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Suroto NS, Rantam FA, Al Fauzi A, Widiyanti P, Turchan A, Pangaribuan V. Selection criteria for patch angioplasty material in carotid endarterectomy. Surg Neurol Int 2022; 13:362. [PMID: 36128094 PMCID: PMC9479565 DOI: 10.25259/sni_470_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/30/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Carotid endarterectomy (CEA) with patch angioplasty has been favored due to its lower reoccurrence of restenosis compared to primary CEA. There are multiple types of patch angioplasty material available. However, selection of patch material is based on uncertain criteria. The aim of this study is to determine the ideal criteria for selecting the best patch material for CEA.
Methods:
We conducted a comprehensive literature search for studies that describe the ideal criteria for selecting patch material for CEA. We compiled all of the criteria mentioned into one table and selecting the criteria which were most frequently mentioned with a simple scoring system.
Results:
A total of 65 studies out of 784 studies were assessed for its full-text eligibility. Thus, we found 23 studies that were eligible for analysis. There are 22 ideal criteria that were mentioned in the analyzed studies. We grouped these criteria into physical characteristics, safety, contribution to hemodynamic, contribution in tissue healing, economic aspect, and ability to prevent postsurgical complication. We proposed 10 ideal criteria for guiding vascular surgeon in selecting the best patch angioplasty material.
Conclusion:
To this day, no material has been discovered which meets all ten criteria. This study’s proposed ideal criteria serve as the foundation for the creation of the best patch angioplasty material.
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Affiliation(s)
- Nur Setiawan Suroto
- Doctoral Program of Medical Science, Faculty of Medicine, Universitas Airlangga,
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, / Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia,
| | - Fedik Abdul Rantam
- Stem Cell Research and Development Center, Universitas Airlangga,
- Department of Microbiology, Virology and Immunology Laboratory, Faculty of Veterinary Medicine, Universitas Airlangga,
| | - Asra Al Fauzi
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, / Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia,
| | - Prihartini Widiyanti
- Biomedical Engineering Study Program, Department of Physics, Faculty of Science and Technology, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Agus Turchan
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, / Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia,
| | - Vega Pangaribuan
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, / Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia,
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Allen KB, Adams JD, Badylak SF, Garrett HE, Mouawad NJ, Oweida SW, Parikshak M, Sultan PK. Extracellular Matrix Patches for Endarterectomy Repair. Front Cardiovasc Med 2021; 8:631750. [PMID: 33644135 PMCID: PMC7904872 DOI: 10.3389/fcvm.2021.631750] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/25/2021] [Indexed: 12/15/2022] Open
Abstract
Patch repair is the preferred method for arteriotomy closure following femoral or carotid endarterectomy. Choosing among available patch options remains a clinical challenge, as current evidence suggests roughly comparable outcomes between autologous grafts and synthetic and biologic materials. Biologic patches have potential advantages over other materials, including reduced risk for infection, mitigation of an excessive foreign body response, and the potential to remodel into healthy, vascularized tissue. Here we review the use of decellularized extracellular matrix (ECM) for cardiovascular applications, particularly endarterectomy repair, and the capacity of these materials to remodel into native, site-appropriate tissues. Also presented are data from two post-market observational studies of patients undergoing iliofemoral and carotid endarterectomy patch repair as well as one histologic case report in a challenging iliofemoral endarterectomy repair, all with the use of small intestine submucosa (SIS)-ECM. In alignment with previously reported studies, high patency was maintained, and adverse event rates were comparable to previously reported rates of patch angioplasty. Histologic analysis from one case identified constructive remodeling of the SIS-ECM, consistent with the histologic characteristics of the endarterectomized vessel. These clinical and histologic results align with the biologic potential described in the academic ECM literature. To our knowledge, this is the first histologic demonstration of SIS-ECM remodeling into site-appropriate vascular tissues following endarterectomy. Together, these findings support the safety and efficacy of SIS-ECM for patch repair of femoral and carotid arteriotomy.
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Affiliation(s)
- Keith B Allen
- St. Luke's Hospital of Kansas City, St. Luke's Mid America Heart Institute, Kansas City, MO, United States
| | - Joshua D Adams
- Carilion Clinic Aortic and Endovascular Surgery, Roanoke, VA, United States
| | - Stephen F Badylak
- Department of Bioengineering, Department of Surgery, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - H Edward Garrett
- Cardiovascular Surgery Clinic, University of Tennessee, Memphis, Memphis, TN, United States
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McCready RA, Kiell CS, Chugh AR, Rapp BM, Webb TH, Barksdale A, Parikshak M, Gerdisch MW. Long-term Results With CorMatrix Extracellular Matrix Patches After Carotid Endarterectomy. J Surg Res 2021; 262:21-26. [PMID: 33530005 DOI: 10.1016/j.jss.2021.01.001] [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: 10/09/2020] [Revised: 11/16/2020] [Accepted: 01/01/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Previous reports of extracellular matrix (ECM) patch use after carotid endarterectomy (CEA) have noted an approximately 10% rate of pseudoaneurysm (PSA) formation. PSA-related rupture of ECM patches has also been described after femoral artery repair. In these studies, different thicknesses (4-ply versus 6-ply) and no standard length of soaking the patch in saline before implantation were used. Herein, we describe our experience with ECM CorMatrix patches in 291 CEAs with 6-ply patches. METHODS The records of 275 consecutive patients undergoing 291 CEAs with CorMatrix 6-ply patches beginning in November of 2011 and extending until 2015 were reviewed. Only 6-ply patches and a 1 min hydration time in saline were used in all patients. No shunts were used. RESULTS There were three deaths within the first 30 d secondary to subsequent cardiac surgical procedures. Nine patients experienced a perioperative stroke (3.1%), only one of which occurred secondary to an occluded internal carotid artery. One patient had a transient ischemic attack with a patent endarterectomy site. In follow-up, 11 patients (4.5%) developed severe recurrent stenoses requiring reintervention. Only one patient (0.34%) developed a PSA at 2 years possibly secondary to chronic infection. The median follow-up was 72 mo. CONCLUSIONS Our experience with 6-ply CorMatrix ECM patches and a brief period of soaking demonstrated that these patches performed well in patients requiring a CEA. Only one PSA was noted.
