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Virmani R, Philippon F, Mittal S, Finn A, Kudlik D, Kirchhof N, Lexcen D, Kassotis J. Effects of envelopes on cardiac implantable electronic device pocket healing: A head-to-head preclinical evaluation. Heart Rhythm 2024; 21:1325-1333. [PMID: 38555971 DOI: 10.1016/j.hrthm.2024.02.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/06/2024] [Accepted: 02/23/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND The healing response to cardiac implantable electronic device (CIED) implantation results in inflammation that can lead to fibrous pocket formation, which may disrupt pocket healing or complicate future interventions. OBJECTIVE The purpose of this study was to assess CIED pocket healing with use of the second-generation TYRX absorbable antibacterial envelope (T2), the next-generation (NG) TYRX absorbable antibacterial envelope under development, and the CanGaroo® extracellular matrix envelope (ECM) compared to no envelope. METHODS A total of 110 CIEDs were implanted in an ovine model, either with (T2, NG, or ECM) or without envelopes. Histopathologic and morphometric analyses were completed at several timepoints after implant (3 days, 7 days, 4 weeks, 12 weeks, 24 weeks). An independent pathologist completed a blinded histopathology assessment of the pockets. RESULTS TYRX (T2/NG) pockets showed similar inflammatory and healing profiles to controls with more rapid provisional matrix formation compared to controls and ECM. ECM pockets exhibited increased acute (3 and 7 days) and chronic (24 weeks) inflammation. T2/NG had almost complete (T2) or complete (NG) absorption by week 12. ECM remained present at week 24 and was associated with significantly thicker capsules (ECM 0.80 ± 0.14 mm; NG 0.37 ± 0.10 mm; control 0.56 ± 0.17 mm). CONCLUSION Compared to ECM, pockets with TYRX showed less inflammation, more rapid provisional matrix formation, faster absorption, and thinner capsules. TYRX pockets had low inflammation comparable to controls with accelerated provisional matrix deposition and tissue adhesion. The healing response to CIEDs used with TYRX fosters the formation of a well-healed pocket, which may bring patient benefit beyond its proven infection reduction.
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Affiliation(s)
| | - Francois Philippon
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Québec, Canada
| | | | - Aloke Finn
- CV Path Institute, Gaithersburg, Maryland
| | | | | | | | - John Kassotis
- Peconic Bay Medical Center-Northwell Health, Riverhead, New York
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2
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Smith E, O'Brien O, Woo M, Pretorius V, Cronin B. Rosai-Dorfman-Destombes Disease: A Rare Cardiac Presentation. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00369-0. [PMID: 38926004 DOI: 10.1053/j.jvca.2024.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/14/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024]
Affiliation(s)
- Emma Smith
- Department of Anesthesiology, University of California, San Diego
| | - Orestes O'Brien
- Department of Anesthesiology, University of California, San Diego
| | - Matt Woo
- Department of Anesthesiology, University of California, San Diego
| | - Victor Pretorius
- Department of Cardiothoracic Surgery, University of California, San Diego
| | - Brett Cronin
- Department of Anesthesiology, University of California, San Diego.
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3
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Schwartzman WE, Jimenez M, Yates AR, Armstrong AK, Salavitabar A, Hor KK, Hoerstrup S, Emmert MY, Shinoka T, Carrillo SA, Breuer CK, Kelly JM. Patch Materials for Pulmonary Artery Arterioplasty and Right Ventricular Outflow Tract Augmentation: A Review. Pediatr Cardiol 2023; 44:973-995. [PMID: 37149833 PMCID: PMC10224813 DOI: 10.1007/s00246-023-03152-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/20/2023] [Indexed: 05/08/2023]
Abstract
Patch augmentation of the right ventricular outflow tract (RVOT) and pulmonary artery (PA) arterioplasty are relatively common procedures in the surgical treatment of patients with congenital heart disease. To date, several patch materials have been applied with no agreed upon clinical standard. Each patch type has unique performance characteristics, cost, and availability. There are limited data describing the various advantages and disadvantages of different patch materials. We performed a review of studies describing the clinical performance of various RVOT and PA patch materials and found a limited but growing body of literature. Short-term clinical performance has been reported for a multitude of patch types, but comparisons are limited by inconsistent study design and scarce histologic data. Standard clinical criteria for assessment of patch efficacy and criteria for intervention need to be applied across patch types. The field is progressing with improvements in outcomes due to newer patch technologies focused on reducing antigenicity and promoting neotissue formation which may have the ability to grow, remodel, and repair.
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Affiliation(s)
| | - Michael Jimenez
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Andrew R Yates
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Aimee K Armstrong
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Arash Salavitabar
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Kan K Hor
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Simon Hoerstrup
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
| | - Maximilian Y Emmert
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Toshiharu Shinoka
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Sergio A Carrillo
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Christopher K Breuer
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - John M Kelly
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA.
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
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4
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Poulis N, Breitenstein P, Hofstede S, Hoerstrup SP, Emmert MY, Fioretta ES. Multiscale analysis of human tissue engineered matrices for next generation heart valve applications. Acta Biomater 2023; 158:101-114. [PMID: 36638939 DOI: 10.1016/j.actbio.2023.01.007] [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: 08/02/2022] [Revised: 12/15/2022] [Accepted: 01/03/2023] [Indexed: 01/12/2023]
Abstract
Human tissue-engineered matrices (hTEMs) have been proposed as a promising approach for in situ tissue engineered heart valves (TEHVs). However, there is still a limited understanding on how ECM composition in hTEMs develops over tissue culture time. Therefore, we performed a longitudinal hTEM assessment by 1) multiscale evaluation of hTEM composition during culture time (2, 4, 6-weeks), using (immuno)histology, biochemical assays, and mass spectrometry (LC-MS/MS); 2) analysis of protein pathways involved in ECM development using gene set enrichment analysis (GSEA); and 3) assessment of hTEM mechanical characterization using uniaxial tensile testing. Finally, as a proof-of-concept, TEHVs manufactured using 6-weeks hTEM samples were tested in a pulse duplicator. LC-MS/MS confirmed the tissue culture time-dependent increase in ECM proteins observed in histology and biochemical assays, revealing the most abundant collagens (COL6, COL12), proteoglycans (HSPG2, VCAN), and glycoproteins (FN, TNC). GSEA identified the most represented protein pathways in the hTEM at 2-weeks (mRNA metabolic processes), 4-weeks (ECM production), and 6-weeks (ECM organization and maturation). Uniaxial mechanical testing showed increased stiffness and stress at failure, and reduction in strain over tissue culture time. hTEM-based TEHVs demonstrated promising in vitro performance at both pulmonary and aortic pressure conditions, with symmetric leaflet coaptation and no stenosis. In conclusion, ECM protein abundance and maturation increased over tissue culture time, with consequent improvement of hTEM mechanical characteristics. These findings suggest that longer tissue culture impacts tissue organization, leading to an hTEM that may be suitable for high-pressure applications. STATEMENT OF SIGNIFICANCE: It is believed that the composition of the extracellular matrix (ECM) in the human tissue engineered matrices (hTEM) may favor tissue engineered heart valve (TEHV) remodeling upon implantation. However, the exact protein composition of the hTEM, and how this impacts tissue mechanical properties, remains unclear. Hence, we developed a reproducible rotation-based tissue culture method to produce hTEM samples. We performed a longitudinal assessment using different analytical techniques and mass spectrometry. Our data provided an in-depth characterization of the hTEM proteome with focus on ECM components, their development, and how they may impact the mechanical properties. Based on these results, we manufactured functional hTEM-based TEHVs at aortic-like condition in vitro. These outcomes pose an important step in translating hTEM-based TEHVs into clinics and in predicting their remodeling potential upon implantation.
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Affiliation(s)
- N Poulis
- Institute for Regenerative Medicine (IREM), University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - P Breitenstein
- Institute for Regenerative Medicine (IREM), University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - S Hofstede
- Laboratory for Orthopaedic Biomechanics, Institute for Biomechanics, ETH Zurich, Lengghalde 5, 8008 Zurich, Switzerland
| | - S P Hoerstrup
- Institute for Regenerative Medicine (IREM), University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland; Wyss Zurich, University and ETH Zurich, Zurich, Switzerland
| | - M Y Emmert
- Institute for Regenerative Medicine (IREM), University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland; Wyss Zurich, University and ETH Zurich, Zurich, Switzerland; Charité Universitätsmedizin Berlin, Berlin, Germany; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany.
| | - E S Fioretta
- Institute for Regenerative Medicine (IREM), University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
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5
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Biological Scaffolds for Congenital Heart Disease. BIOENGINEERING (BASEL, SWITZERLAND) 2023; 10:bioengineering10010057. [PMID: 36671629 PMCID: PMC9854830 DOI: 10.3390/bioengineering10010057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/20/2022] [Accepted: 12/26/2022] [Indexed: 01/05/2023]
Abstract
Congenital heart disease (CHD) is the most predominant birth defect and can require several invasive surgeries throughout childhood. The absence of materials with growth and remodelling potential is a limitation of currently used prosthetics in cardiovascular surgery, as well as their susceptibility to calcification. The field of tissue engineering has emerged as a regenerative medicine approach aiming to develop durable scaffolds possessing the ability to grow and remodel upon implantation into the defective hearts of babies and children with CHD. Though tissue engineering has produced several synthetic scaffolds, most of them failed to be successfully translated in this life-endangering clinical scenario, and currently, biological scaffolds are the most extensively used. This review aims to thoroughly summarise the existing biological scaffolds for the treatment of paediatric CHD, categorised as homografts and xenografts, and present the preclinical and clinical studies. Fixation as well as techniques of decellularisation will be reported, highlighting the importance of these approaches for the successful implantation of biological scaffolds that avoid prosthetic rejection. Additionally, cardiac scaffolds for paediatric CHD can be implanted as acellular prostheses, or recellularised before implantation, and cellularisation techniques will be extensively discussed.
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6
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Mu L, Dong R, Guo B. Biomaterials-Based Cell Therapy for Myocardial Tissue Regeneration. Adv Healthc Mater 2022; 12:e2202699. [PMID: 36572412 DOI: 10.1002/adhm.202202699] [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: 10/19/2022] [Revised: 12/11/2022] [Indexed: 12/28/2022]
Abstract
Cardiovascular diseases (CVDs) have been the leading cause of death worldwide during the past several decades. Cell loss is the main problem that results in cardiac dysfunction and further mortality. Cell therapy aiming to replenish the lost cells is proposed to treat CVDs especially ischemic heart diseases which lead to a big portion of cell loss. Due to the direct injection's low cell retention and survival ratio, cell therapy using biomaterials as cell carriers has attracted more and more attention because of their promotion of cell delivery and maintenance at the aiming sites. In this review, the three main factors involved in cell therapy for myocardial tissue regeneration: cell sources (somatic cells, stem cells, and engineered cells), chemical components of cell carriers (natural materials, synthetic materials, and electroactive materials), and categories of cell delivery materials (patches, microspheres, injectable hydrogels, nanofiber and microneedles, etc.) are systematically summarized. An introduction of the methods including magnetic resonance/radionuclide/photoacoustic and fluorescence imaging for tracking the behavior of transplanted cells in vivo is also included. Current challenges of biomaterials-based cell therapy and their future directions are provided to give both beginners and professionals a clear view of the development and future trends in this area.
