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Kostelnik CJ, Gale MK, Crouse KJ, Shazly T, Eberth JF. Acute Mechanical Consequences of Vessel-Specific Coronary Bypass Combinations. Cardiovasc Eng Technol 2023; 14:404-418. [PMID: 36828977 DOI: 10.1007/s13239-023-00661-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 02/06/2023] [Indexed: 02/26/2023]
Abstract
PURPOSE Premature coronary artery bypass graft (CABG) failure has been linked to geometric, mechanical, and compositional discrepancies between host and graft tissues. Acute hemodynamic disturbances and the introduction of wall stress gradients trigger a myriad of mechanobiological processes at the anastomosis that can be associated with restenosis and graft failure. Although the origins of coronary artery disease dictate the anastomotic target, an opportunity exists for graft-vessel optimization through rationale graft selection. METHODS Here we explored the four distinct regions of the left (L) and right (R) ITA (1 = proximal, 2 = submuscular, 3 = middle, 4 = distal), and four common target vessels in the coronary circulation including the proximal and distal left anterior descending (PLAD & DLAD), right coronary (RCA), and left circumflex (LCX) arteries. Benchtop biaxial mechanical data was used to acquire constitutive model parameters of these tissues and enable vessel-specific computational models to elucidate the mechanical consequences of 32 unique graft-target combinations. RESULTS Simulations revealed the maximum principal wall stresses for the PLAD, RCA, and LCX occurred when anastomosed with LITA1, and the maximum flow-induced shear stress occurred with LITA4. The DLAD, on the other hand, reached stress maximums when anastomosed to LITA4. Using a normalized objective function of simulation output variables, we found LITA2 to be the best graft choice for both LADs, RITA3 for the RCA, and LITA3 for the LCX. CONCLUSION Although mechanical compatibility is just one of many factors determining bypass graft outcomes, our data suggests improvements can be made to the grafting process through vessel-specific regional optimization.
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Affiliation(s)
- Colton J Kostelnik
- Biomedical Engineering Program, University of South Carolina, Columbia, SC, USA
| | - Mary K Gale
- Biomedical Engineering Department, Georgia Institute of Technology, Atlanta, GA, USA
| | - Kiersten J Crouse
- Mechanical Engineering Department, University of South Carolina, Columbia, SC, USA
| | - Tarek Shazly
- Biomedical Engineering Program, University of South Carolina, Columbia, SC, USA
- Mechanical Engineering Department, University of South Carolina, Columbia, SC, USA
| | - John F Eberth
- Biomedical Engineering Program, University of South Carolina, Columbia, SC, USA.
- Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA.
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Kostelnik CJ, Hohn J, Escoto-Diaz CE, Kooistra JB, Stern MM, Swinton DE, Richardson WJ, Carver W, Eberth JF. Small-diameter artery decellularization: Effects of anionic detergent concentration and treatment duration on porcine internal thoracic arteries. J Biomed Mater Res B Appl Biomater 2022; 110:885-897. [PMID: 34855280 PMCID: PMC8854343 DOI: 10.1002/jbm.b.34969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 10/27/2021] [Accepted: 11/13/2021] [Indexed: 11/06/2022]
Abstract
Engineered replacement materials have tremendous potential for vascular applications where over 400,000 damaged and diseased blood vessels are replaced annually in the United States alone. Unlike large diameter blood vessels, which are effectively replaced by synthetic materials, prosthetic small-diameter vessels are prone to early failure, restenosis, and reintervention surgery. We investigated the differential response of varying 0%-6% sodium dodecyl sulfate and sodium deoxycholate anionic detergent concentrations after 24 and 72 h in the presence of DNase using biochemical, histological, and biaxial mechanical analyses to optimize the decellularization process for xenogeneic vascular tissue sources, specifically the porcine internal thoracic artery (ITA). Detergent concentrations greater than 1% were successful at removing cytoplasmic and cell surface proteins but not DNA content after 24 h. A progressive increase in porosity and decrease in glycosaminoglycan (GAG) content was observed with detergent concentration. Augmented porosity was likely due to the removal of both cells and GAGs and could influence recellularization strategies. The treatment duration on the other hand, significantly improved decellularization by reducing DNA content to trace amounts after 72 h. Prolonged treatment times reduced laminin content and influenced the vessel's mechanical behavior in terms of altered circumferential stress and stretch while further increasing porosity. Collectively, DNase with 1% detergent for 72 h provided an effective and efficient decellularization strategy to be employed in the preparation of porcine ITAs as bypass graft scaffolding materials with minor biomechanical and histological penalties.