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Affiliation(s)
- Robert A McCready
- Department of Vascular Surgery, Franciscan Physician Network, Indianapolis, Indiana.
| | - Charles S Kiell
- Department of Vascular Surgery, Franciscan Physician Network, Indianapolis, Indiana
| | - Atul R Chugh
- Department of Cardiology, Franciscan Physician Network, Indianapolis, Indiana
| | - Brian M Rapp
- Department of Vascular Surgery, Franciscan Physician Network, Indianapolis, Indiana
| | - Thomas H Webb
- Department of Vascular Surgery, Franciscan Physician Network, Indianapolis, Indiana
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Bio-Based Covered Stents: The Potential of Biologically Derived Membranes. TISSUE ENGINEERING PART B-REVIEWS 2019; 25:135-151. [DOI: 10.1089/ten.teb.2018.0207] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Fang Q, Gu T, Fan J, Zhang Y, Wang Y, Zhao Y, Zhao P. Evaluation of a hybrid small caliber vascular graft in a rabbit model. J Thorac Cardiovasc Surg 2019; 159:461-473. [PMID: 30981517 DOI: 10.1016/j.jtcvs.2019.02.083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/16/2019] [Accepted: 02/20/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A hybrid small-caliber artificial vascular graft based on bilayer porcine small intestinal submucosa (SIS) with curdlan and dipyridamole mixture film serving as the so-called sandwich filler was developed for biological performance evaluation. We evaluated the performance of the graft and filler. METHODS SIS was coated with heparin by 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide. Curdlan acted as the carrier of dipyridamole. Three types of graft tubes (2 mm internal diameter and 20 mm in length) were manufactured: bilayer SIS with 10% curdlan + 10% dipyridamole mixture film (SCD), bilayer SIS with 10% curdlan film (SC), and monolayer SIS (S). The remodeling characteristics of the grafts were evaluated by implanting them as bypass in rabbit carotid arteries for 2 and 3 months. Each group contained 16 rabbits, and 16 nonsurgical rabbits served as the control group. RESULTS Eight rabbits of each group, including the graft occluded group, were killed at 2 months and the others were killed at 3 months. Follow-up showed that all 8 grafts in SCD group were patent at 2 months. Six of 16 grafts in the SC group and 5 of 16 grafts in the S group were occluded at 2 months. One of 8 SCD grafts were occluded at 3 months and the patent showed a confluent endothelium without intimal hyperplasia. The neointima layer was composed of circumferentially aligned vascular smooth muscle cells. At 3 months, SC and S group grafts showed incomplete endothelialization and varying degrees of mural thrombus, accompanied by occlusion in the SC group (3 of 8) and S group (2 of 8). CONCLUSIONS The novel hybrid small caliber artificial vascular graft exhibited an improvement in revascularization resulting in high patency rate.
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Affiliation(s)
- Qin Fang
- Cardiac Surgery, First Hospital of China Medical University, Shenyang, China
| | - Tianxiang Gu
- Cardiac Surgery, First Hospital of China Medical University, Shenyang, China.
| | - Jun Fan
- Department of Tissue Engineering, China Medical University, Shenyang, China
| | - Yuanming Zhang
- Cardiac Surgery, First Hospital of China Medical University, Shenyang, China
| | - Yongchao Wang
- Cardiac Surgery, First Hospital of China Medical University, Shenyang, China
| | - Ye Zhao
- Cardiac Surgery, First Hospital of China Medical University, Shenyang, China
| | - Pan Zhao
- Department of Tissue Engineering, China Medical University, Shenyang, China
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Iop L, Palmosi T, Dal Sasso E, Gerosa G. Bioengineered tissue solutions for repair, correction and reconstruction in cardiovascular surgery. J Thorac Dis 2018; 10:S2390-S2411. [PMID: 30123578 PMCID: PMC6081367 DOI: 10.21037/jtd.2018.04.27] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 04/02/2018] [Indexed: 01/06/2023]
Abstract
The treatment of cardiac alterations is still nowadays a dramatic issue in the cardiosurgical practice. Synthetic materials applied in this surgery have failed in their long-term therapeutic efficacy due to low biocompatibility and compliance, especially when used in contractile sites. In order to overcome these treatment pitfalls, novel solutions have been developed based on biological tissues. Patches in pericardium, small intestinal submucosa, as well as engineered tissues of myocardium, heart valves and blood vessels have undergone a large preclinical investigation in regenerative medicine studies. Clinical translation has been started or reached by several of these new bioengineered treatment alternatives. This review will describe the preclinical and clinical experiences realized so far with the application of biological tissues in cardiovascular surgery. It will depict the progressive steps realized in the evolution of this research, as well as it will point out the challenges yet to face in order to generate the ideal biomaterial for cardiovascular repair, corrective and reconstructive surgery.
