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Biological Characterization of Human Autologous Pericardium Treated with the Ozaki Procedure for Aortic Valve Reconstruction. J Clin Med 2021; 10:jcm10173954. [PMID: 34501402 PMCID: PMC8432048 DOI: 10.3390/jcm10173954] [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: 07/20/2021] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 12/26/2022] Open
Abstract
Background: The Ozaki procedure is an innovative surgical technique aiming at reconstructing aortic valves with human autologous pericardium. Even if this procedure is widely used, a comprehensive biological characterization of the glutaraldehyde (GA)-fixed pericardial tissue is still missing. Methods: Morphological analysis was performed to assess the general organization of pericardium subjected to the Ozaki procedure (post-Ozaki) in comparison to native tissue (pre-Ozaki). The effect of GA treatment on cell viability and nuclear morphology was then investigated in whole biopsies and a cytotoxicity assay was executed to assess the biocompatibility of pericardium. Finally, human umbilical vein endothelial cells were seeded on post-Ozaki samples to evaluate the influence of GA in modulating the endothelialization ability in vitro and the production of pro-inflammatory mediators. Results: The Ozaki procedure alters the arrangement of collagen and elastic fibers in the extracellular matrix and results in a significant reduction in cell viability compared to native tissue. GA treatment, however, is not cytotoxic to murine fibroblasts as compared to a commercially available bovine pericardium membrane. In addition, in in vitro experiments of endothelial cell adhesion, no difference in the inflammatory mediators with respect to the commercial patch was found. Conclusions: The Ozaki procedure, despite alteration of ECM organization and cell devitalization, allows for the establishment of a noncytotoxic environment in which endothelial cell repopulation occurs.
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2
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Capella-Monsonís H, Zeugolis DI. Decellularized xenografts in regenerative medicine: From processing to clinical application. Xenotransplantation 2021; 28:e12683. [PMID: 33709410 DOI: 10.1111/xen.12683] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/28/2021] [Accepted: 02/25/2021] [Indexed: 12/13/2022]
Abstract
Decellularized xenografts are an inherent component of regenerative medicine. Their preserved structure, mechanical integrity and biofunctional composition have well established them in reparative medicine for a diverse range of clinical indications. Nonetheless, their performance is highly influenced by their source (ie species, age, tissue) and processing (ie decellularization, crosslinking, sterilization and preservation), which govern their final characteristics and determine their success or failure for a specific clinical target. In this review, we provide an overview of the different sources and processing methods used in decellularized xenografts fabrication and discuss their effect on the clinical performance of commercially available decellularized xenografts.
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Affiliation(s)
- Héctor Capella-Monsonís
- 1Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), Biomedical Sciences Building, National University of Ireland Galway (NUI Galway), Galway, Ireland.,Science Foundation Ireland (SFI) Centre for Research in Medical Devices (CÚRAM), Biomedical Sciences Building, National University of Ireland Galway (NUI Galway), Galway, Ireland
| | - Dimitrios I Zeugolis
- 1Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), Biomedical Sciences Building, National University of Ireland Galway (NUI Galway), Galway, Ireland.,Science Foundation Ireland (SFI) Centre for Research in Medical Devices (CÚRAM), Biomedical Sciences Building, National University of Ireland Galway (NUI Galway), Galway, Ireland.,Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
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3
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Fryer ML, Balsam LB. Commentary: Designing better broken hearts: Modeling regurgitant bicuspid aortic valve disease. J Thorac Cardiovasc Surg 2020; 163:e173-e174. [PMID: 32773119 DOI: 10.1016/j.jtcvs.2020.07.018] [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: 07/02/2020] [Revised: 07/02/2020] [Accepted: 07/02/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | - Leora B Balsam
- Division of Cardiac Surgery, UMass Memorial Medical Center, Worcester, Mass.