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Affiliation(s)
- Lei Mu
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Ruonan Dong
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Baolin Guo
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, 710049, China.,State Key Laboratory for Mechanical Behavior of Materials, and Frontier Institute of Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
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7
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Nummi A, Pätilä T, Mulari S, Lampinen M, Nieminen T, Mäyränpää MI, Vento A, Harjula A, Kankuri E. Epicardial transplantation of autologous atrial appendage micrografts: evaluation of safety and feasibility in pigs after coronary artery occlusion. SCAND CARDIOVASC J 2022; 56:352-360. [PMID: 36002941 DOI: 10.1080/14017431.2022.2111462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/04/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Abstract
Objectives. Several approaches devised for clinical utilization of cell-based therapies for heart failure often suffer from complex and lengthy preparation stages. Epicardial delivery of autologous atrial appendage micrografts (AAMs) with a clinically used extracellular matrix (ECM) patch provides a straightforward therapy alternative. We evaluated the operative feasibility and the effect of micrografts on the patch-induced epicardial foreign body inflammatory response in a porcine model of myocardial infarction. Design. Right atrial appendages were harvested and mechanically processed into AAMs. The left anterior descending coronary artery was ligated to generate acute infarction. Patches of ECM matrix with or without AAMs were transplanted epicardially onto the infarcted area. Four pigs received the ECM and four received the AAMs patch. Cardiac function was studied by echocardiography both preoperatively and at 3-week follow-up. The primary outcome measures were safety and feasibility of the therapy administration, and the secondary outcome was the inflammatory response to ECM. Results. Neither AAMs nor ECM patch-related complications were detected during the follow-up time. AAMs patch preparation was feasible according to time and safety. Inflammation was greatly reduced in AAMs when compared with ECM patches as measured by the amount of infiltrated inflammatory cells and area of inflammation. Immunohistochemistry demonstrated an increased CD3+ cell density in the AAMs patch infiltrate. Conclusions. Epicardial AAMs transplantation demonstrated safety and clinical feasibility. The use of micrografts significantly inhibited ECM-induced foreign body inflammatory reactivity. Transplantation of AAMs shows good clinical applicability as adjuvant therapy to cardiac surgery and can suppress acute inflammatory reactivity.
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Affiliation(s)
- Annu Nummi
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tommi Pätilä
- Pediatric Cardiac Surgery, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Severi Mulari
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Milla Lampinen
- Department of Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Tuomo Nieminen
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Päijät-Häme Joint Authority for Health and Wellbeing, Lahti, Finland
| | - Mikko I Mäyränpää
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Vento
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ari Harjula
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Esko Kankuri
- Department of Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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8
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Ma M. Are There Still Reasons to Use Porcine Small Intestinal Submucosa? J Am Coll Cardiol 2022; 80:1069-1070. [PMID: 36075676 DOI: 10.1016/j.jacc.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Michael Ma
- Stanford University School of Medicine, Stanford, California, USA.
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9
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Sengupta A, Beroukhim R, Baird CW, Del Nido PJ, Geva T, Gauvreau K, Marcus E, Sanders SP, Nathan M. Outcomes of Repair of Congenital Aortic Valve Lesions Using Autologous Pericardium vs Porcine Intestinal Submucosa. J Am Coll Cardiol 2022; 80:1060-1068. [PMID: 36075675 DOI: 10.1016/j.jacc.2022.06.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/11/2022] [Accepted: 06/21/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Outcomes following congenital aortic valve (AoV) repair are plagued by progressive dysfunction of currently available leaflet substitute materials. OBJECTIVES We compared the long-term outcomes of congenital AoV repair using porcine intestinal submucosa vs autologous pericardium (AP). METHODS This was a single-center retrospective review of all patients who underwent congenital AoV repair with either porcine intestinal submucosa or AP from October 2009 to March 2013. The primary outcome was postdischarge (late) unplanned AoV reintervention. Secondary outcomes included number of late AoV reinterventions and a composite of at least moderate aortic regurgitation or stenosis at latest follow-up or before the first reintervention. Associations between leaflet repair material and outcomes were assessed using multivariable regression models, adjusting for prespecified patient-related and operative variables. RESULTS Of 26 porcine intestinal submucosa and 49 AP patients who met entry criteria, the median age was 11.0 years (IQR: 4.7-16.6 years). At a median follow-up of 8.5 years (IQR: 4.4-9.6 years), 17 (65.4%) porcine intestinal submucosa and 22 (44.9%) AP patients underwent at least 1 AoV reintervention. On multivariable analysis, porcine intestinal submucosa use was significantly associated with unplanned AoV reintervention (HR: 4.6; 95% CI: 2.2-9.8; P < 0.001), number of postdischarge AoV reinterventions (incidence rate ratio: 1.7; 95% CI: 1.0-2.9; P = 0.037), and at least moderate aortic regurgitation or stenosis at latest follow-up or before the first reintervention (OR: 5.0; 95% CI: 1.2-21.0; P = 0.027). CONCLUSIONS Aortic valvuloplasty with porcine intestinal submucosa is associated with earlier time to reintervention compared with autologous pericardium. The search for the ideal AoV leaflet repair material continues.
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Affiliation(s)
- Aditya Sengupta
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.
| | - Rebecca Beroukhim
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher W Baird
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Pedro J Del Nido
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Edward Marcus
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Stephen P Sanders
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA; Cardiac Registry, Departments of Cardiology, Pathology and Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Meena Nathan
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
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10
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Poulis N, Martin M, Hoerstrup SP, Emmert MY, Fioretta ES. Macrophage-extracellular matrix interactions: Perspectives for tissue engineered heart valve remodeling. Front Cardiovasc Med 2022; 9:952178. [PMID: 36176991 PMCID: PMC9513146 DOI: 10.3389/fcvm.2022.952178] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
In situ heart valve tissue engineering approaches have been proposed as promising strategies to overcome the limitations of current heart valve replacements. Tissue engineered heart valves (TEHVs) generated from in vitro grown tissue engineered matrices (TEMs) aim at mimicking the microenvironmental cues from the extracellular matrix (ECM) to favor integration and remodeling of the implant. A key role of the ECM is to provide mechanical support to and attract host cells into the construct. Additionally, each ECM component plays a critical role in regulating cell adhesion, growth, migration, and differentiation potential. Importantly, the immune response to the implanted TEHV is also modulated biophysically via macrophage-ECM protein interactions. Therefore, the aim of this review is to summarize what is currently known about the interactions and signaling networks occurring between ECM proteins and macrophages, and how these interactions may impact the long-term in situ remodeling outcomes of TEMs. First, we provide an overview of in situ tissue engineering approaches and their clinical relevance, followed by a discussion on the fundamentals of the remodeling cascades. We then focus on the role of circulation-derived and resident tissue macrophages, with particular emphasis on the ramifications that ECM proteins and peptides may have in regulating the host immune response. Finally, the relevance of these findings for heart valve tissue engineering applications is discussed.
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Affiliation(s)
- Nikolaos Poulis
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland
| | - Marcy Martin
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland
| | - Simon P. Hoerstrup
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland
- Wyss Zurich, University and Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
| | - Maximilian Y. Emmert
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland
- Wyss Zurich, University and Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
- Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- *Correspondence: Maximilian Y. Emmert, ,
| | - Emanuela S. Fioretta
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland
- Emanuela S. Fioretta,
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11
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Rapetto F, Iacobazzi D, Narayan SA, Skeffington K, Salih T, Mostafa S, Alvino VV, Upex A, Madeddu P, Ghorbel MT, Caputo M. Wharton's Jelly-Mesenchymal Stem Cell-Engineered Conduit for Pulmonary Artery Reconstruction in Growing Piglets. JACC Basic Transl Sci 2022; 7:207-219. [PMID: 35411313 PMCID: PMC8993765 DOI: 10.1016/j.jacbts.2021.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 11/23/2022]
Abstract
Surgical treatment of congenital heart defects affecting the right ventricular outflow tract often requires complex reconstruction and multiple reoperations. With a randomized controlled trial, we compared a novel tissue-engineered small intestine submucosa-based graft for pulmonary artery reconstruction (seeded with mesenchymal stem cells derived from Wharton's Jelly) with conventional small intestine submucosa in growing piglets. Six months after implantation, seeded grafts showed integration with host tissues at cellular level and exhibited growth potential on transthoracic echocardiography and cardiovascular magnetic resonance. Our seeded graft is a promising biomaterial for pulmonary artery reconstruction in pediatric patients with right ventricular outflow tract abnormalities.
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Affiliation(s)
- Filippo Rapetto
- Department of Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, United Kingdom
- Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Dominga Iacobazzi
- Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Srinivas A. Narayan
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Katie Skeffington
- Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Tasneem Salih
- Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Shahd Mostafa
- Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Valeria V. Alvino
- Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Adrian Upex
- Department of Anaesthesia, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Paolo Madeddu
- Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Mohamed T. Ghorbel
- Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Massimo Caputo
- Department of Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, United Kingdom
- Translational Health Sciences, University of Bristol, Bristol, United Kingdom
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12
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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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Dye-Mediated Photo-Oxidation Biomaterial Fixation: Analysis of Bioinductivity and Mechanical Properties of Bovine Pericardium for Use in Cardiac Surgery. Int J Mol Sci 2021; 22:ijms221910768. [PMID: 34639108 PMCID: PMC8509588 DOI: 10.3390/ijms221910768] [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: 08/28/2021] [Revised: 09/27/2021] [Accepted: 09/30/2021] [Indexed: 11/17/2022] Open
Abstract
Extracellular matrix bioscaffolds can influence the cardiac microenvironment and modulate endogenous cellular mechanisms. These materials can optimize cardiac surgery for repair and reconstruction. We investigated the biocompatibility and bioinductivity of bovine pericardium fixed via dye-mediated photo-oxidation on human cardiac fibroblast activity. We compared a dye-mediated photo-oxidation fixed bioscaffold to glutaraldehyde-fixed and non-fixed bioscaffolds reported in contemporary literature in cardiac surgery. Human cardiac fibroblasts from consenting patients were seeded on to bioscaffold materials to assess the biocompatibility and bioinductivity. Human cardiac fibroblast gene expression, secretome, morphology and viability were studied. Dye-mediated photo-oxidation fixed acellular bovine pericardium preserves human cardiac fibroblast phenotype and viability; and potentiates a pro-vasculogenic paracrine response. Material tensile properties were compared with biomechanical testing. Dye-mediated photo-oxidation fixed acellular bovine pericardium had higher compliance compared to glutaraldehyde-fixed bioscaffold in response to tensile force. The biocompatibility, bioinductivity, and biomechanical properties of dye-mediated photo-oxidation fixed bovine pericardium demonstrate its feasibility as a bioscaffold for use in cardiac surgery. As a fixed yet bioinductive solution, this bioscaffold demonstrates enhanced compliance and retains bioinductive properties that may leverage endogenous reparative pathways. Dye-mediated photo-oxidation fixed bioscaffold warrants further investigation as a viable tool for cardiac repair and reconstruction.