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Affiliation(s)
- Laura Iop
- Cardiovascular Regenerative Medicine, Department of Cardiac, Thoracic and Vascular Surgery, University of Padua and Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Tiziana Palmosi
- Cardiovascular Regenerative Medicine, Department of Cardiac, Thoracic and Vascular Surgery, University of Padua and Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Eleonora Dal Sasso
- Cardiovascular Regenerative Medicine, Department of Cardiac, Thoracic and Vascular Surgery, University of Padua and Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Gino Gerosa
- Cardiovascular Regenerative Medicine, Department of Cardiac, Thoracic and Vascular Surgery, University of Padua and Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
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Early complications of biologic extracellular matrix patch after use for femoral artery repair. J Vasc Surg 2016; 65:705-710. [PMID: 27751739 DOI: 10.1016/j.jvs.2016.07.131] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 07/30/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND The CorMatrix (CorMatrix Cardiovascular, Roswell, Ga) biologic extracellular patch derived from porcine small intestinal mucosa provides a biologic scaffold for cellular ingrowth and eventual tissue regeneration. It has been used in a variety of applications, including cardiac and vascular repair procedures. METHODS CorMatrix was used as a patch arterioplasty for femoral artery repair in conjunction with endarterectomy for seven separate procedures in six patients (one patient underwent staged, bilateral femoral procedures). RESULTS Patients were a median age of 67 years (interquartile range, 3.6 years). Six of seven procedures (86%) were performed on male patients. There were no operative deaths. Three of seven procedures (43%) resulted in significant early complications. Two procedures (29%) resulted in catastrophic biologic extracellular matrix patch disruption (11 and 19 days after initial procedure), requiring emergency exploration, patch removal, and definitive repair with vein patch arterioplasty. Both patches demonstrated an absence of growth on culture. One procedure (14%) resulted in groin pseudoaneurysm formation. Use of the CorMatrix patch was suspended upon recognition of significant complications. CONCLUSIONS Use of CorMatrix patch in the femoral artery position demonstrates a high incidence of early postoperative complications, including catastrophic patch disruption and pseudoaneurysm formation.
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Chang CW, Petrie T, Clark A, Lin X, Sondergaard CS, Griffiths LG. Mesenchymal Stem Cell Seeding of Porcine Small Intestinal Submucosal Extracellular Matrix for Cardiovascular Applications. PLoS One 2016; 11:e0153412. [PMID: 27070546 PMCID: PMC4829265 DOI: 10.1371/journal.pone.0153412] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 03/29/2016] [Indexed: 01/16/2023] Open
Abstract
In this study, we investigate the translational potential of a novel combined construct using an FDA-approved decellularized porcine small intestinal submucosa extracellular matrix (SIS-ECM) seeded with human or porcine mesenchymal stem cells (MSCs) for cardiovascular indications. With the emerging success of individual component in various clinical applications, the combination of SIS-ECM with MSCs could provide additional therapeutic potential compared to individual components alone for cardiovascular repair. We tested the in vitro effects of MSC-seeding on SIS-ECM on resultant construct structure/function properties and MSC phenotypes. Additionally, we evaluated the ability of porcine MSCs to modulate recipient graft-specific response towards SIS-ECM in a porcine cardiac patch in vivo model. Specifically, we determined: 1) in vitro loading-capacity of human MSCs on SIS-ECM, 2) effect of cell seeding on SIS-ECM structure, compositions and mechanical properties, 3) effect of SIS-ECM seeding on human MSC phenotypes and differentiation potential, and 4) optimal orientation and dose of porcine MSCs seeded SIS-ECM for an in vivo cardiac application. In this study, histological structure, biochemical compositions and mechanical properties of the FDA-approved SIS-ECM biomaterial were retained following MSCs repopulation in vitro. Similarly, the cellular phenotypes and differentiation potential of MSCs were preserved following seeding on SIS-ECM. In a porcine in vivo patch study, the presence of porcine MSCs on SIS-ECM significantly reduced adaptive T cell response regardless of cell dose and orientation compared to SIS-ECM alone. These findings substantiate the clinical translational potential of combined SIS-ECM seeded with MSCs as a promising therapeutic candidate for cardiac applications.
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Affiliation(s)
- Chia Wei Chang
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, California, United States of America
| | - Tye Petrie
- Department of Surgery, School of Medicine, University of California, Davis, Sacramento, California, United States of America
| | - Alycia Clark
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, California, United States of America
| | - Xin Lin
- Department of Surgery, School of Medicine, University of California, Davis, Sacramento, California, United States of America
| | - Claus S. Sondergaard
- Department of Surgery, School of Medicine, University of California, Davis, Sacramento, California, United States of America
| | - Leigh G. Griffiths
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, California, United States of America
- * E-mail:
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Hodonsky C, Mundada L, Wang S, Witt R, Raff G, Kaushal S, Si MS. Effects of scaffold material used in cardiovascular surgery on mesenchymal stem cells and cardiac progenitor cells. Ann Thorac Surg 2014; 99:605-11. [PMID: 25497071 DOI: 10.1016/j.athoracsur.2014.08.071] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 08/04/2014] [Accepted: 08/15/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Polytetrafluoroethylene (PTFE) and porcine small intestinal submucosa (pSIS) are patch materials used in congenital heart surgery. Porcine SIS is an extracellular-matrix scaffold that may interact with stem or progenitor cells. To evaluate this, we determined the in vitro effects of pSIS and PTFE on human bone marrow mesenchymal stromal cells (MSCs) and cardiac progenitor cells (CPCs) in 3 areas; cell proliferation, angiogenic growth-factor production, and differentiation. METHODS Human MSCs and CPCs were seeded onto pSIS and PTFE patches. Cell-seeded patches were cultured and then assessed for cell viability and proliferation and supernatant vascular endothelial growth factor A (VEGFA) levels. Cell proliferation was quantified by MTT assay (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide). Quantitative real-time polymerase chain reaction was performed on cell-seeded scaffolds to determine relative changes in gene expression related to angiogenesis and cardiogenesis. RESULTS The MSCs and CPCs were able to attach and proliferate on pSIS and PTFE. The proliferation rate of each cell type was similar on pSIS. Total RNA isolation was only possible from the cell-seeded pSIS patches. The MSC VEGFA production was increased by pSIS. Porcine SIS promoted an angiogenic gene profile in MSCs and an early cardiogenic profile in CPCs. CONCLUSIONS Both PTFE and pSIS allow for varying degrees of cell proliferation. Porcine SIS elicits different phenotypical responses in MSCs as compared with CPCs, which indicates that pSIS may be a bioactive scaffold that modulates stem cell activation and proliferation. These findings highlight the differences in scaffold material strategies and suggest potential advantages of bioactive approaches.