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4
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The utility of aortic valve leaflet reconstruction techniques in children and young adults. J Thorac Cardiovasc Surg 2020; 159:2369-2378. [DOI: 10.1016/j.jtcvs.2019.09.176] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/06/2019] [Accepted: 09/22/2019] [Indexed: 12/16/2022]
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5
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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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6
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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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7
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Marinho E, Carbonari RC, Malmonge SM, Leão CR. Mechanical behavior of bovine pericardium treated with hyaluronic acid derivative for bioprosthetic aortic valves. J Biomed Mater Res B Appl Biomater 2019; 107:2273-2280. [PMID: 30684295 DOI: 10.1002/jbm.b.34319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 12/04/2018] [Accepted: 12/19/2018] [Indexed: 11/07/2022]
Abstract
We studied the mechanical behavior of bovine pericardium (BP) after anticalcification treatment using hyaluronic acid (HA) derivative. To simulate the physiological environment and stimulate the calcification process, the BP samples were immersed into simulated body fluid solution. We conducted scanning electron microscopy with energy dispersive X-ray spectrometry, and uniaxial mechanical tests of HA-treated and non-treated samples. Although our microstructural analyses indicated that the HA treatment actually prevents the formation of calcium phosphate deposits, the mechanical tests show significant increase of stiffness of the HA-treated samples. Using data from our mechanical tests as input parameters, we performed finite element (FE) computer simulations to estimate how this increase in the BP stiffness affects the stress distribution in the bioprosthetic leaflet. Although the maximum stress observed during the closing phase of the membrane in vivo is below the experimental yield stress in all cases we analyzed, our FE results indicate that increase of BP stiffness due to HA anticalcification treatment results in higher risk of disruption and failure of the leaflets in bioprosthetic heart valves. Since our FE results indicate that the commissure and the fixed edge are the regions that withstand the highest mechanical stresses during the closing phase, new designs of the valve might be efficient to enhance the endurance of the prosthesis. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 2273-2280, 2019.
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Affiliation(s)
- Enesio Marinho
- Centro de Engenharia, Modelagem e Ciências Sociais Aplicadas, Universidade Federal do ABC, Avenida dos Estados, 5001, Santo André, São Paulo, 09210-580, Brazil
| | - Ronny Calixto Carbonari
- Centro de Engenharia, Modelagem e Ciências Sociais Aplicadas, Universidade Federal do ABC, Avenida dos Estados, 5001, Santo André, São Paulo, 09210-580, Brazil
| | - Sonia M Malmonge
- Centro de Engenharia, Modelagem e Ciências Sociais Aplicadas, Universidade Federal do ABC, Avenida dos Estados, 5001, Santo André, São Paulo, 09210-580, Brazil
| | - Cedric Rocha Leão
- Centro de Engenharia, Modelagem e Ciências Sociais Aplicadas, Universidade Federal do ABC, Avenida dos Estados, 5001, Santo André, São Paulo, 09210-580, Brazil
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8
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Abstract
PURPOSE OF REVIEW Recently, there has been a renewed interest with regard to surgical strategies for aortic valve preservation in the presence of isolated valve disease or concomitant aortic root disease, despite concerns having been raised about the mid/long-term durability of such repair techniques for the aortic valve. The aim of the present review is to analyze the currently available evidence about aortic valve repair strategies, for either bicuspid or tricuspid valves. RECENT FINDINGS An improved understanding of the surgical anatomy and functional analysis of the aortic valve and root has allowed a systematic classification for the mechanisms of aortic valve insufficiency. Similarly, the use of dedicated instruments and devices has led to improved outcomes in terms of not only long-term survival but also freedom from reoperation. SUMMARY Aortic valve repair, either as a stand-alone procedure or especially in combination with surgery of the root, is a well-tolerated and effective procedure with excellent outcomes at mid/long term. Recent efforts allowed the refinement of surgical techniques to develop a systematic approach to aortic valve repair, which implies a thorough understanding of the surgical anatomy, the functional causes of disease, and the available repair techniques along with their potential limitations. A specialized team including dedicated surgeons and cardiologists appears to be crucial to achieve durable and satisfactory outcomes following aortic valve repair.
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9
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Yang B, Kilari S, Brahmbhatt A, McCall DL, Torres EN, Leof EB, Mukhopadhyay D, Misra S. CorMatrix Wrapped Around the Adventitia of the Arteriovenous Fistula Outflow Vein Attenuates Venous Neointimal Hyperplasia. Sci Rep 2017; 7:14298. [PMID: 29085001 PMCID: PMC5662725 DOI: 10.1038/s41598-017-14696-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 10/17/2017] [Indexed: 11/28/2022] Open
Abstract
Venous neointimal hyperplasia (VNH) at the outflow vein of hemodialysis AVF is a major factor contributing to failure. CorMatrix is an extracellular matrix that has been used in cardiovascular procedures primarily as scaffolding during surgery. In the present study, we sought to determine whether CorMatrix wrapped around the outflow vein of arteriovenous fistula (AVF) at the time of creation could reduce VNH. In mice, the carotid artery to the ipsilateral jugular vein was connected to create an AVF, and CorMatrix scaffold was wrapped around the outflow vein compared to control mice that received no scaffolding. Immunohistochemistry, Western blot, and qRT-PCR were performed on the outflow vein at 7 and 21 days after AVF creation. In outflow veins treated with CorMatrix, there was an increase in the mean lumen vessel area with a decrease in the ratio of neointima area/media + adventitia area (P < 0.05). Furthermore, there was a significant increase in apoptosis, with a reduction in cell density and proliferation in the outflow veins treated with CorMatrix compared to controls (P < 0.05). Immunohistochemical analysis revealed a significant reduction in fibroblasts, myofibroblasts, macrophages, and leukocytes with a reduction in Tnf-α gene expression (P < 0.05). In conclusion, outflow veins treated with CorMatrix have reduced VNH.