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Affiliation(s)
- CJ Kostelnik
- Biomedical Engineering Program, University of South Carolina College of Eng., Columbia, SC
| | - J Hohn
- Department of Cell Biology & Anatomy, University of South Carolina School of Med., Columbia, SC
| | - CE Escoto-Diaz
- Department of Biology, Winthrop University, Rock Hill, SC
| | - JB Kooistra
- Department of Biology, Winthrop University, Rock Hill, SC
| | - MM Stern
- Department of Biology, Winthrop University, Rock Hill, SC
| | - DE Swinton
- Department of Chemistry, Claflin University, Orangeburg, SC
| | - WJ Richardson
- Department of Bioengineering, Clemson University, Clemson, SC
| | - W Carver
- Department of Cell Biology and Anatomy, University of South Carolina, School of Medicine, Columbia, SC
| | - JF Eberth
- Department of Cell Biology & Anatomy, University of South Carolina School of Med., Columbia, SC
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Parissis H, Parissis M. Up-to-Date, Skeletonized or Pedicle Bilateral Internal Mammary Artery; Does It Matter? Ann Thorac Cardiovasc Surg 2022; 29:53-69. [PMID: 36047135 PMCID: PMC10126765 DOI: 10.5761/atcs.ra.22-00094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE In this article, we reported on the up-to-date literature regarding skeletonized bilateral internal mammary artery (BIMA) flow and the effect on sternal perfusion. We also reviewed the pros and cons of the skeletonization technique versus the conventional pedicle technique for harvesting the BIMA. METHODS We performed an up-to-date review using the PubMed database, with a specific focus on the contemporary published literature. RESULTS BIMA skeletonization can preserve the sternal microcirculation, minimize tissue damage, and maintain blood supply to the chest wall at the tissue level. This effect is also apparent in diabetics. Deep sternal wound infection (DSWI) rates are significantly less with skeletonization versus the conventional pedicle technique and are comparable to single internal mammary artery harvesting. CONCLUSIONS Contemporary large-scale studies demonstrate that skeletonization of the BIMA increases conduit length, provides superior flow, reduces the incidence of DSWIs, and improves late survival. Hopefully, this review will increase awareness of the compelling evidence in favor of using skeletonized internal mammary arteries and stimulate increased uptake of BIMA revascularization surgery.
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Kostelnik CJ, Crouse KJ, Carver W, Eberth JF. Longitudinal histomechanical heterogeneity of the internal thoracic artery. J Mech Behav Biomed Mater 2021; 116:104314. [PMID: 33476887 DOI: 10.1016/j.jmbbm.2021.104314] [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: 06/01/2020] [Revised: 12/10/2020] [Accepted: 01/03/2021] [Indexed: 11/16/2022]
Abstract
The internal thoracic artery (ITA) is the principal choice for coronary artery bypass grafting (CABG) due to its mechanical compatibility, histological composition, anti-thrombogenic lumen, and single anastomotic junction. Originating at the subclavian artery, traversing the thoracic cavity, and terminating at the superior epigastric and musculophrenic bifurcation, bilateral ITAs follow a protracted circuitous pathway. The physiological hemodynamics, anatomical configuration, and perivascular changes that occur throughout this length influence the tissue's microstructure and gross mechanical properties. Since histomechanics play a major role in premature graft failure we used inflation-extension testing to quantify the regional material and biaxial mechanical properties at four distinct locations along the left (L) and right (R) ITA and fit the results to a structurally-motivated constitutive model. Our comparative analysis of 44 vessel segments revealed a significant increase in the amount of collagen but not smooth muscle and a significant decrease in elastin and elastic lamellae present with distance from the heart. A subsequent decrease in the total deformation energy and isotropic contribution to the strain energy was present in the LITA but not RITA. Circumferential stress and compliance generally decreased along the length of the LITA while axial stress increased in the RITA. When comparing RITAs to LITAs, some morphological and histological differences were found in proximal sections while distal sections revealed differences predominantly in compliance and axial stress. Overall, this information can be used to better guide graft selection, graft preparation, and xenograft-based tissue-engineering strategies for CABG.
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Affiliation(s)
- Colton J Kostelnik
- Biomedical Engineering Program, University of South Carolina, Columbia, SC, USA
| | - Kiersten J Crouse
- Mechanical Engineering Department, University of South Carolina, Columbia, SC, USA
| | - Wayne Carver
- Cell Biology and Anatomy Department, University of South Carolina, Columbia, SC, USA
| | - John F Eberth
- Biomedical Engineering Program, University of South Carolina, Columbia, SC, USA; Cell Biology and Anatomy Department, University of South Carolina, Columbia, SC, USA.