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Affiliation(s)
- Chani Hodonsky
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Lakshmi Mundada
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Shuyun Wang
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Russell Witt
- Department of Surgery, University of California at Davis Medical Center, Sacramento, California
| | - Gary Raff
- Department of Surgery, University of California at Davis Medical Center, Sacramento, California
| | - Sunjay Kaushal
- Department of Surgery, University Maryland, Baltimore, Maryland
| | - Ming-Sing Si
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
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Weber SS, Annenberg AJ, Wright CB, Braverman TS, Mesh CL. Early pseudoaneurysm degeneration in biologic extracellular matrix patch for carotid repair. J Vasc Surg 2013; 59:1116-8. [PMID: 23809202 DOI: 10.1016/j.jvs.2013.05.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 05/03/2013] [Accepted: 05/07/2013] [Indexed: 12/01/2022]
Abstract
A newly-approved carotid patch, derived from porcine small intestinal submucosa (SIS), is thought to allow functional tissue regeneration by acting as a biologic scaffold of extracellular matrix. We report three cases of asymptomatic pseudoaneurysm after SIS patch closure. At exploration there were intact suture lines, no growth from cultures, and central patch herniation. Histopathologic examination showed postendarterectomy neointima in the artery and disorganized collagen in the pseudoaneurysm. SIS patch remnants adjacent to macrophage infiltration and neovascularization indicated ongoing processes of degradation and synthesis. Imbalances between degradation and host tissue synthesis are problems that may unpredictably affect SIS patch integrity.
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Affiliation(s)
- Steven S Weber
- Department of Surgery, Mercy Jewish Hospital, Cincinnati, Ohio
| | | | | | | | - Charles L Mesh
- Department of Surgery, Mercy Jewish Hospital, Cincinnati, Ohio; Cardiac, Vascular, and Thoracic Surgeons, Inc, Cincinnati, Ohio.
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Pace Napoleone C, Gargiulo G. Editorial Comment: Do not throw away anything from the pig. Eur J Cardiothorac Surg 2013; 44:77-8. [DOI: 10.1093/ejcts/ezt158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Witt RG, Raff G, Van Gundy J, Rodgers-Ohlau M, Si MS. Short-term experience of porcine small intestinal submucosa patches in paediatric cardiovascular surgery. Eur J Cardiothorac Surg 2013; 44:72-6. [DOI: 10.1093/ejcts/ezs638] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Boni L, Chalajour F, Sasaki T, Snyder RL, Boyd WD, Riemer RK, Reddy VM. Reconstruction of pulmonary artery with porcine small intestinal submucosa in a lamb surgical model: Viability and growth potential. J Thorac Cardiovasc Surg 2012; 144:963-969.e1; discussion 969. [PMID: 22917684 DOI: 10.1016/j.jtcvs.2012.07.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 06/30/2012] [Accepted: 07/12/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES This study investigated the time-dependent remodeling and growth potential of porcine small intestine submucosa as a biomaterial for the reconstruction of pulmonary arteries in a lamb model. METHODS Left pulmonary arteries were partially replaced with small intestine submucosal biomaterial in 6 lambs. Two animals each were humanely killed at 1, 3, and 6 months. Computed tomographic angiography, macroscopic examination of the implanted patch, and microscopic analysis of tissue explants were performed. RESULTS All animals survived without complications. Patency and arborization of the pulmonary arteries were detected 6 months after implantation. There was no macroscopic narrowing or aneurysm formation in the patch area. The luminal appearance of the patch was similar to the intimal layer of the adjacent native pulmonary artery. Scanning electron microscopy showed that the luminal surface of the patch was covered by confluent cells. Immunohistochemical examination confirmed endothelialization of the luminal side of the patch in all of the explanted patches. The presence of smooth muscle cells in the medial layer was confirmed at all time points; however, expression of elastin, growth of the muscular layer, and complete degradation of patch material were detectable only after 6 months. The presence of c-Kit-positive cells suggests migration of multipotent cells into the patch, which may play a role in remodeling the small intestine submucosal biomaterial. CONCLUSIONS Our data confirmed that remodeling and growth potential of the small intestine submucosal biomaterial are time dependent. Additional experiments are required to investigate the stability of the patch material over a longer period.
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Affiliation(s)
- Lorenzo Boni
- Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
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McCready RA. Working towards a better understanding of the biomechanics of the carotid artery. J Surg Res 2012; 180:43-4. [PMID: 22316674 DOI: 10.1016/j.jss.2011.11.1016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 11/15/2011] [Accepted: 11/18/2011] [Indexed: 11/25/2022]
Affiliation(s)
- Robert Alan McCready
- Clarian Health Partners, Department of Vascular Surgery, 1801 North Senate Blvd, Suite 755, Indianapolis, IN, USA.