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Jelodari S, Sadroddiny E. Decellularization of Small Intestinal Submucosa. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1345:71-84. [PMID: 34582015 DOI: 10.1007/978-3-030-82735-9_7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Small intestinal submucosa (SIS) is the most studied extracellular matrix (ECM) for repair and regeneration of different organs and tissues. Promising results of SIS-ECM as a vascular graft, led scientists to examine its applicability for repairing other tissues. Overall results indicated that SIS grafts induce tissue regeneration and remodeling to almost native condition. Investigating immunomodulatory effects of SIS is another interesting field of research. SIS can be utilized in different forms for multiple clinical and experimental studies. The aim of this chapter is to investigate the decellularization process of SIS and its common clinical application.
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Affiliation(s)
- Sahar Jelodari
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Sadroddiny
- Department of Medical Biotechnology, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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15
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Hu K, Siddiqi U, Lee B, Pena E, Schulz K, Vogel M, Combs P, El-Zein C, Ilbawi M, Vricella L, Hibino N. Pediatric aortic valve repair: Any development in the material for cusp extension valvuloplasty? J Card Surg 2021; 36:4054-4060. [PMID: 34423475 DOI: 10.1111/jocs.15931] [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: 06/28/2021] [Revised: 08/13/2021] [Accepted: 08/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Aortic cusp extension is a technique for aortic valve (AV) repairs in pediatric patients. The choice of the material used in this procedure may influence the time before reoperation is required. We aimed to assess postoperative and long-term outcomes of patients receiving either pericardial or synthetic repairs. METHODS We conducted a single-center, retrospective study of pediatric patients undergoing aortic cusp extension valvuloplasty (N = 38) with either autologous pericardium (n = 30) or CorMatrix (n = 8) between April 2009 and July 2016. Short- and long-term postoperative outcomes were compared between the two groups. Freedom from reoperation was compared using Kaplan-Meier analysis. Degree of aortic stenosis (AS) and aortic regurgitation (AR) were recorded at baseline, postoperatively, and at outpatient follow-up. RESULTS At 5 years after repair, freedom from reoperation was significantly lower in the CorMatrix group (12.5%) compared to the pericardium group (62.5%) (p = .01). For the entire cohort, there was a statistically significant decrease in the peak trans-valvar gradient between preoperative and postoperative assessments with no significant change at outpatient follow-up. In the pericardium group, 28 (93%) had moderate to severe AR at baseline which improved to 11 (37%) postoperatively and increased to 21 (70%) at time of follow-up. In the biomaterial group, eight (100%) had moderate to severe AR which improved to three (38%) postoperatively and increased to seven (88%) at time of follow-up. CONCLUSION In terms of durability, the traditional autologous pericardium may outperform the new CorMatrix for AV repairs using the cusp extension method.
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Affiliation(s)
- Kelli Hu
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois, USA
| | - Umar Siddiqi
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois, USA
| | - Brian Lee
- Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, Illinois, USA
| | - Emily Pena
- Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, Illinois, USA
| | - Kelci Schulz
- Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, Illinois, USA
| | - Maggie Vogel
- Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, Illinois, USA
| | - Pamela Combs
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois, USA
| | - Chawki El-Zein
- Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, Illinois, USA
| | - Michel Ilbawi
- Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, Illinois, USA
| | - Luca Vricella
- Pediatric Cardiology, Advocate Children's Hospital, Oak Lawn, Illinois, USA
| | - Narutoshi Hibino
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois, USA
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Over 400 Uses of An Intestinal Submucosal Extracellular Matrix Patch in a Congenital Heart Program. Ann Thorac Surg 2021; 114:1475-1483. [PMID: 34375649 DOI: 10.1016/j.athoracsur.2021.06.087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/04/2021] [Accepted: 06/28/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Repair of complex congenital heart disease frequently requires usage of a patch as an anatomical substitute. The study's aim is to evaluate the use, effectiveness and safety of utilizing small intestine submucosa extracellular matrix (SIS-ECM) patches in a congenital cardiac surgery program. METHODS This is a single-center, retrospective, cohort study of surgeries utilizing SIS-ECM between 2012-2019. The SIS-ECM data was categorized by usage and type (4-ply and 2-ply). All re-interventions/complications were reviewed by an independent surgeon, a practicing congenital heart surgeon and a pediatric cardiologist. RESULTS 408 SIS-ECM patches were used in 309 patients (M/F=188/121; median age 8.5months). The usage consisted of 314 (77%) arterioplasties, 22 (5.4%) venoplasties, 63 (15.4%) intracardiac repairs, and 9 (2.2%) valve repairs. The most common usage was pulmonary artery repair (n=181; 44.4%). Median follow-up time was 3.9 years (range: 3days-7.4years). Ten (2.5%) patches required surgical (2 in first 30-days and 5 in 1st year) and 27 (6.6%) required percutaneous re-interventions (2 in first 30-days and 22 in 1st year). Between 4-ply (n=376) and 2-ply (n=32) SIS-ECM, rate of surgical (2.1% (n=8) vs 6.3% (n=2); p=0.18) or percutaneous re-interventions (6.4% (n=24) vs 9.4% (n=3); p=0.46) was not different. There were no deaths related to the SIS-ECM patch or reports of calcification. CONCLUSIONS SIS-ECM is a viable patch option that can be used in various cardiac and vascular reconstructive surgeries with low risk of failure and calcification. Long-term, positive outcomes may be maximized by consistent techniques and understanding appropriate applications of the patch.
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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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18
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Gębczak K, Wiatrak B, Fortuna W. Evaluation of PC12 Cells' Proliferation, Adhesion and Migration with the Use of an Extracellular Matrix (CorMatrix) for Application in Neural Tissue Engineering. MATERIALS 2021; 14:ma14143858. [PMID: 34300779 PMCID: PMC8307728 DOI: 10.3390/ma14143858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 01/19/2023]
Abstract
The use of extracellular matrix (ECM) biomaterials for soft tissue repair has proved extremely successful in animal models and in some clinical settings. The aim of the study was to investigate the effect of the commercially obtained CorMatrix bioscaffold on the viability, proliferation and migration of rat pheochromocytoma cell line PC12. PC12 cells were plated directly onto a CorMatrix flake or the well surface of a 12-well plate and cultured in RPMI-1640 medium and a medium supplemented with the nerve growth factor (NGF). The surface of the culture plates was modified with collagen type I (Col I). The number of PC12 cells was counted at four time points and then analysed for apoptosis using a staining kit containing annexin V conjugate with fluorescein and propidium iodide (PI). The effect of CorMatrix bioscaffold on the proliferation and migration of PC12 cells was tested by staining the cells with Hoechst 33258 solution for analysis using fluorescence microscopy. The research showed that the percentage of apoptotic and necrotic cells was low (less than 7%). CorMatrix stimulates the proliferation and possibly migration of PC12 cells that populate all levels of the three-dimensional architecture of the biomaterial. Further research on the mechanical and biochemical capabilities of CorMatrix offers prospects for the use of this material in neuro-regenerative applications.
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Affiliation(s)
- Katarzyna Gębczak
- Department of Basic Medical Sciences, Wroclaw Medical University, Borowska 211, 50-556 Wroclaw, Poland;
- Correspondence:
| | - Benita Wiatrak
- Department of Basic Medical Sciences, Wroclaw Medical University, Borowska 211, 50-556 Wroclaw, Poland;
- Department of Pharmacology, Faculty of Medicine, Wroclaw Medical University, Mikulicza-Radeckiego 2, 50-345 Wroclaw, Poland
| | - Wojciech Fortuna
- Department of Neurosurgery, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland;
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Matsuzaki Y, Wiet MG, Boe BA, Shinoka T. The Real Need for Regenerative Medicine in the Future of Congenital Heart Disease Treatment. Biomedicines 2021; 9:478. [PMID: 33925558 PMCID: PMC8145070 DOI: 10.3390/biomedicines9050478] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/19/2021] [Accepted: 04/24/2021] [Indexed: 11/23/2022] Open
Abstract
Bioabsorbable materials made from polymeric compounds have been used in many fields of regenerative medicine to promote tissue regeneration. These materials replace autologous tissue and, due to their growth potential, make excellent substitutes for cardiovascular applications in the treatment of congenital heart disease. However, there remains a sizable gap between their theoretical advantages and actual clinical application within pediatric cardiovascular surgery. This review will focus on four areas of regenerative medicine in which bioabsorbable materials have the potential to alleviate the burden where current treatment options have been unable to within the field of pediatric cardiovascular surgery. These four areas include tissue-engineered pulmonary valves, tissue-engineered patches, regenerative medicine options for treatment of pulmonary vein stenosis and tissue-engineered vascular grafts. We will discuss the research and development of biocompatible materials reported to date, the evaluation of materials in vitro, and the results of studies that have progressed to clinical trials.
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Affiliation(s)
- Yuichi Matsuzaki
- Center for Regenerative Medicine, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, T2294, Columbus, OH 43205, USA; (Y.M.); (M.G.W.)
| | - Matthew G. Wiet
- Center for Regenerative Medicine, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, T2294, Columbus, OH 43205, USA; (Y.M.); (M.G.W.)
| | - Brian A. Boe
- Department of Cardiology, The Heart Center, Nationwide Children’s Hospital, 700 Children’s Drive, T2294, Columbus, OH 43205, USA;
| | - Toshiharu Shinoka
- Center for Regenerative Medicine, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, T2294, Columbus, OH 43205, USA; (Y.M.); (M.G.W.)