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Affiliation(s)
- Binxia Yang
- Vascular and Interventional Radiology Translational Laboratory, Department of Radiology, Rochester, Minnesota, USA
| | - Sreenivasulu Kilari
- Vascular and Interventional Radiology Translational Laboratory, Department of Radiology, Rochester, Minnesota, USA
| | - Akshaar Brahmbhatt
- Vascular and Interventional Radiology Translational Laboratory, Department of Radiology, Rochester, Minnesota, USA
| | - Deborah L McCall
- Vascular and Interventional Radiology Translational Laboratory, Department of Radiology, Rochester, Minnesota, USA
| | - Evelyn Nieves Torres
- Vascular and Interventional Radiology Translational Laboratory, Department of Radiology, Rochester, Minnesota, USA
| | - Edward B Leof
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota, USA
| | - Debabrata Mukhopadhyay
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sanjay Misra
- Vascular and Interventional Radiology Translational Laboratory, Department of Radiology, Rochester, Minnesota, USA. .,Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota, USA.
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10
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Zuin M, Rigatelli G, Faggian G, Roncon L. Mathematics and Cardiovascular Interventions: Role of the Finite Element Modeling in Clinical Decision Making. JACC Cardiovasc Interv 2016; 9:507-8. [PMID: 26965944 DOI: 10.1016/j.jcin.2015.12.274] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 12/18/2015] [Accepted: 12/28/2015] [Indexed: 12/19/2022]
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11
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Labrosse MR, Jafar R, Ngu J, Boodhwani M. Planar biaxial testing of heart valve cusp replacement biomaterials: Experiments, theory and material constants. Acta Biomater 2016; 45:303-320. [PMID: 27570204 DOI: 10.1016/j.actbio.2016.08.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 07/22/2016] [Accepted: 08/19/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Aortic valve (AV) repair has become an attractive option to correct aortic insufficiency. Yet, cusp reconstruction with various cusp replacement materials has been associated with greater long-term repair failures, and it is still unknown how such materials mechanically compare with native leaflets. We used planar biaxial testing to characterize six clinically relevant cusp replacement materials, along with native porcine AV leaflets, to ascertain which materials would be best suited for valve repair. METHODS We tested at least six samples of: 1) fresh autologous porcine pericardium (APP), 2) glutaraldehyde fixed porcine pericardium (GPP), 3) St Jude Medical pericardial patch (SJM), 4) CardioCel patch (CC), 5) PeriGuard (PG), 6) Supple PeriGuard (SPG) and 7) fresh porcine AV leaflets (PC). We introduced efficient displacement-controlled testing protocols and processing, as well as advanced convexity requirements on the strain energy functions used to describe the mechanical response of the materials under loading. RESULTS The proposed experimental and data processing pipeline allowed for a robust in-plane characterization of all the materials tested, with constants determined for two Fung-like hyperelastic, anisotropic strain energy models. CONCLUSIONS Overall, CC and SPG (respectively PG) patches ranked as the closest mechanical equivalents to young (respectively aged) AV leaflets. Because the native leaflets as well as CC, PG and SPG patches exhibit significant anisotropic behaviors, it is suggested that the fiber and cross-fiber directions of these replacement biomaterials be matched with those of the host AV leaflets. STATEMENT OF SIGNIFICANCE The long-term performance of cusp replacement materials would ideally be evaluated in large animal models for AV disease and cusp repair, and over several months or more. Given the unavailability and impracticality of such models, detailed information on stress-strain behavior, as studied herein, and investigations of durability and valve dynamics will be the best surrogates, as they have been for prosthetic valves. Overall, comparison with Fig. 3 suggests that CC and SPG (respectively PG) patches may be the closest mechanical equivalents to young (respectively aged) AV leaflets. Interestingly, the thicknesses of these materials are close to those reported for porcine and younger human AV leaflets, which may facilitate surgical implantation, by contrast to the thinner APP which has poor handling qualities. Because the native leaflets as well as CC, PG and SPG patches exhibit anisotropic behaviors, from a mechanistic perspective alone, it stands to reason that cardiac surgeons should seek to intraoperatively match the fiber and cross-fiber directions of these replacement biomaterials with those of the repaired AV leaflets.
