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van der Valk DC, Fomina A, Uiterwijk M, Hooijmans CR, Akiva A, Kluin J, Bouten CV, Smits AI. Calcification in Pulmonary Heart Valve Tissue Engineering. JACC Basic Transl Sci 2023. [DOI: 10.1016/j.jacbts.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Tissue Engineered Transcatheter Pulmonary Valved Stent Implantation: Current State and Future Prospect. Int J Mol Sci 2022; 23:ijms23020723. [PMID: 35054905 PMCID: PMC8776029 DOI: 10.3390/ijms23020723] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 02/07/2023] Open
Abstract
Patients with the complex congenital heart disease (CHD) are usually associated with right ventricular outflow tract dysfunction and typically require multiple surgical interventions during their lives to relieve the right ventricular outflow tract abnormality. Transcatheter pulmonary valve replacement was used as a non-surgical, less invasive alternative treatment for right ventricular outflow tract dysfunction and has been rapidly developing over the past years. Despite the current favorable results of transcatheter pulmonary valve replacement, many patients eligible for pulmonary valve replacement are still not candidates for transcatheter pulmonary valve replacement. Therefore, one of the significant future challenges is to expand transcatheter pulmonary valve replacement to a broader patient population. This review describes the limitations and problems of existing techniques and focuses on decellularized tissue engineering for pulmonary valve stenting.
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Uiterwijk M, van der Valk DC, van Vliet R, de Brouwer IJ, Hooijmans CR, Kluin J. Pulmonary valve tissue engineering strategies in large animal models. PLoS One 2021; 16:e0258046. [PMID: 34610023 PMCID: PMC8491907 DOI: 10.1371/journal.pone.0258046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 09/16/2021] [Indexed: 01/10/2023] Open
Abstract
In the last 25 years, numerous tissue engineered heart valve (TEHV) strategies have been studied in large animal models. To evaluate, qualify and summarize all available publications, we conducted a systematic review and meta-analysis. We identified 80 reports that studied TEHVs of synthetic or natural scaffolds in pulmonary position (n = 693 animals). We identified substantial heterogeneity in study designs, methods and outcomes. Most importantly, the quality assessment showed poor reporting in randomization and blinding strategies. Meta-analysis showed no differences in mortality and rate of valve regurgitation between different scaffolds or strategies. However, it revealed a higher transvalvular pressure gradient in synthetic scaffolds (11.6 mmHg; 95% CI, [7.31-15.89]) compared to natural scaffolds (4,67 mmHg; 95% CI, [3,94-5.39]; p = 0.003). These results should be interpreted with caution due to lack of a standardized control group, substantial study heterogeneity, and relatively low number of comparable studies in subgroup analyses. Based on this review, the most adequate scaffold model is still undefined. This review endorses that, to move the TEHV field forward and enable reliable comparisons, it is essential to define standardized methods and ways of reporting. This would greatly enhance the value of individual large animal studies.