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de Barros-Marques SR, Marques-Lins E, de Albuquerque MCS, de Andrade-Aguiar JL. Sugarcane biopolymer patch in femoral vein angioplasty on dogs. J Vasc Surg 2012; 55:517-21. [DOI: 10.1016/j.jvs.2011.05.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 04/27/2011] [Accepted: 05/17/2011] [Indexed: 10/17/2022]
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Fallon A, Goodchild T, Wang R, Matheny RG. Remodeling of extracellular matrix patch used for carotid artery repair. J Surg Res 2011; 175:e25-34. [PMID: 22316677 DOI: 10.1016/j.jss.2011.11.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Revised: 10/17/2011] [Accepted: 11/01/2011] [Indexed: 01/25/2023]
Abstract
BACKGROUND We evaluated the in vitro strength and in vivo arterial-wall response to an extracellular-matrix-based patch material in a sheep model of carotid artery repair. MATERIALS AND METHODS A six-ply sheet of acellular, porcine extracellular matrix (ECM) was subjected to in vitro material strength testing and implanted in 15 sheep for 30, 90, and 180 d. Bovine pericardium was used as a control in some animals. In vivo graft patency was assessed by angiography. Explanted grafts were evaluated by histopathology and burst-strength testing. RESULTS Mean (SD) in vitro suture retention force of the ECM sheet was 14.5 (3.06) N; tensile strength was 29.7 (6.11) N; and probe burst strength was 185 (22.6) N. In vivo, mild stenosis was observed at 30 d for all patches; stenosis was absent at 90 d in the ECM-repaired arteries but not bovine pericardium controls. Pseudoaneurysm was not observed in any animal. Histopathology showed progressive graft degradation, collagen deposition, formation of neocapillaries and fibrocellular neointima, and endothelialization, but no calcification. Mean (SD) burst pressure for unrepaired arteries was 2608 (858) mmHg and 1473 (694) mmHg for ECM-repaired vessels. Mean change in diameter from unloaded state to burst pressure was 29% (9.7) for unrepaired vessels and 24% (13.4) for ECM-repaired vessels. CONCLUSIONS The six-ply ECM sheet can withstand the forces encountered after carotid artery repair. In sheep, it shows evidence of progressive, constructive remodeling as early as 30 d post-implantation with rapid deposition of endothelium. ECM shows promise as a patch material for CEA repair.
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Affiliation(s)
- Anna Fallon
- CorMatrix Cardiovascular, Inc., Alpharetta, Georgia 30009, USA.
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Sakurai H, Takeuchi M, Nakamori D, Kono T, Soejima K, Yamaki T, Nozaki M. Prefabricated flap for multiple facial units reconstruction using a jejunal seromuscular patch as a vascular carrier. Burns 2010; 36:e31-5. [DOI: 10.1016/j.burns.2008.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Accepted: 09/06/2008] [Indexed: 11/30/2022]
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Brown BN, Barnes CA, Kasick RT, Michel R, Gilbert TW, Beer-Stolz D, Castner DG, Ratner BD, Badylak SF. Surface characterization of extracellular matrix scaffolds. Biomaterials 2009; 31:428-37. [PMID: 19828192 DOI: 10.1016/j.biomaterials.2009.09.061] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 09/16/2009] [Indexed: 01/21/2023]
Abstract
Extracellular matrix (ECM) scaffolds prepared from different tissue sources or using different methods have been demonstrated to have distinctive effects upon cell adhesion patterns and the ability to support and maintain differentiated phenotypes. It is unknown whether the molecular composition or the ultrastructure of the ECM plays a greater role in determining the phenotype of the cells with which it comes into contact. However, when implanted, the topology and ligand landscape of the material will determine the host molecules that bind and the type and behavior of cells that mediate the host response. Therefore, a comprehensive understanding of surface characteristics is essential in the design of scaffolds for specific clinical applications. The surface characteristics of ECM scaffolds derived from porcine urinary bladder, small intestine, and liver as well as the effects of two commonly used methods of chemical cross-linking upon UBM were investigated. Electron microscopy and time of flight secondary ion mass spectroscopy were used to examine the surface characteristics of the scaffolds. The results show that ECM scaffolds have unique morphologic and structural properties which are dependant on the organ or tissue from which the scaffold is harvested. Furthermore, the results show that the surface characteristics of an ECM scaffold are changed through chemical cross-linking.
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Affiliation(s)
- Bryan N Brown
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15219, USA
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Tsai JW, Ayubi FS, Rice RD, Zhang Z, Armstrong PJ. Permacol (Porcine Dermal Collagen) and Alloderm (Acellular Cadaveric Dermis) as a Vascular Patch Repair for Common Carotid Arteriotomy in a Rabbit Model. Ann Vasc Surg 2009; 23:374-81. [DOI: 10.1016/j.avsg.2008.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Revised: 09/06/2008] [Accepted: 10/14/2008] [Indexed: 10/21/2022]
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Marques SRDB, Lins EM, Aguiar JLDA, Albuquerque MCS, Rossiter RDO, Montenegro LT, Vieira RJ. Um novo substituto vascular: arterioplastia femoral em cães com remendo de membrana de biopolímero de cana-de-açúcar - avaliação hemodinâmica e histopatológica. J Vasc Bras 2007. [DOI: 10.1590/s1677-54492007000400003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
CONTEXTO: A obtenção de um substituto arterial ideal para o emprego nas reconstruções das artérias de pequeno e médio calibre é ainda o principal objetivo da maioria das pesquisas científicas desenvolvidas no campo dos substitutos vasculares. A membrana de biopolímero de cana-de-açúcar pode ser de grande utilidade para a realização das reconstruções arteriais em vasos de calibre inferior a 4 mm e assim permitir o tratamento de doenças que afetam milhões de pessoas no Brasil e em todo o mundo. OBJETIVO: Avaliar do ponto de vista hemodinâmico e histopatológico o comportamento da membrana do biopolímero de cana-de-açúcar quando utilizada com remendo em arterioplastias femorais em cães. MÉTODO: Oito cães adultos mestiços sob anestesia geral foram submetidos no Núcleo de Cirurgia Experimental do Centro de Ciências da Saúde-UFPE a velocimetria Doppler percutânea das artérias femorais direita e esquerda para controle pré-operatório. Sob condições de assepsia e anti-sepsia, os cães foram submetidos a arterioplastia femoral bilateral com remendos da membrana de biopolímero de cana-de-açúcar no lado esquerdo e de PTFE expandido (e-PTFE) no lado direito. Na primeira semana pós-operatória, os cães foram submetidos a avaliação clínica diária e semanal a partir do oitavo dia. A avaliação clínica consistiu no exame dos pulsos femorais, na avaliação da marcha e na observação da presença de tumor pulsátil, hematoma ou hemorragia e infecção da ferida operatória. Após 180 dias das arterioplastias, sob anestesia geral, procedeu-se nova fluxometria Doppler percutânea das artérias femorais. Os animais foram submetidos à dissecção das artérias femorais, medido o diâmetro arterial e realizada velocimetria Doppler trans-operatória em pontos proximal e distal à arterioplastia. A seguir foi realizada laparotomia e exposição da aorta abdominal para acesso arteriográfico. Os segmentos das artérias femorais com os remendos foram retirados para estudo histopatológico e os animais foram mortos com dose tóxica de anestésico. RESULTADOS: No período de avaliação de 180 dias, nos dois grupos, não foram observados casos de infecção da ferida operatória, dilatação, ruptura, falso-aneurisma ou trombose. Nos dois grupos foi encontrada, na superfície externa dos remendos, uma resposta inflamatória crônica com neutrófilos e linfócitos além de fibrose. Na superfície interna dos remendos, em ambos os grupos, foi encontrada fibrose. No grupo controle ocorreu invasão dos remendos de e-PTFE por fibroblastos. CONCLUSÕES: Com base nos resultados obtidos com o modelo experimental utilizado, durante o período de observação de 180 dias, conclui-se que a membrana do biopolímero de cana-de-açúcar constitui-se em um substituto arterial adequado quando utilizado sob forma de remendos em artérias femorais de cães.