- Department of Cardiothoracic Surgery, The Heart Center, Nationwide Children’s Hospital, 700 Children’s Drive, T2294, Columbus, OH 43205, USA
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20
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Iacobazzi D, Rapetto F, Albertario A, Swim MM, Narayan S, Skeffington K, Salih T, Alvino VV, Madeddu P, Ghorbel MT, Caputo M. Wharton's Jelly-Mesenchymal Stem Cell-Engineered Conduit for Pediatric Translation in Heart Defect. Tissue Eng Part A 2021; 27:201-213. [PMID: 32571164 DOI: 10.1089/ten.tea.2020.0088] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The materials available for the right ventricular outflow tract (RVOT) reconstruction in patients with tetralogy of fallot (TOF)/pulmonary atresia come with the severe limitation of long-term degeneration and lack of growth potential, causing right ventricular dysfunction, aneurysm formation, and arrhythmias, thus necessitating several high-risk reoperations throughout patients' lives. In this study, we evaluated the capacity of mesenchymal stem cells (MSCs) derived from the Wharton's Jelly (WJ-MSCs), the gelatinous inner portion of the umbilical cord, to grow and recellularize an extracellular matrix (ECM) graft in our optimized xeno-free, good manufacturing practice-compliant culture system. WJ-MSCs were phenotypically and functionally characterized by flow cytometry and multilineage differentiation capacity, respectively. The typical MSC immunophenotype and functional characteristics were retained in our xeno-free culture system, as well as the capacity to grow and engraft onto a naturally occurring scaffold. WJ-MSCs, from both human and swine source, showed excellent capacity to recellularize ECM graft producing a living cell-seeded construct. In addition, we have provided an in vivo proof of concept of feasibility of the cellularized conduit, engineered with swine WJ-MSCs, to be used in a novel porcine model of main pulmonary artery reconstruction, where it showed good integration within the host tissue. Our study indicates that the addition of WJ-MSCs to the ECM scaffold can upgrade the material, converting it into a living tissue, with the potential to grow, repair, and remodel the RVOT. These results could potentially represent a paradigm shift in pediatric cardiac intervention toward new modalities for effective and personalized surgical restoration of pulmonary artery and RVOT function in TOF/pulmonary atresia patients. Impact Statement The materials available for pulmonary artery reconstruction in pediatric patients with Congenital Heart Defect come with the limitation of long-term degeneration and lack of growth, thus necessitating several reoperations. Here, we describe a novel approach combining perinatal stem cells and naturally occurring scaffold to create a living tissue engineered conduit that showed good growth potential in a pulmonary artery reconstruction porcine model. We envision this approach is of great interest and relevance in tissue engineering field applied to cardiovascular regenerative medicine, as it may open up new avenues for correction of congenital cardiac defects, with remarkable medical and social benefits.
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Affiliation(s)
- Dominga Iacobazzi
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol Royal Infirmary, Bristol, United Kingdom
| | - Filippo Rapetto
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol Royal Infirmary, Bristol, United Kingdom
| | - Ambra Albertario
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol Royal Infirmary, Bristol, United Kingdom
| | - Megan M Swim
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol Royal Infirmary, Bristol, United Kingdom
| | - Srinivas Narayan
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol Royal Infirmary, Bristol, United Kingdom
| | - Katie Skeffington
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol Royal Infirmary, Bristol, United Kingdom
| | - Tasneem Salih
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol Royal Infirmary, Bristol, United Kingdom
| | - Vincenza Valeria Alvino
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol Royal Infirmary, Bristol, United Kingdom
| | - Paolo Madeddu
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol Royal Infirmary, Bristol, United Kingdom
| | - Mohamed T Ghorbel
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol Royal Infirmary, Bristol, United Kingdom
| | - Massimo Caputo
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol Royal Infirmary, Bristol, United Kingdom
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21
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Chakraborty B, Wang H. Pathological Changes of Adult Mitral Valves after Failed CorMatrix ECM Repair. JOURNAL OF CLINICAL AND TRANSLATIONAL PATHOLOGY 2021; 1:9-15. [PMID: 34957472 PMCID: PMC8697744 DOI: 10.14218/jctp.2021.00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES CorMatrix acts as a tissue scaffold and is intended to promote the proliferation of small vessels and tissue remodeling to replicate normal tissue function. METHODS At Temple University Hospital, Philadelphia, PA, USA from 2013 to 2016, CorMatrix material was utilized during mitral valve anterior leaflet augmentation repair in 25 adult patients, and four patients required repeat interventions at 4-12 months (8.25 ± 4.35 months) after the initial repair. This study evaluated the pathological changes in four patients. RESULTS Histological examination of the CorMatrix showed matrix degradation in all cases. At 4 months after repair, mixed acute and chronic inflammatory cells that included eosinophils were visible within the matrix, which was more severe around the suture material. Later, the extent of inflammation abated and became more chronic with macrophage dominance. Some macrophages and multinucleated cells were visible deep in the matrix. The neovascularization was limited to the tissue-matrix boundary at early time points; the more mature vessels with dilated lumens extended deeper into the matrix as time increased, combined with some elongated fibroblast-like cells. In addition, marked acute and chronic inflammation with neutrophil and eosinophil infiltrate was identified in the surrounding native tissue at 4 months, especially around the suture material. Marked granulomatous inflammation was identified in all cases, with prominent multinucleated giant cells present at later time points (50%). Immunohistochemical staining for CD68 and CD163 showed prominent M2 macrophages in the CorMatrix and surrounding tissue. CONCLUSIONS Our results demonstrated time-dependent changes in failed CorMatrix repaired valves after mitral valve repair, with macrophages and neovascularization in the matrix 12 months after the initial repair.
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Affiliation(s)
- Baidarbhi Chakraborty
- Department of Pathology and Laboratory Medicine, Temple University Hospital, Philadelphia, PA, USA
| | - He Wang
- Department of Pathology, Yale University School of Medicine, 310 Cedar Street, New Haven, CT, USA
- Correspondence to: He Wang, Department of Pathology, Yale University School of Medicine, 310 Cedar Street, New Haven, CT 06520, USA. Tel: +1-203-789-3707, Fax: +1-203-789-3710,
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22
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Poncelet AJ. Biodegradable patches: Where are we going now? Ann Thorac Surg 2020; 112:1522. [PMID: 33279548 DOI: 10.1016/j.athoracsur.2020.09.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/07/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Alain Jean Poncelet
- Cliniques Universitaires Saint Luc, Cardio-Thoracic Surgery, Avenue Hippocrate 10, Brussels, 1200, Belgium.
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23
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Mously H, Kim J, Wheat HL, Sayed A, Elgudin Y. Recurrent ventricular septal defect following closure CorMatrix: A case report. J Card Surg 2020; 36:392-395. [PMID: 33225482 DOI: 10.1111/jocs.15163] [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: 02/04/2020] [Revised: 08/28/2020] [Accepted: 09/26/2020] [Indexed: 11/29/2022]
Abstract
Ventricular septal ruptures are an uncommon complication following acute myocardial infarction. Operative repair, utilizing a patch for closure of the defect, is the primary treatment modality to achieve hemodynamic stability. The use of an extracellular matrix derived from small intestinal submucosa as a scaffold for tissue repair is becoming increasingly common. Here, we present the case of a 58-year-old female found to have a ventricular septal rupture and posterior left ventricular aneurysm following late presentation after a myocardial infarction that required operative repair with a CorMatrix patch. Upon readmission for dyspnea and poor exercise tolerance several months later, the patch was subsequently found to have near-completely reabsorbed. There is a paucity of long-term outcomes data following the use of CorMatrix for septal defects, with rare reports of such reabsorption. Further study is required to identify the incidence and implications of such findings.
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Affiliation(s)
- Haytham Mously
- Department of Cardiovascular Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Joseph Kim
- Department of Cardiovascular Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Heather L Wheat
- Department of Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Asim Sayed
- Department of Cardiovascular Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Yakov Elgudin
- Department of Cardiothoracic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Bibevski S, Ruzmetov M, Ladich E, Mendoza LE, Scholl FG. Reconstruction of the Neopulmonary Root After Coronary Button Harvest for Arterial Switch Operation Using 2-ply Extracellular Matrix (Tyke): A Post-Implant Histology. Front Cardiovasc Med 2020; 7:562136. [PMID: 33195455 PMCID: PMC7661546 DOI: 10.3389/fcvm.2020.562136] [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: 06/05/2020] [Accepted: 10/06/2020] [Indexed: 11/15/2022] Open
Abstract
In children with Transposition of the Great Arteries (TGA), the pulmonary artery, and aorta are connected to the heart abnormally resulting in blue blood (deoxygenated) recirculating to the body and red blood (oxygenated) recirculating to the lungs. The arterial switch operation (ASO) is the standard of care for transposition of the great arteries (TGA), and given the low risk of early mortality and satisfactory long-term outcomes, focus is now on managing longer term complications such as neo-aortic root dilatation, and pulmonary artery stenosis. Since May 2016, we have used 2-ply extracellular matrix (ECM; Tyke) for reconstruction of the coronary button defects using a pantaloon patch. We present histology of implanted 2-ply ECM (Tyke) from a patient who went back to surgery for development of subaortic stenosis ~12 months after ASO.
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Affiliation(s)
- Steve Bibevski
- Division of Pediatric Cardiothoracic Surgery, The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL, United States
| | - Mark Ruzmetov
- Division of Pediatric Cardiothoracic Surgery, The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL, United States
| | - Elena Ladich
- Division of Pediatric Cardiothoracic Surgery, The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL, United States.,Section of Pathology, The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL, United States
| | - Laura E Mendoza
- Division of Pediatric Cardiothoracic Surgery, The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL, United States
| | - Frank G Scholl
- Division of Pediatric Cardiothoracic Surgery, The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL, United States
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Sood V, Heider A, Rabah R, Si MS, Ohye RG. Evaluation of Explanted CorMatrix Tyke Extracardiac Patches in Infants With Congenital Heart Disease. Ann Thorac Surg 2020; 112:1518-1522. [PMID: 33098878 DOI: 10.1016/j.athoracsur.2020.06.151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/06/2020] [Accepted: 06/29/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Animal data demonstrate that intracardiac patches of decellularized porcine small intestine submucosa (CorMatrix; CorMatrix Cardiovascular, Atlanta, GA) become repopulated with native cells, suggesting the possibility of a substrate for regenerative tissue in humans. Although human studies have not demonstrated this regenerative property with intracardiac patches, it is possible that other environments may better promote native cell repopulation. We report a prospective series of explanted CorMatrix extracardiac patches placed in infants with congenital heart disease. METHODS CorMatrix Tyke patches were used in pulmonary artery patch closure during the Norwood procedure. The patch material was explanted as part of the hemi-Fontan procedure. Specimens were analyzed with the use of hematoxylin and eosin, Movat pentachrome, and trichrome stains. RESULTS Of the 11 implantations, 9 specimens were explanted. One patient did not survive to hemi-Fontan procedure. One patient's patch was removed, but not analyzed. Acellular material, chronic inflammation, fibrosis, and foreign body giant cell reaction was seen in all explanted patches. No explanted CorMatrix Tyke material demonstrated evidence of ingrowth of native endothelial tissue at a median of 4.9 months in vivo. CONCLUSIONS CorMatrix Tyke patch material, placed as a pulmonary artery patch in an extracardiac position, remained pliable and mostly free of calcification. However, these patches did not show evidence of native endothelial tissue at a median of 4.9 months in vivo.