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Histomorphometric analysis of the human internal thoracic artery and relationship with cardiovascular risk factors. PLoS One 2019; 14:e0211421. [PMID: 30682154 PMCID: PMC6347214 DOI: 10.1371/journal.pone.0211421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/31/2018] [Indexed: 11/19/2022] Open
Abstract
In this study, we aimed at performing a histomorphometric analysis of human left internal thoracic artery (ITA) samples as well as at correlating the histomorphometric findings with the clinical profile, including risk factors and medication. Distal segments of ITA were obtained from 54 patients undergoing coronary artery bypass grafting. Histological observation was performed in paraffin-embedded transverse sections of ITA through four staining protocols: hematoxylin-eosin, van Gieson, Masson’s trichrome and von Kossa. Morphometric analysis included the intimal width (IW), medial width (MW) and intima/media ratio (IMR). No overt atherosclerotic lesions were observed. Mild calcifications were observed across the vascular wall layers in almost all samples. Multivariable linear regression analysis showed associations between IW and IMR and the following clinical variables: age, gender, kidney function expressed as eGFR and myocardial infarction history. Age (odds ratio = 1.16, P = 0.004), female gender (odds ratio = 11.34, P = 0.011), eGFR (odds ratio = 1.03, P = 0.059) and myocardial infarction history (odds ratio = 4.81, P = 0.040) were identified as the main clinical predictors for intimal hyperplasia. Preatherosclerotic lesions in ITA samples from patients undergoing coronary revascularization were associated not only with classical cardiovascular risk factors such as age and gender, but also with other clinical variables, namely kidney function and myocardial infarction history.
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Saraiva FA, Girerd N, Cerqueira RJ, Ferreira JP, Vilas-Boas N, Pinho P, Barros A, Amorim MJ, Lourenço AP, Leite-Moreira AF. Survival after bilateral internal mammary artery in coronary artery bypass grafting: Are women at risk? Int J Cardiol 2018; 270:89-95. [DOI: 10.1016/j.ijcard.2018.05.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 04/03/2018] [Accepted: 05/09/2018] [Indexed: 01/07/2023]
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Gode S, Sen O, Kadirogulları E, Reyhancan A, Kyaruzi M, Satılmısoglu MH, Erkanlı K. A Study Demonstrating the Quantitative Relationship Between Internal Thoracic Artery Length and Free Flow. Heart Lung Circ 2018; 27:872-877. [DOI: 10.1016/j.hlc.2017.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 07/21/2017] [Accepted: 07/26/2017] [Indexed: 11/30/2022]
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Ultrastructural and histomorphologic properties of the internal thoracic artery: implications for coronary revascularization. Coron Artery Dis 2017; 28:518-527. [PMID: 28678142 DOI: 10.1097/mca.0000000000000527] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Coronary artery disease represents a major health problem worldwide for which coronary artery bypass surgery remains a standard of care. Among the several grafts that are available, the internal thoracic artery (ITA) has long been considered the best as several advantages have been described compared with other vessels (e.g. saphenous vein or radial artery), namely, an absent to minor atherosclerotic development. In fact, several studies showed the presence of preatherosclerotic lesions, such as intimal and/or medial thickening, medial fibrosis, among others, in the presence of certain cardiovascular risk factors as well as established atherosclerotic lesions (i.e. type II or more lesions). This paper primarily aimed at reviewing the current knowledge on the histomorphological characteristics of ITA as well as the comparative histomorphology of ITA with other vessel grafts currently in use in coronary surgery. As some of the evidence is not clear or consensual, this paper also aimed at reviewing the main histopathological, histomorphometrical, and ultrastructural findings in ITAs from patients with known cardiovascular risk factors (e.g. aging, obesity, hypertension, diabetes, smoking, and others). As the presence of preatherosclerotic and/or atherosclerotic lesions may compromise the success of the myocardial revascularization and lead to graft failure, contributing toward the associated morbidity and/or mortality, it is essential to improve the scientific knowledge on the structural characterization of ITAs and its correlation with the cardiovascular risk profile.
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He GW. Cautions on use of distal internal thoracic artery and its bifurcations. J Thorac Cardiovasc Surg 2014; 149:1050-1. [PMID: 25636527 DOI: 10.1016/j.jtcvs.2014.12.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 12/20/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Guo-Wei He
- TEDA International Cardiovascular Hospital, Tianjin, China, The Affiliated Hospital of Hangzhou Normal University and Zhejiang University, Hangzhou, China, and Department of Surgery, Oregon Health and Science University, Portland, Ore.
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