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Affiliation(s)
- Michel R Labrosse
- Department of Mechanical Engineering, University of Ottawa, 161 Louis Pasteur, Ottawa, Ontario K1N 6N5, Canada; Division of Cardiac Surgery, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada.
| | - Reza Jafar
- Department of Mechanical Engineering, University of Ottawa, 161 Louis Pasteur, Ottawa, Ontario K1N 6N5, Canada; Division of Cardiac Surgery, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada
| | - Janet Ngu
- Division of Cardiac Surgery, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada
| | - Munir Boodhwani
- Division of Cardiac Surgery, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada
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12
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Mosala Nezhad Z, Poncelet A, de Kerchove L, Gianello P, Fervaille C, El Khoury G. Small intestinal submucosa extracellular matrix (CorMatrix®) in cardiovascular surgery: a systematic review. Interact Cardiovasc Thorac Surg 2016; 22:839-50. [PMID: 26912574 DOI: 10.1093/icvts/ivw020] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 01/08/2016] [Indexed: 11/12/2022] Open
Abstract
Extracellular matrix (ECM) derived from small intestinal submucosa (SIS) is widely used in clinical applications as a scaffold for tissue repair. Recently, CorMatrix® porcine SIS-ECM (CorMatrix Cardiovascular, Inc., Roswell, GA, USA) has gained popularity for 'next-generation' cardiovascular tissue engineering due to its ease of use, remodelling properties, lack of immunogenicity, absorbability and potential to promote native tissue growth. Here, we provide an overview of the biology of porcine SIS-ECM and systematically review the preclinical and clinical literature on its use in cardiovascular surgery. CorMatrix® has been used in a variety of cardiovascular surgical applications, and since it is the most widely used SIS-ECM, this material is the focus of this review. Since CorMatrix® is a relatively new product for cardiovascular surgery, some clinical and preclinical studies published lack systematic reporting of functional and pathological findings in sufficient numbers of subjects. There are also emerging reports to suggest that, contrary to expectations, an undesirable inflammatory response may occur in CorMatrix® implants in humans and longer-term outcomes at particular sites, such as the heart valves, may be suboptimal. Large-scale clinical studies are needed driven by robust protocols that aim to quantify the pathological process of tissue repair.
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Affiliation(s)
- Zahra Mosala Nezhad
- Institute of Experimental and Clinical Research (IREC), Division of Cardiovascular Research (CARD), Université catholique de Louvain, Brussels, Belgium Department of Cardiovascular and Thoracic Surgery, Université catholique de Louvain, Saint-Luc University Hospital, Brussels, Belgium
| | - Alain Poncelet
- Institute of Experimental and Clinical Research (IREC), Division of Cardiovascular Research (CARD), Université catholique de Louvain, Brussels, Belgium Department of Cardiovascular and Thoracic Surgery, Université catholique de Louvain, Saint-Luc University Hospital, Brussels, Belgium
| | - Laurent de Kerchove
- Institute of Experimental and Clinical Research (IREC), Division of Cardiovascular Research (CARD), Université catholique de Louvain, Brussels, Belgium Department of Cardiovascular and Thoracic Surgery, Université catholique de Louvain, Saint-Luc University Hospital, Brussels, Belgium
| | - Pierre Gianello
- Institute of Experimental and Clinical Research (IREC), Division of Experimental Surgery and Transplantation (CHEX), Université catholique de Louvain, Brussels, Belgium
| | - Caroline Fervaille
- Laboratory of Anatomy Pathology, Université catholique de Louvain, Godinne University Hospital-CHU, Yvoir, Belgium
| | - Gebrine El Khoury
- Institute of Experimental and Clinical Research (IREC), Division of Cardiovascular Research (CARD), Université catholique de Louvain, Brussels, Belgium Department of Cardiovascular and Thoracic Surgery, Université catholique de Louvain, Saint-Luc University Hospital, Brussels, Belgium
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13
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Year in review: complex valve reconstruction. Curr Opin Cardiol 2016; 31:154-61. [PMID: 26814652 DOI: 10.1097/hco.0000000000000268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW In recent years, great emphasis has been placed on reconstructive techniques for the surgical management of heart valve disease. In this review, we discuss recent data and current practice as it pertains to the subject of reconstructive valve surgery. RECENT FINDINGS New techniques and an improved understanding of the mechanisms of aortic insufficiency have led to marked improvement in the early and late outcomes of aortic valve repair. While mitral valve repair is the established approach for the management of degenerative mitral valve disease, surgical technique continues to be refined, with valve reconstruction principles applied to increasingly challenging anatomy. Moreover, the introduction of novel biomaterials has allowed extension of the indication for valve reconstruction to circumstances of extensive tissue defect, including infective endocarditis. SUMMARY Valve reconstruction is increasingly being recognized as an alternative to valve replacement. It alleviates the risks of prosthesis-related complications and is especially appealing in young and middle-aged adults. While early and midterm outcomes appear promising, further studies are warranted to assess the clinical benefit and long-term durability of complex valve reconstruction procedures.