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Affiliation(s)
- Vikram Sood
- Department of Cardiac Surgery, Section of Pediatric Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Michigan.
| | - Amer Heider
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Rajah Rabah
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ming-Sing Si
- Department of Cardiac Surgery, Section of Pediatric Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Richard G Ohye
- Department of Cardiac Surgery, Section of Pediatric Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Michigan
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Ip JE, Xu L, Lerman BB. Differences between cardiac implantable electronic device envelopes evaluated in an animal model. J Cardiovasc Electrophysiol 2020; 32:1346-1354. [PMID: 33010088 DOI: 10.1111/jce.14766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 08/19/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Cardiac implantable electronic device (CIED) pocket related problems such as infection, hematoma, and device erosion cause significant morbidity and the clinical consequences are substantial. Bioabsorbable materials have been developed to assist in the prevention of these complications but there has not been any direct comparison of these adjunctive devices to reduce these complications. We sought to directly compare the TYRX absorbable antibacterial and CanGaroo extracellular matrix (ECM) envelopes in an animal model susceptible to these specific CIED-related complications (i.e., skin erosion and infection). METHODS AND RESULTS Sixteen mice undergoing implantation with biopotential transmitters were divided into three groups (no envelope = 4, TYRX = 5, and CanGaroo = 7) and monitored for device-related complications. Following 12 weeks of implantation, gross and histological analysis of the remaining capsules was performed. Three animals in the CanGaroo group (43%) had device erosion compared to none in the TYRX group. The remaining capsules excised at 12 weeks were qualitatively thicker following CanGaroo compared to TYRX and no envelope and histological evaluation demonstrated increased connective tissue with CanGaroo. CONCLUSION CanGaroo ECM envelopes did not reduce the incidence of device erosion and were associated with qualitatively thicker capsules and connective tissue staining at 12 weeks compared to no envelope or TYRX. Further studies regarding the use of these envelopes to prevent device erosion and their subsequent impact on capsule formation are warranted.
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Affiliation(s)
- James E Ip
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Linna Xu
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Bruce B Lerman
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
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Kiper C, Cua CL, Baker P, McConnell P. Mitral Valve Replacement in Pediatrics Using an Extracellular Matrix Cylinder Valve: A Case Series. Pediatr Cardiol 2020; 41:1458-1465. [PMID: 32607741 DOI: 10.1007/s00246-020-02382-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/22/2020] [Indexed: 11/25/2022]
Abstract
Mitral valve replacement (MVR) in children under 2 years is associated with significant morbidity and mortality. Decellularized porcine intestinal submucosa is a commercially available formulation of an extracellular matrix (ECM) with an indication for cardiac tissue repair. The present study reports our experience using ECM cylinder valves in patients for MVR. A retrospective review of patients under 2 years who underwent ECM custom-made cylinder mitral valve (ECM-MV) replacement was performed. Clinical, demographic, operative and post-operative follow-up data, including serial echocardiographic data are presented. Eight patients (age 5.6 ± 1.6 months; weight: 6.0 ± 1.1 kg) were identified who underwent ECM-MVR. There was one in-hospital death and no major neurological events. Six patients underwent replacement of their cylinder valve with either a Melody valve inside the ECM-MVR (n = 3), a mechanical valve (n = 2), or a decellularized bovine pericardial cylinder valve (n = 1). The mean time to replacement surgery was 8.4 ± 2.6 months after ECM-MV. The indications for replacement of ECM-MV included mitral stenosis/regurgitation (n = 4) or dehiscence (n = 2). One remaining patient is 24 months from ECM-MV, with trivial regurgitation and no stenosis. Mitral valve creation using ECM is an option for MVR in pediatrics, avoiding anticoagulation, and provides a suitable construct for later placement of a Melody valve, extending surgical and non-surgical options. However, the durability of the native ECM-MV in the mitral position is concerning considering the high re-intervention rate in a relatively short time period. Further studies are needed to determine the longer-term outcomes of this valve in this complex patient population.
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Affiliation(s)
- Carmen Kiper
- Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Clifford L Cua
- Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Peter Baker
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Patrick McConnell
- Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, OH, 43205, USA
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Poulis N, Zaytseva P, Gähwiler EKN, Motta SE, Fioretta ES, Cesarovic N, Falk V, Hoerstrup SP, Emmert MY. Tissue engineered heart valves for transcatheter aortic valve implantation: current state, challenges, and future developments. Expert Rev Cardiovasc Ther 2020; 18:681-696. [DOI: 10.1080/14779072.2020.1792777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Nikolaos Poulis
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
| | - Polina Zaytseva
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
| | - Eric K. N. Gähwiler
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
| | - Sarah E. Motta
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
- Wyss Translational Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
| | | | - Nikola Cesarovic
- Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology in Zurich, Zurich, Switzerland
| | - Volkmar Falk
- Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology in Zurich, Zurich, Switzerland
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- German Center of Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| | - Simon P. Hoerstrup
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
- Wyss Translational Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Maximilian Y. Emmert
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
- Wyss Translational Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
- Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
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Next-generation tissue-engineered heart valves with repair, remodelling and regeneration capacity. Nat Rev Cardiol 2020; 18:92-116. [PMID: 32908285 DOI: 10.1038/s41569-020-0422-8] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/09/2020] [Indexed: 02/06/2023]
Abstract
Valvular heart disease is a major cause of morbidity and mortality worldwide. Surgical valve repair or replacement has been the standard of care for patients with valvular heart disease for many decades, but transcatheter heart valve therapy has revolutionized the field in the past 15 years. However, despite the tremendous technical evolution of transcatheter heart valves, to date, the clinically available heart valve prostheses for surgical and transcatheter replacement have considerable limitations. The design of next-generation tissue-engineered heart valves (TEHVs) with repair, remodelling and regenerative capacity can address these limitations, and TEHVs could become a promising therapeutic alternative for patients with valvular disease. In this Review, we present a comprehensive overview of current clinically adopted heart valve replacement options, with a focus on transcatheter prostheses. We discuss the various concepts of heart valve tissue engineering underlying the design of next-generation TEHVs, focusing on off-the-shelf technologies. We also summarize the latest preclinical and clinical evidence for the use of these TEHVs and describe the current scientific, regulatory and clinical challenges associated with the safe and broad clinical translation of this technology.
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Gaggi G, Di Credico A, Izzicupo P, Sancilio S, Di Mauro M, Iannetti G, Dolci S, Amabile G, Di Baldassarre A, Ghinassi B. Decellularized Extracellular Matrices and Cardiac Differentiation: Study on Human Amniotic Fluid-Stem Cells. Int J Mol Sci 2020; 21:E6317. [PMID: 32878275 PMCID: PMC7504221 DOI: 10.3390/ijms21176317] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/28/2020] [Accepted: 08/28/2020] [Indexed: 02/07/2023] Open
Abstract
Cell therapy with a variety of stem populations is increasingly being investigated as a promising regenerative strategy for cardiovascular (CV) diseases. Their combination with adequate scaffolds represents an improved therapeutic approach. Recently, several biomaterials were investigated as scaffolds for CV tissue repair, with decellularized extracellular matrices (dECMs) arousing increasing interest for cardiac tissue engineering applications. The aim of this study was to analyze whether dECMs support the cardiac differentiation of CardiopoieticAF stem cells. These perinatal stem cells, which can be easily isolated without ethical or safety limitations, display a high cardiac differentiative potential. Differentiation was previously achieved by culturing them on Matrigel, but this 3D scaffold is not transplantable. The identification of a new transplantable scaffold able to support CardiopoieticAF stem cell cardiac differentiation is pivotal prior to encouraging translation of in vitro studies in animal model preclinical investigations. Our data demonstrated that decellularized extracellular matrices already used in cardiac surgery (the porcine CorTMPATCH and the equine MatrixPatchTM) can efficiently support the proliferation and cardiac differentiation of CardiopoieticAF stem cells and represent a useful cellular scaffold to be transplanted with stem cells in animal hosts.
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Affiliation(s)
- Giulia Gaggi
- Haman Anatomy and Cell Differentiation Lab, Department of Medicine and Aging Sciences, University “G.d’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy; (G.G.); (A.D.C.); (P.I.); (S.S.); (A.D.B.)
| | - Andrea Di Credico
- Haman Anatomy and Cell Differentiation Lab, Department of Medicine and Aging Sciences, University “G.d’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy; (G.G.); (A.D.C.); (P.I.); (S.S.); (A.D.B.)
| | - Pascal Izzicupo
- Haman Anatomy and Cell Differentiation Lab, Department of Medicine and Aging Sciences, University “G.d’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy; (G.G.); (A.D.C.); (P.I.); (S.S.); (A.D.B.)
| | - Silvia Sancilio
- Haman Anatomy and Cell Differentiation Lab, Department of Medicine and Aging Sciences, University “G.d’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy; (G.G.); (A.D.C.); (P.I.); (S.S.); (A.D.B.)
| | - Michele Di Mauro
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), 6202 Maastricht, The Netherlands;
| | | | - Susanna Dolci
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | | | - Angela Di Baldassarre
- Haman Anatomy and Cell Differentiation Lab, Department of Medicine and Aging Sciences, University “G.d’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy; (G.G.); (A.D.C.); (P.I.); (S.S.); (A.D.B.)
| | - Barbara Ghinassi
- Haman Anatomy and Cell Differentiation Lab, Department of Medicine and Aging Sciences, University “G.d’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy; (G.G.); (A.D.C.); (P.I.); (S.S.); (A.D.B.)
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Baird CW, Cooney B, Chávez M, Sleeper LA, Marx GR, Del Nido PJ. Congenital aortic and truncal valve reconstruction using the Ozaki technique: Short-term clinical results. J Thorac Cardiovasc Surg 2020; 161:1567-1577. [PMID: 33612305 DOI: 10.1016/j.jtcvs.2020.01.087] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 12/30/2019] [Accepted: 01/01/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Aortic valve reconstruction (AVRec) with neocuspidization or the Ozaki procedure with complete cusp replacement for aortic valve disease has excellent mid-term results in adults. Limited results of AVRec in pediatric patients have been reported. We report our early outcomes of the Ozaki procedure for congenital aortic and truncal valve disease. METHODS A retrospective analysis was performed on all 57 patients with congenital aortic and truncal valve disease who had a 3-leaflet Ozaki procedure at a single institution from August 2015 to February 2019. Outcome measures included mortality, surgical or catheter-based reinterventions, and echocardiographic measurements. RESULTS Twenty-four patients had aortic regurgitation (AR), 6 had aortic stenosis (AS), and 27 patients had AS/AR. Two patients had quadricuspid valves, 26 had tricuspid, 20 had bicuspid, and 9 had unicusp aortic valves. Four patients had truncus arteriosus. Thirty-four patients had previous aortic valve repairs and 5 had replacements. Preoperative echocardiography mean annular diameter was 20.90 ± 4.98 cm and peak gradient for patients with AS/AR was 53.62 ± 22.20 mm Hg. Autologous, Photofix, and CardioCel bovine pericardia were used in 20, 35, and 2 patients. Eight patients required aortic root enlargement and 20 had sinus enlargement. Fifty-one patients had concomitant procedures. Median intensive care unit and hospital length of stay were 1.87 and 6.38 days. There were no hospital mortalities or early conversions to valve replacement. At discharge, 98% of patients had mild or less regurgitation and peak aortic gradient was 16.9 ± 9.5 mm Hg. Two patients underwent aortic valve replacement. At median follow-up of 8.1 months, 96% and 91% of patients had less than moderate regurgitation and stenosis, respectively. CONCLUSIONS The AVRec procedure has acceptable short-term results and should be considered for valve reconstruction in pediatric patients with congenital aortic and truncal valve disease. Longer-term follow-up is necessary to determine the optimal patch material and late valve function and continued annular growth.