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Ahuja V, Tefera G. Successful Covered Stent-Graft Exclusion of Carotid Artery Pseudo-aneurysm: Two Case Reports and Review of Literature. Ann Vasc Surg 2007; 21:367-72. [PMID: 17484973 DOI: 10.1016/j.avsg.2006.06.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Revised: 06/05/2006] [Accepted: 06/09/2006] [Indexed: 11/18/2022]
Abstract
Postendarterectomy carotid artery pseudo-aneurysm (CPA) is a relatively infrequent complication with an estimated incidence of 0.3%-0.6%. A report from a single center experience on open-surgical repair of CPA has shown the associated high morbidity and mortality. Endovascular therapy is emerging as a safer alternative to open-surgical therapy. We describe two cases of CPA treated with commercially available Viabahn stent graft system (Gore AL, Flagstaff, AZ).
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MESH Headings
- Aged
- Aged, 80 and over
- Aneurysm, False/etiology
- Aneurysm, False/surgery
- Blood Vessel Prosthesis Implantation
- Carotid Artery Diseases/surgery
- Carotid Artery, Common/diagnostic imaging
- Carotid Artery, Common/pathology
- Carotid Artery, Common/surgery
- Endarterectomy, Carotid/adverse effects
- Female
- Humans
- Male
- Reoperation
- Stents
- Tomography, X-Ray Computed
- Ultrasonography, Doppler, Duplex
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Affiliation(s)
- Vanita Ahuja
- University of Wisconsin Medical School, Madison, WI 53792, USA
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Gilbert TW, Stewart-Akers AM, Simmons-Byrd A, Badylak SF. Degradation and Remodeling of Small Intestinal Submucosa in Canine Achilles Tendon Repair. J Bone Joint Surg Am 2007. [DOI: 10.2106/00004623-200703000-00020] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Gilbert TW, Stewart-Akers AM, Badylak SF. A quantitative method for evaluating the degradation of biologic scaffold materials. Biomaterials 2007; 28:147-50. [PMID: 16949150 DOI: 10.1016/j.biomaterials.2006.08.022] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2006] [Accepted: 08/11/2006] [Indexed: 11/26/2022]
Abstract
Scaffolds derived from naturally occurring extracellular matrix (ECM) have found extensive use in the fields of tissue engineering and regenerative medicine. Many of these scaffolds are designed to degrade rapidly as they are replaced by new host tissue. Other scaffolds are chemically crosslinked to slow the rate of degradation or add strength to the scaffold. Commercially available ECM scaffolds have considerable variability with regards to tissue origin and methods of processing, and little is known about their rate of degradation and the fate of their degradation products. A novel method is described herein to integrally label ECM with a radioactive isotope ((14)C). It was found that a number of tissues are efficiently labeled, including heart, liver, trachea, pancreas, small intestine, and urinary bladder tissue. Of the tissues analyzed, only spleen was not found to contain detectable levels of (14)C. The technique is extremely sensitive, accurate, and safe, but requires access to accelerator mass spectrometry, and is expensive and time consuming. This model represents the first described quantitative method to determine the rate of degradation for an ECM scaffold and to track the fate of the degradation products.
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Affiliation(s)
- Thomas W Gilbert
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 100 Technology Drive, Suite 200, Pittsburgh, PA 15219, USA
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Aguiar JLDA, Lins EM, Marques SRDB, Coelho ARDB, Rossiter RDO, Melo RJVD. Surgarcane biopolymer patch in femoral artery angioplasty on dogs. Acta Cir Bras 2007; 22 Suppl 1:77-81. [PMID: 17505660 DOI: 10.1590/s0102-86502007000700015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE: The objective of this study was to evaluate the use of the sugarcane biopolymer membrane in femoral artery patch angioplasty on dogs. METHODS: Eight dogs were submitted to bilateral femoral artery patch angioplasty with a sugarcane biopolymer membrane patch on one side and e-PTFE patch on the contralateral side. This research was performed at Experimental Surgical Research Laboratory of the Centro de Ciências da Saúde at Universidade Federal de Pernambuco. The dogs were submitted to a new surgery at 180 days after the patch angioplasty in order to harvest the femoral artery. All the animals were evaluated by: clinical examination, measure of femoral artery diameter, arteriogram and Doppler fluxometry. Yet the material harvested was sent to histological study. Each animal served as its own control. RESULTS: In all vessels of both groups there were no cases of infection, aneurysm formation, rupture or pseudoaneurysm formation and thrombosis. In both groups it was observed a chronic inflammatory reaction with lymphocytes, neutrophils and fibrosis in the outer surface of the patches. It was observed fibrosis in the inner surfaces of all the patches. In e-PTFE patches occurred invasion by fibroblasts. CONCLUSION: The sugarcane biopolymer membrane can be used as a patch in femoral artery angioplasty on dogs.
