bonn-Rhein-Sieg University of Applied Science, Von-Liebig-Street 20, Rheinbach 53359, Germany.
| | - Kathrin Harre
- Faculty of Mechanical Engineering/Process Engineering, University of Applied Science Dresden, Friedrich-List-Platz 1, Dresden 01069, Germany.
| | - Edda Tobiasch
- Department of Natural Science, Bonn-Rhein-Sieg University of Applied Science, Von-Liebig-Street 20, Rheinbach 53359, Germany.
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Phillips J, Riley KO, Woodworth BA. Porcine small intestine submucosal grafts for post-tumor resection orbital reconstruction. Laryngoscope 2013; 124:E219-23. [PMID: 24214917 DOI: 10.1002/lary.24515] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 10/15/2013] [Accepted: 11/06/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Removal of the medial orbital wall for sinonasal tumor involvement is required to obtain complete oncologic resection. However, orbital fat herniation can produce significant morbidity, including enophthalmos and diplopia. The purpose of the current study was to evaluate outcomes following use of porcine small intestine submucosa (SIS) grafts for orbital reconstruction following extirpation of sinonasal malignancies. STUDY DESIGN Case series in a tertiary hospital setting. METHODS Review of prospectively collected data regarding orbital reconstruction using SIS was performed. Demographics, tumor histology, size of orbital defect, adjuvant treatment, clinical status, and complications were recorded. RESULTS Seventeen patients (average age, 58 years; range, 27-82 years) had SIS grafting of the medial orbital wall over a 5-year period at our tertiary academic institution. The average orbital wall defect size was 4.6 cm(2) (range, 1 cm(2)-24 cm(2)). Tumor histopathology included esthesioneuroblastoma (n = 5), squamous cell carcinoma (n = 4), adenocarcinoma (n = 2), sinonasal undifferentiated carcinoma (n = 2), melanoma (n = 3), and neuroendocrine carcinoma (n = 1). Surgical goals were curative intent in all patients. Ten patients had postoperative radiation therapy, whereas five individuals had surgical extirpation following neoadjuvant chemotherapy and radiation. All patients had complete locoregional control at last clinical follow-up (average, 16 months; range, 2-54 months), although three patients developed distant metastases. The only orbital complications noted were enophthalmos (n = 1), periorbital cellulitis (n = 1), and orbital wall crusting (n = 1). CONCLUSIONS SIS reconstruction of orbital wall defects was effective in the current series of patients, with only one patient developing noticeable enophthalmos and a low incidence of surgical complications. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- James Phillips
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
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Initial Experience with Intraventricular Repair Using CorMatrix Extracellular Matrix. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2013; 8:348-52. [DOI: 10.1097/imi.0000000000000014] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective Pericardial patches for intraventricular repair are limited by progressive calcification, thickening, and retraction. The aim of this study was to evaluate the safety of CorMatrix extracellular matrix (ECM) for intraventricular repair of mechanical complications of myocardial infarction (MI). Methods CorMatrix ECM is a novel material synthesized from decellularized porcine small intestinal submucosa. Between July 2011 and October 2012, a total of 11 consecutive patients with post-MI complications including ventricular aneurysm (n = 7), ventricular septal defect (VSD; n = 3), and both aneurysm and VSD (n = 1) underwent patch repair using CorMatrix ECM. Clinical follow-up and interval transthoracic echocardiography data were collected. Results Eleven patients underwent Dor or linear left ventricular aneurysm repair and/or patch VSD repair. There were two reoperations and one surgical mortality but no cases of CorMatrix ECM repair failures. The mean ± SD clinical follow-up was 207 ± 211 days, and the longest follow-up was 642 days, during which there was no readmission for any cardiac cause or death. The mean ± SD transthoracic echocardiography follow-up was 176 ± 220 days, which demonstrated integrity of CorMatrix ECM repair in all cases. Conclusions In our series, CorMatrix ECM was a safe alternative for ventricular patch repair of mechanical complications after MI in the short-term. This series supports the continued study of the efficacy and the regenerative potential of this novel material for cardiac repair.
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Yanagawa B, Rao V, Yau TM, Cusimano RJ. Initial Experience with Intraventricular Repair Using CorMatrix Extracellular Matrix. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2013. [DOI: 10.1177/155698451300800505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Bobby Yanagawa
- Division of Cardiovascular Surgery, University Health Network, Department of Surgery, University of Toronto, Toronto, ON Canada
| | - Vivek Rao
- Division of Cardiovascular Surgery, University Health Network, Department of Surgery, University of Toronto, Toronto, ON Canada
| | - Terrence M. Yau
- Division of Cardiovascular Surgery, University Health Network, Department of Surgery, University of Toronto, Toronto, ON Canada
| | - Robert J. Cusimano
- Division of Cardiovascular Surgery, University Health Network, Department of Surgery, University of Toronto, Toronto, ON Canada
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