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Affiliation(s)
- Christopher W Baird
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston Children's Hospital, Boston, Mass.
| | - Brenda Cooney
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass
| | - Mariana Chávez
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass
| | - Lynn A Sleeper
- Harvard Medical School, Boston Children's Hospital, Boston, Mass; Department of Cardiology, Boston Children's Hospital, Boston, Mass
| | - Gerald R Marx
- Harvard Medical School, Boston Children's Hospital, Boston, Mass; Department of Cardiology, Boston Children's Hospital, Boston, Mass
| | - Pedro J Del Nido
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston Children's Hospital, Boston, Mass
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Alvino VV, Kilcooley M, Thomas AC, Carrabba M, Fagnano M, Cathery W, Avolio E, Iacobazzi D, Ghorbel M, Caputo M, Madeddu P. In Vitro and In Vivo Preclinical Testing of Pericyte-Engineered Grafts for the Correction of Congenital Heart Defects. J Am Heart Assoc 2020; 9:e014214. [PMID: 32067581 PMCID: PMC7070228 DOI: 10.1161/jaha.119.014214] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background We have previously reported the possibility of using pericytes from leftovers of palliative surgery of congenital heart disease to engineer clinically certified prosthetic grafts. Methods and Results Here, we assessed the feasibility of using prosthetic conduits engineered with neonatal swine pericytes to reconstruct the pulmonary artery of 9‐week‐old piglets. Human and swine cardiac pericytes were similar regarding anatomical localization in the heart and antigenic profile following isolation and culture expansion. Like human pericytes, the swine surrogates form clones after single‐cell sorting, secrete angiogenic factors, and extracellular matrix proteins and support endothelial cell migration and network formation in vitro. Swine pericytes seeded or unseeded (control) CorMatrix conduits were cultured under static conditions for 5 days, then they were shaped into conduits and incubated in a flow bioreactor for 1 or 2 weeks. Immunohistological studies showed the viability and integration of pericytes in the outer layer of the conduit. Mechanical tests documented a reduction in stiffness and an increase in strain at maximum load in seeded conduits in comparison with unseeded conduits. Control and pericyte‐engineered conduits were then used to replace the left pulmonary artery of piglets. After 4 months, anatomical and functional integration of the grafts was confirmed using Doppler echography, cardiac magnetic resonance imaging, and histology. Conclusions These findings demonstrate the feasibility of using neonatal cardiac pericytes for reconstruction of small‐size branch pulmonary arteries in a large animal model.
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Affiliation(s)
- Valeria Vincenza Alvino
- Bristol Heart Institute Translational Health Sciences University of Bristol Bristol Royal Infirmary Bristol United Kingdom
| | - Michael Kilcooley
- Bristol Heart Institute Translational Health Sciences University of Bristol Bristol Royal Infirmary Bristol United Kingdom
| | - Anita C Thomas
- Bristol Heart Institute Translational Health Sciences University of Bristol Bristol Royal Infirmary Bristol United Kingdom
| | - Michele Carrabba
- Bristol Heart Institute Translational Health Sciences University of Bristol Bristol Royal Infirmary Bristol United Kingdom
| | - Marco Fagnano
- Bristol Heart Institute Translational Health Sciences University of Bristol Bristol Royal Infirmary Bristol United Kingdom
| | - William Cathery
- Bristol Heart Institute Translational Health Sciences University of Bristol Bristol Royal Infirmary Bristol United Kingdom
| | - Elisa Avolio
- Bristol Heart Institute Translational Health Sciences University of Bristol Bristol Royal Infirmary Bristol United Kingdom
| | - Dominga Iacobazzi
- Bristol Heart Institute Translational Health Sciences University of Bristol Bristol Royal Infirmary Bristol United Kingdom
| | - Mohamed Ghorbel
- Bristol Heart Institute Translational Health Sciences University of Bristol Bristol Royal Infirmary Bristol United Kingdom
| | - Massimo Caputo
- Bristol Heart Institute Translational Health Sciences University of Bristol Bristol Royal Infirmary Bristol United Kingdom
| | - Paolo Madeddu
- Bristol Heart Institute Translational Health Sciences University of Bristol Bristol Royal Infirmary Bristol United Kingdom
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Acute In Vivo Functional Assessment of a Biodegradable Stentless Elastomeric Tricuspid Valve. J Cardiovasc Transl Res 2020; 13:796-805. [DOI: 10.1007/s12265-020-09960-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/21/2020] [Indexed: 02/07/2023]
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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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van Rijswijk JW, Talacua H, Mulder K, van Hout GPJ, Bouten CVC, Gründeman PF, Kluin J. Failure of decellularized porcine small intestinal submucosa as a heart valved conduit. J Thorac Cardiovasc Surg 2020; 160:e201-e215. [PMID: 32151387 DOI: 10.1016/j.jtcvs.2019.09.164] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 09/08/2019] [Accepted: 09/23/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Decellularized extracellular matrix made from porcine small intestinal submucosa, commercially available as CorMatrix (CorMatrix Cardiovascular, Inc, Roswell, Ga) is used off-label to reconstruct heart valves. Recently, surgeons experienced failures and words of caution were raised. The aim of this study was to evaluate decellularized porcine small intestinal submucosa as right-sided heart valved conduit in a xenogeneic animal model. METHODS A pulmonary valve replacement was performed with custom-made valved conduits in 10 lambs and 10 sheep (1 month [3 lambs and 3 sheep], 3 months [3 lambs and 3 sheep], 6 months [4 lambs and 4 sheep]). Valve function was assessed after implantation and before the animal was put to death. Explanted conduits were inspected macroscopically and analyzed using immunohistochemistry and scanning electron microscopy. They also underwent mechanical testing and testing for biochemical composition. RESULTS All valved conduits were successfully implanted. Five sheep and 2 lambs died due to congestive heart failure within 2 months after surgery. In the animals that died, the valve leaflets were thickened with signs of inflammation (endocarditis in 4). Five sheep and 8 lambs (1 month: 6 out of 6 animals, 3 months: 4 out of 6 animals, 6 months: 3 out of 8 animals) survived planned follow-up. At the time they were put to death, 5 lambs had significant pulmonary stenosis and 1 sheep showed severe regurgitation. A well-functioning valve was seen in 4 sheep and 3 lambs for up to 3 months. These leaflets showed limited signs of remodeling. CONCLUSIONS Fifty percent of sheep and 20% of lambs died due to valve failure before the planned follow-up period was complete. A well-functioning valve was seen in 35% of animals, albeit with limited signs of tissue remodeling at ≤3 months after implantation. Further analysis is needed to understand the disturbing dichotomous outcome before clinical application can be advised.
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Affiliation(s)
- Jan Willem van Rijswijk
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hanna Talacua
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Khadija Mulder
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Gerardus P J van Hout
- Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Carlijn V C Bouten
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Paul F Gründeman
- Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Formica F, Hsia TY. Commentary: "CorMatrix: If it is too good to be true, …". J Thorac Cardiovasc Surg 2019; 160:e222-e223. [PMID: 31870552 DOI: 10.1016/j.jtcvs.2019.11.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 11/12/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Francesco Formica
- Cardiac Surgery Unit, San Gerardo Hospital, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
| | - Tain-Yen Hsia
- Pediatric Cardiac Surgery, Yale New Haven Children's Hospital, New Haven, Conn
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Rao S, Stewart RD, Pettersson G, Tan C, Golz S, Komarlu R. Failure of Cellularization of Ventriculotomy Patch Leading to Right Ventricular Pseudoaneurysm. World J Pediatr Congenit Heart Surg 2019; 11:123-126. [PMID: 31755355 DOI: 10.1177/2150135119880547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Enlargement of the bulboventricular foramen (BVF) in double-inlet left ventricle or the ventricular septal defect (VSD) in tricuspid atresia with transposition of the great arteries is one approach for prevention or treatment of systemic ventricular outflow obstruction. Most often, BVF/VSD restriction is bypassed preemptively or addressed directly at the time of Glenn/Fontan procedures as part of staged univentricular palliation. We describe a patient who underwent enlargement of a restrictive VSD during Fontan completion and subsequently presented with an asymptomatic pseudoaneurysm of the right ventricle at the ventriculotomy site.
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Affiliation(s)
- Sruti Rao
- Department of Pediatric Cardiology, Nemours Cardiac Center, AI. DuPont Hospital for Children, Wilmington, DE, USA.,Department of Pediatric Cardiology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Robert D Stewart
- Department of Cardiothoracic Surgery, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Gosta Pettersson
- Department of Cardiothoracic Surgery, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Carmela Tan
- Department of Pathology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Suzanne Golz
- Department of Pediatric Cardiology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Rukmini Komarlu
- Department of Pediatric Cardiology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
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Liakopoulos OJ. Commentary: Extracellular matrix tube graft in the mitral position: It's feasible, but is it durable? J Thorac Cardiovasc Surg 2019; 160:113-114. [PMID: 31627950 DOI: 10.1016/j.jtcvs.2019.08.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 08/27/2019] [Accepted: 08/27/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Oliver J Liakopoulos
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany.
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40
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Albertario A, Swim MM, Ahmed EM, Iacobazzi D, Yeong M, Madeddu P, Ghorbel MT, Caputo M. Successful Reconstruction of the Right Ventricular Outflow Tract by Implantation of Thymus Stem Cell Engineered Graft in Growing Swine. JACC Basic Transl Sci 2019; 4:364-384. [PMID: 31312760 PMCID: PMC6609916 DOI: 10.1016/j.jacbts.2019.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/29/2019] [Accepted: 02/02/2019] [Indexed: 11/29/2022]
Abstract
T-MSCs were isolated from the thymus gland of new born pigs, expanded, characterized and seeded onto a commercially available scaffold. The seeded-grafts were cultured within a bioreactor and then used to reconstruct the RVOT of a growing swine model. Pigs were followed up for 4.5 months; then scanned with a cardiac magnetic resonance and terminated to harvest the implants. By comparing the outcome of the seeded-grafts to the unseeded-ones used as control, we observed a reduced fibrosis and an improved RVOT strain, cardiac remodeling and endothelialization.
Graft cellularization holds great promise in overcoming the limitations associated with prosthetic materials currently used in corrective cardiac surgery. In this study, the authors evaluated the advantages of graft cellularization for right ventricular outflow tract reconstruction in a novel porcine model. After 4.5 months from implantation, improved myocardial strain, better endothelialization and cardiomyocyte incorporation, and reduced fibrosis were observed in the cellularized grafts compared with the acellular grafts. To the authors’ knowledge, this is the first demonstration of successful right ventricular outflow tract correction using bioengineered grafts in a large animal model.