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Chaouat M, Le Visage C, Autissier A, Chaubet F, Letourneur D. The evaluation of a small-diameter polysaccharide-based arterial graft in rats. Biomaterials 2006; 27:5546-53. [PMID: 16857256 DOI: 10.1016/j.biomaterials.2006.06.032] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Accepted: 06/30/2006] [Indexed: 12/21/2022]
Abstract
Cardiovascular diseases may require surgery such as arterial bypasses that are usually performed with synthetic PTFE and Dacron grafts with diameter above 6mm. For smaller diameter replacement, healthy vascular tissue from the patient is not always available to carry out this type of graft. The purpose of this study was to evaluate the effectiveness of a small-diameter polysaccharide-based scaffold as an alternative arterial replacement. Tubular polysaccharide-based grafts of 2 mm internal diameter were prepared and moulded by a cross-linking technique. Fifteen Wistar adult rats underwent infrarenal aortic bypass with these grafts using microsurgical techniques. Grafts withstood aortic blood pressure and exhibited physiological blood flow, as evaluated with ultrasound techniques and angiographies at 4 and 8 weeks post-surgery. Harvested grafts were morphologically evaluated by light microscopy and immunohistochemistry. Neointima formation at 8 weeks was evidenced through collagen deposition and smooth muscle-like cells circumferential growth on the luminal surface without intimal hyperplasia or aneurysm formation. In conclusion, we described a 2mm polysaccharide-based arterial material being investigated in vivo and demonstrating patency for up to 8 weeks post-surgery with neointima formation and absence of intimal hyperplasia.
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Affiliation(s)
- Marc Chaouat
- Inserm, U698, Bio-ingénierie Cardiovasculaire, CHU Xavier Bichat, Bât. Inserm, 46 Rue Henri Huchard, F-75877 Paris Cedex 18, France
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Al-Rawi PG, Turner CL, Waran V, Ng I, Kirkpatrick PJ. A randomized trial of synthetic patch versus direct primary closure in carotid endarterectomy. Neurosurgery 2006; 59:822-8; discussion 828-9. [PMID: 17038946 DOI: 10.1227/01.neu.0000232640.11438.c0] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To define whether or not direct microscopic closure with or without the use of a vascular patch is advantageous in terms of clinical outcome and late vessel occlusion rates after microsurgical carotid endarterectomy. METHODS Three hundred thirty-eight elective carotid endarterectomies in 315 patients were randomized to direct arteriotomy or closure with a polyester collagen-coated vascular patch. Ten procedures did not follow the randomization process because of technical difficulties and were excluded. Vessel patency (duplex ultrasound) and outcome were assessed during and immediately after surgery and at 4 and 12 months after surgery. RESULTS Four-month ultrasound assessment (n = 321) identified five occluded vessels: two in the patch group (n = 149) and three in the direct closure group (n = 172). Six patients in the patch group had died or were significantly disabled at 4 months, compared with five in the direct closure group. At the 12-month assessment (n = 313), eight vessels had occluded: five from the patched group (n = 146) and three from the direct closure group (n = 167). Eight patients in the patch group had died or were significantly disabled, compared with four in the direct closure group. No statistically significant difference between the two groups in terms of vessel occlusion, morbidity, or mortality was seen (P > 0.1). CONCLUSION No difference in vessel patency and clinical outcome has been identified after microscopic patch angioplasty and direct arteriotomy repair. The authors conclude that there is no benefit from the routine use of patch angioplasty in microscopic carotid endarterectomy.
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Affiliation(s)
- Pippa G Al-Rawi
- University Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, England, UK.
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Jux C, Bertram H, Wohlsein P, Bruegmann M, Paul T. Interventional Atrial Septal Defect Closure Using a Totally Bioresorbable Occluder Matrix. J Am Coll Cardiol 2006; 48:161-9. [PMID: 16814662 DOI: 10.1016/j.jacc.2006.02.057] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2005] [Revised: 02/09/2006] [Accepted: 02/14/2006] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We sought to test the hypothesis that interventional atrial septal defect (ASD) closure can be performed safely and effectively using a bioresorbable occluder matrix. BACKGROUND The ideal septal occluder scaffold should promote the healthiest and most complete healing response while eventually facilitating the full resorption of the material and leaving "native" tissue behind, thus minimizing the potential for future complications from chronic foreign body and maintaining the possibility for later unobstructed transseptal access to the left atrium. METHODS The STARFlex occluders (NMT Medical Inc., Boston, Massachusetts) were modified by substituting the conventional polyester fabric for a bioengineered, acellular type-I collagen matrix derived from porcine submucosa with a heparin-coated surface (BioSTAR occluder, NMT Medical Inc.). Comparative transcatheter closure of ASDs was performed in young sheep (n = 36). Gross pathology and histopathology were obtained after follow-up periods ranging from 7 days to 2 years. RESULTS The STARFlex (control) devices were encapsulated time-dependently by ingrown fibrous tissue. Histology showed a mild but chronically persisting foreign body reaction. By contrast, BioSTAR devices exhibited a mild-to-moderate transient cellular immune response. Heparin coating of the BioSTAR surface improved the biocompatibility of the device by reducing surface thrombogencity. A remodeling process of the collagen scaffold, starting after 30 days in vivo, resulted in the full replacement of the matrix by host tissue after 2 years of follow-up. CONCLUSIONS The BioSTAR device is the first septal occluder with a totally bioresorbable matrix that is fully replaced by host tissue during the healing process. The promising results of this study support testing of the BioSTAR device in clinical trials.
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Affiliation(s)
- Christian Jux
- Department of Pediatric Cardiology, Georg-August University, Goettingen, Germany.