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14
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Regeer MV, Versteegh MI, Marsan NA, Bax JJ, Delgado V. The role of multimodality imaging in the selection of patients for aortic valve repair. Expert Rev Cardiovasc Ther 2015; 14:75-86. [DOI: 10.1586/14779072.2016.1109448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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15
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Al-Atassi T, Toeg HD, Jafar R, Sohmer B, Labrosse M, Boodhwani M. Impact of aortic annular geometry on aortic valve insufficiency: Insights from a preclinical, ex vivo, porcine model. J Thorac Cardiovasc Surg 2015. [PMID: 26215361 DOI: 10.1016/j.jtcvs.2015.06.060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We sought to create a model of aortic insufficiency in a left heart simulator combined with 3-dimensional echocardiography and finite element modeling of the aortic valve. We examined the effects of aortic root geometry alteration on aortic insufficiency. METHODS Porcine aortic roots were analyzed on a left heart simulator before (control, n = 8) and after intervention (n = 8). Intervention entailed 3 vertical incisions at the sinotubular junction with diamond-shaped patches incorporated into the defects to increase the sinotubular junction diameter. Hemodynamic parameters were assessed, including regurgitant volume and fraction. Video and echocardiography images evaluated aortic valve function, coaptation surface area, aortic insufficiency, and effective regurgitant orifice area. Finite element modeling corroborated relationships between root geometry and aortic insufficiency, and examined cusp stress. RESULTS The intervention resulted in a sinotubular junction diameter increase of 55% ± 4%. The sinotubular junction to ventriculo-aortic junction diameter ratio was significantly higher in the intervention group (1.89 ± 0.16 vs 1.47 ± 0.04, P = .02). Increased sinotubular junction diameter resulted in aortic insufficiency assessed by regurgitant volume (28 ± 7 mL vs 5 ± 2 mL, P = .004), regurgitant fraction (36% ± 5% vs 7% ± 1%, P < .001), and effective regurgitant orifice (15 ± 5 mm(2) vs 0 mm(2), P = .016). Intervention coaptation surface area was smaller (1.03 ± 0.11 cm(2) vs 1.80 ± 0.08 cm(2), P < .001). There was a linear correlation between increased sinotubular junction/ventriculo-aortic junction ratio and regurgitant fraction (R(2) = 0.65, P = .003). The finite element modeling demonstrated a similar relationship between increasing sinotubular junction diameter and aortic insufficiency severity, and between end-diastolic cusp stresses and sinotubular junction diameters (R(2) = 0.98, P < .001). CONCLUSIONS In this model, increasing sinotubular junction diameter is linearly related to reduced coaptation surface area and increasing aortic insufficiency severity. This model provides new insights into aortic insufficiency mechanisms and may be used to evaluate novel interventions for aortic valve repair.
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Affiliation(s)
- Talal Al-Atassi
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Canada
| | - Hadi Daood Toeg
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Canada
| | - Reza Jafar
- Department of Mechanical Engineering, University of Ottawa, Ottawa, Canada
| | - Benjamin Sohmer
- Department of Anesthesiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Michel Labrosse
- Department of Mechanical Engineering, University of Ottawa, Ottawa, Canada
| | - Munir Boodhwani
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Canada.
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