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Key Words
- CM, cardiomyocyte
- Cx-43, connexin-43
- DMEM, Dulbecco’s modified Eagle’s medium
- EC, endothelial cell
- FBS, fetal bovine serum
- IL, interleukin
- IsoB4, isolectin B4
- MSC, mesenchymal stem cell
- PBS, phosphate-buffered saline
- PS, penicillin/streptomycin
- RT, room temperature
- RV, right ventricular
- RVOT, right ventricular outflow tract
- RVOT-MS, fractional area of change in the right ventricular outflow tract
- SIS-ECM, small intestinal submucosa–derived extracellular matrix
- T-MSC, thymus-derived mesenchymal stem cell
- VMSC, vascular smooth muscle cell
- cMYH, cardiac myosin heavy chain
- congenital heart disease
- reconstruction
- right ventricular outflow swine model
- tissue engineering
- tract stem cells
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Affiliation(s)
- Ambra Albertario
- University of Bristol, Bristol Heart Institute, Bristol, United Kingdom
| | - Megan M Swim
- University of Bristol, Bristol Heart Institute, Bristol, United Kingdom
| | | | - Dominga Iacobazzi
- University of Bristol, Bristol Heart Institute, Bristol, United Kingdom
| | - Michael Yeong
- University of Bristol, Bristol Heart Institute, Bristol, United Kingdom
| | - Paolo Madeddu
- University of Bristol, Bristol Heart Institute, Bristol, United Kingdom
| | - Mohamed T Ghorbel
- University of Bristol, Bristol Heart Institute, Bristol, United Kingdom
| | - Massimo Caputo
- University of Bristol, Bristol Heart Institute, Bristol, United Kingdom
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41
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Tomdio AN, Moey MYY, Siddiqui I, Movahed A. Dehiscence and embolization of CorMatrix tricuspid valve replacement in the setting of infective endocarditis: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 2:yty086. [PMID: 31020163 PMCID: PMC6177076 DOI: 10.1093/ehjcr/yty086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 07/05/2018] [Indexed: 11/22/2022]
Abstract
Background Due to increased morbidity and mortality, prosthetic valve infective endocarditis (IE) with dehiscence requires urgent intervention. Early identification and therapy may prevent embolization. Case summary A 27-year-old Caucasian woman with a history of hepatitis C, intravenous drug abuse, and tricuspid valve (TV) replacement was admitted for recurrent IE. She was found to have bacteraemia and fungaemia, and empiric antibiotics were initiated. Transthoracic echocardiogram (TTE) revealed a mobile ‘mass’ on the TV and dehiscence. The patient developed cardiogenic shock and repeat TTE showed a ruptured TV and absence of the ‘mass’, suspicious of embolization. She underwent emergent surgery with TV replacement using a Biocor valve and retrieval of the old CorMatrix valve found in the right mid pulmonary artery (PA). The patient was successfully weaned off inotropic agents and completed a prolonged course of antibiotics and anti-fungals. Discussion The multi-disciplinary decision on timing of surgical intervention was challenging, especially due to ongoing mycobacterial infection that increased operative risk. With clinical deterioration, urgent surgery was performed revealing an embolized prosthetic valve in the PA. New surgical options for TV replacement in IE with extracellular-based material have shown promising outcomes with little reported data of long term complications. This case demonstrates a rare occurrence of embolized CorMatrix TV and highlights the challenge in timing of appropriate surgical intervention in a septic patient with thrombocytopenia.
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Affiliation(s)
- Anna N Tomdio
- Department of Internal Medicine, Vidant Medical Center/East Carolina University, Greenville, NC, USA
| | - Melissa Y Y Moey
- Department of Internal Medicine, Vidant Medical Center/East Carolina University, Greenville, NC, USA
| | - Irfan Siddiqui
- Department of Cardiology, Vidant Medical Center/East Carolina University, Greenville, NC, USA
| | - Assad Movahed
- Department of Cardiology, Vidant Medical Center/East Carolina University, Greenville, NC, USA
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Pattar SS, Fatehi Hassanabad A, Fedak PWM. Acellular Extracellular Matrix Bioscaffolds for Cardiac Repair and Regeneration. Front Cell Dev Biol 2019; 7:63. [PMID: 31080800 PMCID: PMC6497812 DOI: 10.3389/fcell.2019.00063] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 04/08/2019] [Indexed: 12/19/2022] Open
Abstract
Heart failure is a progressive deterioration of cardiac pump function over time and is often a manifestation of ischemic injury caused by myocardial infarction (MI). Post-MI, structural remodeling of the infarcted myocardium ensues. Dysregulation of extracellular matrix (ECM) homeostasis is a hallmark of structural cardiac remodeling and is largely driven by cardiac fibroblast activation. While initially adaptive, structural cardiac remodeling leads to irreversible heart failure due to the progressive loss of cardiac function. Loss of pump function is associated with myocardial fibrosis, wall thinning, and left ventricular (LV) dilatation. Surgical revascularization of the damaged myocardium via coronary artery bypass graft (CABG) surgery and/or percutaneous coronary intervention (PCI) can enhance myocardial perfusion and is beneficial. However, these interventions alone are unable to prevent progressive fibrotic remodeling and loss of heart function that leads to clinical end-stage heart failure. Acellular biologic ECM scaffolds can be surgically implanted onto injured myocardial regions during open-heart surgery as an adjunct therapy to surgical revascularization. This presents a novel therapeutic approach to alter maladaptive remodeling and promote functional recovery. Acellular ECM bioscaffolds have been shown to provide passive structural support to the damaged myocardium and also to act as a dynamic bioactive reservoir capable of promoting endogenous mechanisms of tissue repair, such as vasculogenesis. The composition and structure of xenogenic acellular ECM bioscaffolds are determined by the physiological requirements of the tissue from which they are derived. The capacity of different tissue-derived acellular bioscaffolds to attenuate cardiac remodeling and restore ECM homeostasis after injury may depend on such properties. Accordingly, the search and discovery of an optimal ECM bioscaffold for use in cardiac repair is warranted and may be facilitated by comparing bioscaffolds. This review will provide a summary of the acellular ECM bioscaffolds currently available for use in cardiac surgery with a focus on how they attenuate cardiac remodeling by providing the necessary environmental cues to promote endogenous mechanisms of tissue repair.
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Affiliation(s)
- Simranjit S Pattar
- Section of Cardiac Surgery, Department of Cardiac Science, Cumming School of Medicine, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Science, Cumming School of Medicine, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Paul W M Fedak
- Section of Cardiac Surgery, Department of Cardiac Science, Cumming School of Medicine, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
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Leskovar B, Furlan T, Poznic S, Hrastelj M, Adamlje A. Using CorMatrix for partial and complete (re)construction of arteriovenous fistulas in haemodialysis patients: (Re)construction of arteriovenous fistulas with CorMatrix. J Vasc Access 2019; 20:597-603. [PMID: 30722717 DOI: 10.1177/1129729819826032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION CorMatrix is an acellular extracellular matrix that acts as a biological scaffold and remodels into site-specific tissue. We used it for the (re)construction of arteriovenous fistulas. METHODS In this prospective pilot case study, we used CorMatrix in six patients. We included patients who required vascular access reconstruction due to thrombosis of unsalvageable arteriovenous fistulas, patients with high-flow arteriovenous fistulas and patients with microvasculature in which autologous arteriovenous fistulas did not mature, requiring reconstruction with a graft. We sutured the CorMatrix plate into a tubular shape and then constructed arterial and venous anastomoses. RESULTS There were no periprocedural complications, CorMatrix-related infections, bleeding or limb swelling after the procedures. CorMatrix was first punctured after 8-10 weeks. In five patients, a percutaneous angioplasty due to CorMatrix stenosis was performed; in one patient, a stent was placed due to refractory stenosis. We observed eight thromboses during the observation period (four in one patient). Perianastomotic stenosis of CorMatrix and interdialytic hypotension were the causes of the thrombosis in five patients, cephalic arch stenosis in two patients and thromboembolism to the brachial artery and arteriovenous fistula in one patient. Thrombendarteriectomy was successful in 87.5% of patients, and one patient required arteriovenous fistula reconstruction. After a median observation period of 12.5 (range 4-23) months, all arteriovenous fistulas were patent, with a median brachial artery flow of 1450 (range 700-1700) mL/min. CONCLUSION Arteriovenous fistula (re)construction with CorMatrix seems to be feasible and safe, with a relatively high incidence of neointimal hyperplasia, predominantly at venous anastomoses, but additional clinical studies are needed.
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Affiliation(s)
- Bostjan Leskovar
- Department of Internal Medicine, Trbovlje General Hospital, Trbovlje, Slovenia
| | - Tjasa Furlan
- Department of Internal Medicine, Trbovlje General Hospital, Trbovlje, Slovenia
| | - Simona Poznic
- Department of Internal Medicine, Trbovlje General Hospital, Trbovlje, Slovenia
| | - Miran Hrastelj
- Department of Surgery, Trbovlje General Hospital, Trbovlje, Slovenia
| | - Anton Adamlje
- Department of Haemodialysis, Trbovlje General Hospital, Trbovlje, Slovenia
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Evaluation of cellular ingrowth within porcine extracellular matrix scaffolding in congenital heart disease surgery. Cardiovasc Pathol 2018; 39:54-60. [PMID: 30660869 DOI: 10.1016/j.carpath.2018.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/07/2018] [Accepted: 12/11/2018] [Indexed: 11/22/2022] Open
Abstract
The search for an ideal material for cardiac tissue repair has led to utilization of porcine small intestinal submucosa extracellular matrix (CorMatrix). Here, we examine the histologic features of CorMatrix and the associated cellular growth at a variety of time intervals. Tissues with CorMatrix from ten patients (4 male, 6 female) with ages ranging from 2 weeks to 2 years, and implant duration ranging from 1 week to 2 years were included in this study. Samples for analysis were collected at autopsy. Surgical repair sites included great vessel repair (n=9), atrial septum defect (n=1), coronary vessels (n=1), as well as aortic (n=1) and mitral valve (n=2) leaflets. In all specimens, CorMatrix was composed of dense laminated regions of collagen, without appreciable elastin staining. In most grafts, especially those implanted for extended periods of time, tissue with luminal CD31 positivity covered the intimal surface of the CorMatrix graft. This tissue (neo-intima) consisted of spindled myofibroblasts (SMA) and small CD31 positive vessels with occasional mononuclear cells in a matrix composed of collagen, glycosaminoglycans, and rarely elastin, after extended periods of implantation. These features were readily identified in patients as early as 1 month after CorMatrix implantation. The matrix comprising the CorMatrix itself remained largely acellular, despite implantation times up to 2 years, with degradation of the graft material. We provide a framework for histologic expectations when evaluating explanted CorMatrix grafts. In this regard, the CorMatrix matrix is likely to remain acellular without significant elastin deposition, whereas the intimal and adventitial surfaces become coated by proliferating cells in a novel matrix of collagen and glycosaminoglycans.