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Petter-Puchner AH, Fortelny RH, Mittermayr R, Walder N, Ohlinger W, Redl H. Adverse effects of porcine small intestine submucosa implants in experimental ventral hernia repair. Surg Endosc 2006; 20:942-6. [PMID: 16738987 DOI: 10.1007/s00464-005-0568-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2005] [Accepted: 11/30/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND Biomeshes made of porcine small intestine submucosa (SIS) have recently been suggested for repair of ventral hernia. A fully biodegradable combination of implant and fibrin sealant fixation was assessed in a new rat model with sutures serving as control. METHODS In 10 Sprague-Dawley rats, two defects per animal were created in the abdominal wall left and right of the linea alba (1 cm in diameter), and the peritoneum was spared. The lesions were left untreated for 10 days to achieve a chronic condition and were then covered with SIS (2 x 2 cm), sealed or sutured (n = 10 per group). Randomization allowed sealant and sutures in one animal. Animals were killed on postoperative day 17, and implant sites were analyzed macroscopically, histologically, and microbiologically. RESULTS Abscedation, encapsulation, and putrid seroma were observed in all samples, regardless of fixation technique. Histology revealed lytic necrosis and extensive inflammatory response of the surrounding tissue. Tissue samples obtained from three implant sites were positive for beta-hemolytic Streptococcus. SIS was not detectable after 17 days. CONCLUSIONS Adverse effects were observed using SIS in an experimental model of ventral hernia and were not linked to fixation method or study design. Further experimental investigations on SIS are necessary before its clinical use in hernia repair.
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Affiliation(s)
- A H Petter-Puchner
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Research Center for Traumatology of AUVA, Donaueschingenstrasse 13, A-1200, Vienna, Austria.
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Yavuz K, Geyik S, Pavcnik D, Uchida BT, Corless CL, Hartley DE, Goktay A, Correa LO, Timmermans H, Hodde JP, Kaufman JA, Keller FS, Rösch J. Comparison of the Endothelialization of Small Intestinal Submucosa, Dacron, and Expanded Polytetrafluoroethylene Suspended in the Thoracoabdominal Aorta in Sheep. J Vasc Interv Radiol 2006; 17:873-82. [PMID: 16687754 DOI: 10.1097/01.rvi.0000217938.20787.bb] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study was undertaken to evaluate and compare endothelialization of small intestinal submucosa (SIS), Dacron, and expanded polytetrafluoroethylene (ePTFE) in high-pressure flow without aortic wall contact and to evaluate the suitability of SIS as a vascular graft material. MATERIALS AND METHODS In 12 adult sheep, three types of membrane leaflets of similar thickness (approximately 200 mum) were suspended within large square stents without contact with the thoracoabdominal aortic wall: SIS (n = 12), Dacron (n = 12), and ePTFE (n = 12). Each animal received one leaflet of each material. Aortograms were obtained before and after percutaneous implantation and when the animal was killed at 8 weeks (n = 6) or 18 weeks (n = 6). Cell coverage and remodeling of SIS, Dacron, and ePTFE membranes were assessed by gross and histologic microscopic examinations. RESULTS Thirty-five successfully implanted leaflets were evaluated. SIS showed progressive remodeling. Thirty-three leaflets exhibited thickening as a result of neointimal formation and endothelialization, most likely from circulating endothelial cells. Dacron exhibited the greatest and most progressing degree of neointimal formation and endothelialization, followed by SIS and then ePTFE. With SIS and ePTFE, neointimal formation decreased with time, but endothelialization was stable. Uneven neointimal formation and endothelialization on the outer surfaces and distal leaflet positions were seen. CONCLUSIONS SIS showed progressive remodeling with moderate and regressive neointimal formation and moderate stable endothelialization. Further study of its durability and incorporation into the aortic wall needs to be performed to evaluate its suitability as a cover for aortic endografts.
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Affiliation(s)
- Kivilcim Yavuz
- Department of Radiology, Royal Perth Hospital, Perth, Australia
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Kim MS, Seo KS, Hyun H, Kim SK, Khang G, Lee HB. Sustained release of bovine serum albumin using implantable wafers prepared by MPEG-PLGA diblock copolymers. Int J Pharm 2005; 304:165-77. [PMID: 16198075 DOI: 10.1016/j.ijpharm.2005.08.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Revised: 08/14/2005] [Accepted: 08/16/2005] [Indexed: 10/25/2022]
Abstract
MPEG-PLGA diblock copolymers, consisting of methoxy polyethylene glycol (MPEG) and poly(L-lactic-co-glycolic acid) (PLGA), were synthesized by ring-opening polymerization of L-lactide and glycolide in the presence of MPEG as an initiator. Implantable wafers, using diblock copolymers as a drug carrier, were fabricated by direct compression method after freeze milling of the diblock copolymers and bovine serum albumin-fluorescein isothiocyanate (BSA-FITC) as a model protein drug. The wafers prepared with MPEG-PLGA diblock copolymers exhibited initial burst in the release of BSA. The BSA release profiles from the wafers depended on MPEG-PLGA diblock copolymer compositions. The in vitro release of the BSA also correlated with the degradation rate of the PLGA part in the diblock polymers. The wafers prepared from diblock copolymers with an increased MPEG segment showed the more structural metamorphosis of crack form due to higher water absorption of MPEG inside the wafer, and induced faster BSA release. The wafers prepared by using MPEG-PLGA diblock copolymers in the presence of small intestinal submucosa (SIS) as a drug carrier additive exhibited controlled BSA release profiles, although the wafers exhibited release patterns with a lag time at the initial stage as the MPEG segment in diblock copolymer compositions increased. Thus, we confirmed that the MPEG-PLGA diblock copolymers could be used as a protein delivery carrier in implantable wafer form.
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Affiliation(s)
- Moon Suk Kim
- Nanobiomaterials Laboratory, Korea Research Institute of Chemical Technology, P.O. Box 107, 100 Jang-dong, Yuseong-gu, Daejeon 305-600, Republic of Korea.
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