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45
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Reinventing the Saphenous Vein: Reconstructing the Anterior Mitral Leaflet With a Saphenous Vein. Ann Thorac Surg 2018; 107:e287-e289. [PMID: 30513313 DOI: 10.1016/j.athoracsur.2018.10.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/02/2018] [Accepted: 10/21/2018] [Indexed: 11/22/2022]
Abstract
Mitral valve repair can sometimes require leaflet augmentation or a patch repair of a defect in the leaflet. No ideal patch material is currently available that can grow and adapt to the mitral leaflet. This report describes a new technique using autologous saphenous vein as patch material. The saphenous vein is untreated, living tissue and remains flexible as a patch or leaflet augmentation for up to 3 years on echocardiography.
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46
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Nguyen KH. Invited Commentary. Ann Thorac Surg 2018; 106:1852-1853. [PMID: 30107142 DOI: 10.1016/j.athoracsur.2018.06.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 06/26/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Khanh H Nguyen
- Department of Surgery, Maria Fareri Children's Hospital, Westchester Medical Center, 100 Woods Rd, Rm C2235, Valhalla, NY 10595.
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47
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Porcine Small Intestinal Submucosa May Be a Suitable Material for Norwood Arch Reconstruction. Ann Thorac Surg 2018; 106:1847-1852. [PMID: 30055141 DOI: 10.1016/j.athoracsur.2018.06.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 05/31/2018] [Accepted: 06/07/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Norwood palliation typically requires patch augmentation of the ascending aorta and aortic arch. Patients having undergone Norwood palliation are at risk of recurrent arch obstruction, the risk of which may be affected by the type of patch material used at the time of Norwood palliation. We sought to determine the freedom from neoaortic arch reintervention and overall survival in patients who underwent Norwood palliation utilizing porcine small intestinal submucosa (PSIS) as the patch material. METHODS Retrospective chart review was performed to identify patients who underwent a Norwood operation utilizing PSIS material at our institution. Cardiac diagnosis, age at surgery, shunt type, need for reintervention, and outcome (survival, transplant, and death) were evaluated. RESULTS Forty-four patients had PSIS material utilized for arch reconstruction at the time of Norwood palliation. There were only five neoaortic arch reinterventions in 4 patients (11.4%). An additional 10 reinterventions, unrelated to the PSIS patch, were performed, including five shunt revisions and five branch pulmonary artery interventions. There were 3 deaths, and 5 patients underwent transplantation. Median follow-up was 387.5 days (range, 4 to 1,513). CONCLUSIONS Freedom from neoaortic arch reintervention and survival after Norwood palliation with PSIS patch material is promising. The PSIS appears noninferior and may be an appropriate tissue choice for Norwood palliation. Studies with longer follow-up are needed to determine the rate of neoaortic reintervention over time.
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48
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Bouten CVC, Smits AIPM, Baaijens FPT. Can We Grow Valves Inside the Heart? Perspective on Material-based In Situ Heart Valve Tissue Engineering. Front Cardiovasc Med 2018; 5:54. [PMID: 29896481 PMCID: PMC5987128 DOI: 10.3389/fcvm.2018.00054] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/09/2018] [Indexed: 12/14/2022] Open
Abstract
In situ heart valve tissue engineering using cell-free synthetic, biodegradable scaffolds is under development as a clinically attractive approach to create living valves right inside the heart of a patient. In this approach, a valve-shaped porous scaffold "implant" is rapidly populated by endogenous cells that initiate neo-tissue formation in pace with scaffold degradation. While this may constitute a cost-effective procedure, compatible with regulatory and clinical standards worldwide, the new technology heavily relies on the development of advanced biomaterials, the processing thereof into (minimally invasive deliverable) scaffolds, and the interaction of such materials with endogenous cells and neo-tissue under hemodynamic conditions. Despite the first positive preclinical results and the initiation of a small-scale clinical trial by commercial parties, in situ tissue formation is not well understood. In addition, it remains to be determined whether the resulting neo-tissue can grow with the body and preserves functional homeostasis throughout life. More important yet, it is still unknown if and how in situ tissue formation can be controlled under conditions of genetic or acquired disease. Here, we discuss the recent advances of material-based in situ heart valve tissue engineering and highlight the most critical issues that remain before clinical application can be expected. We argue that a combination of basic science - unveiling the mechanisms of the human body to respond to the implanted biomaterial under (patho)physiological conditions - and technological advancements - relating to the development of next generation materials and the prediction of in situ tissue growth and adaptation - is essential to take the next step towards a realistic and rewarding translation of in situ heart valve tissue engineering.
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Affiliation(s)
- Carlijn V. C. Bouten
- Soft Tissue Engineering and Mechanobiology, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, Netherlands
| | - Anthal I. P. M. Smits
- Soft Tissue Engineering and Mechanobiology, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, Netherlands
| | - Frank P. T. Baaijens
- Soft Tissue Engineering and Mechanobiology, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, Netherlands
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van Steenberghe M, Schubert T, Bouzin C, Caravaggio C, Guiot Y, Xhema D, Gianello P. Enhanced Vascular Biocompatibility and Remodeling of Decellularized and Secured Xenogeneic/Allogeneic Matrices in a Porcine Model. Eur Surg Res 2018; 59:58-71. [PMID: 29621750 DOI: 10.1159/000487591] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 02/12/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND/PURPOSE Calcifications and absence of growth potential are the major drawbacks of glutaraldehyde-treated prosthesis. Decellularized and secured xeno-/allogeneic matrices were assessed in a preclinical porcine model for biocompatibility and vascular remodeling in comparison to glutaraldehyde-fixed bovine pericardium (GBP; control). METHODS Native human (fascia lata, pericardium) and porcine tissues (peritoneum) were used and treated. In vitro, biopsies were performed before and after treatment to assess decellularization (hematoxylin and eosin/DAPI). In vivo, each decellularized and control tissue sample was implanted subcutaneously in 4 mini-pigs. In addition, 9 mini-pigs received a patch or a tubularized prosthesis interposition on the carotid artery or abdominal aorta of decellularized (D) human fascia lata (DHFL; n = 4), human pericardium (DHP; n = 9), porcine peritoneum (DPPt; n = 7), and control tissue (GBP: n = 3). Arteries were harvested after 1 month and subcutaneous samples after 15-30 days. Tissues were processed for hematoxylin and eosin/von Kossa staining and immunohistochemistry for CD31, alpha-smooth muscle actin, CD3, and CD68. Histomorphometry was achieved by point counting. RESULTS A 95% decellularization was confirmed for DHP and DPPt, and to a lower degree for DHFL. In the subcutaneous protocol, CD3 infiltration was significantly higher at day 30 in GBP and DHFL, and CD68 infiltration was significantly higher for GBP (p < 0.05). In intravascular study, no deaths, aneurysms, or pseudoaneurysms were observed. Inflammatory reaction was significantly higher for DHFL and GBP (p < 0.05), while it was lower and comparable for DHP/DPPt. DHP and DPPt showed deeper recellularization, and a new arterial wall was characterized. CONCLUSIONS In a preclinical model, DPPt and DHP offered better results than conventional commercialized GBP for biocompatibility and vascular remodeling.
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Affiliation(s)
- Mathieu van Steenberghe
- Pôle de Chirurgie Expérimentale et Transplantation (CHEX), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, Université Catholique de Louvain, Brussels, Belgium
| | - Thomas Schubert
- Pôle de Chirurgie Expérimentale et Transplantation (CHEX), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, Université Catholique de Louvain, Brussels, Belgium.,Banque de Tissus, Unité de Thérapie Cellulaire et Tissulaire de L'Appareil Locomoteur, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Caroline Bouzin
- IREC Imaging Platform (2IP), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, Université Catholique de Louvain, Brussels, Belgium
| | - Carlo Caravaggio
- Service de Chirurgie Vasculaire, Site Notre-Dame, Centre Hospitalier de Wallonie Picarde (CHwapi), Tournai, Belgium
| | - Yves Guiot
- Service d'Anatomopathologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Daela Xhema
- Pôle de Chirurgie Expérimentale et Transplantation (CHEX), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, Université Catholique de Louvain, Brussels, Belgium
| | - Pierre Gianello
- Pôle de Chirurgie Expérimentale et Transplantation (CHEX), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, Université Catholique de Louvain, Brussels, Belgium
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50
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Gates KV, Griffiths LG. Chronic graft-specific cell-mediated immune response toward candidate xenogeneic biomaterial. Immunol Res 2018; 66:288-298. [PMID: 29446013 DOI: 10.1007/s12026-018-8985-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Despite rabbits becoming an increasingly popular animal model, a flow cytometry panel that combines T cell markers (CD3, CD4, CD8, CD25, FOXP3) with a method for monitoring proliferation is lacking in this species. It has been shown that the rabbit model can be used to identify xenoantigens within bovine pericardium (BP), a common biological heart valve replacement material; however, these methods rely on monitoring the humoral immune response. The development of a rabbit T cell proliferation assay has utility in monitoring graft-specific cell-mediated immune responses toward bovine pericardium. Isolation and culture conditions were optimized to avoid cell death, red blood cell contamination, and non-specific proliferation. Effect of cell culture and stimulation on distribution and intensity of T cell markers was analyzed and compared between cells isolated from naïve and BP-immunized rabbits. Submaximal levels (0.25 μg/mL) of concavalin A were used to stimulate proliferation toward BP extract, with resultant proliferation compared between naïve and BP-immunized rabbits. Density stratification followed by ammonium potassium chloride (ACK) lysis yielded the greatest number of viable peripheral blood mononuclear cells with the least amount of erythrocyte contamination. Flat-bottomed plates were necessary to reduce non-specific proliferation in culture. T cells responded appropriately to maximal mitogenic stimulation (5 μg/mL concavalin A). Interestingly, immunization increased the intensity of FOXP3 in T regulatory cells compared to cells from naïve animals. With addition of submaximal levels of concavalin A, T cells from immunized rabbits proliferated in response to BP protein extract, while cells from naïve rabbits did not. In immunized rabbits, not only did more CD4+ T cells proliferate in response to BP re-stimulation, but the intensity of CD25 was increased indicating cell activation. This research provides a functional cell-mediated screening assay for assessment of BP-based biomaterials in rabbits, overcoming the limitations of previous humoral immune system-based assessments of biomaterial antigenicity in this important experimental animal species.
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Affiliation(s)
- Katherine V Gates
- Department of Veterinary Medicine: Medicine and Epidemiology, University of California, Davis, One Shields Avenue, Davis, CA, 95616, USA.,Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Stabile 4-58, Rochester, MN, 55905, USA
| | - Leigh G Griffiths
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Stabile 4-58, Rochester, MN, 55905, USA.
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