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Affiliation(s)
- M. Uiterwijk
- Heart Center, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - D. C. van der Valk
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - R. van Vliet
- Faculty of medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - I. J. de Brouwer
- Faculty of medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - C. R. Hooijmans
- Department for Health Evidence Unit SYRCLE, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Anesthesiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J. Kluin
- Heart Center, Amsterdam University Medical Center, Amsterdam, The Netherlands
- * E-mail:
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Lutter G, Topal A, Hansen JH, Haneya A, Santhanthan J, Freitag-Wolf S, Frank D, Puehler T. Transcatheter pulmonary valve replacement: a new polycarbonate urethane valve. Eur J Cardiothorac Surg 2021; 59:1048-1056. [PMID: 33538794 DOI: 10.1093/ejcts/ezaa479] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/17/2020] [Accepted: 11/29/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Transcatheter pulmonary valve replacement has become a valid treatment option for right ventricular outflow tract diseases. However, some limitations occur in patients with wide, compliant right ventricular outflow tracts that might be amenable to treatment with self-expanding valved protheses. An experimental ovine study was designed to evaluate a novel dip-coated, low-profile trileaflet polycarbonate urethane (PCU) heart valve mounted into a self-expandable nitinol stent. METHODS The PCU valves were produced by a dip-coating technique, mounted in a conical-shaped nitinol stent and provided with a leaflet thickness of 100-150 µm. The valved stents were implanted percutaneously via transfemoral access in 6 consecutive sheep divided into 2 groups. Three animals were followed up for 1 month and the remainder, for 6 months. Angiographic measurements and transthoracic echocardiography were performed before and after implantation and at the end of the 1- or 6-month observation period, respectively. RESULTS Orthotopic positioning of the valve was achieved in all animals. All except 1 had competent valves during the follow-up period. The peak-to-peak gradient across the PCU valved stents was 4.6 ± 1.0 mmHg after 1 month and 4.4 ± 2.3 mmHg after 6 months of follow-up. Macroscopic and microscopic post-mortem evaluation indicated good morphological and structural results. There were no stent fractures, leaflet calcification or thrombus formation. CONCLUSIONS This study demonstrates successful transcatheter pulmonary valve replacement with a novel dip-coated valved nitinol stent. The trileaflet PCU prostheses indicated good functional and biocompatible properties after a 6-month observation period.
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Affiliation(s)
- Georg Lutter
- Department of Experimental Surgery and Heart Valve Replacement, University of Kiel, Medical School, Campus Kiel, Kiel, Germany.,DZHK (German Center for Cardiovascular Research), partner Site Hamburg/Kiel/Lübeck, Kiel, Germany.,Department of Cardiovascular Surgery, University of Kiel, Medical School, Campus Kiel, Kiel, Germany
| | - Ayça Topal
- Department of Experimental Surgery and Heart Valve Replacement, University of Kiel, Medical School, Campus Kiel, Kiel, Germany
| | - Jan Hinnerk Hansen
- Department of Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Assad Haneya
- Department of Cardiovascular Surgery, University of Kiel, Medical School, Campus Kiel, Kiel, Germany
| | - Janarthan Santhanthan
- Department of Cardiology, University of Vancouver, Medical School, Vancouver, Canada
| | - Sandra Freitag-Wolf
- Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Derk Frank
- DZHK (German Center for Cardiovascular Research), partner Site Hamburg/Kiel/Lübeck, Kiel, Germany.,Department of Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Thomas Puehler
- Department of Experimental Surgery and Heart Valve Replacement, University of Kiel, Medical School, Campus Kiel, Kiel, Germany.,DZHK (German Center for Cardiovascular Research), partner Site Hamburg/Kiel/Lübeck, Kiel, Germany.,Department of Cardiovascular Surgery, University of Kiel, Medical School, Campus Kiel, Kiel, Germany
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Jover E, Fagnano M, Angelini G, Madeddu P. Cell Sources for Tissue Engineering Strategies to Treat Calcific Valve Disease. Front Cardiovasc Med 2018; 5:155. [PMID: 30460245 PMCID: PMC6232262 DOI: 10.3389/fcvm.2018.00155] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 10/10/2018] [Indexed: 12/15/2022] Open
Abstract
Cardiovascular calcification is an independent risk factor and an established predictor of adverse cardiovascular events. Despite concomitant factors leading to atherosclerosis and heart valve disease (VHD), the latter has been identified as an independent pathological entity. Calcific aortic valve stenosis is the most common form of VDH resulting of either congenital malformations or senile “degeneration.” About 2% of the population over 65 years is affected by aortic valve stenosis which represents a major cause of morbidity and mortality in the elderly. A multifactorial, complex and active heterotopic bone-like formation process, including extracellular matrix remodeling, osteogenesis and angiogenesis, drives heart valve “degeneration” and calcification, finally causing left ventricle outflow obstruction. Surgical heart valve replacement is the current therapeutic option for those patients diagnosed with severe VHD representing more than 20% of all cardiac surgeries nowadays. Tissue Engineering of Heart Valves (TEHV) is emerging as a valuable alternative for definitive treatment of VHD and promises to overcome either the chronic oral anticoagulation or the time-dependent deterioration and reintervention of current mechanical or biological prosthesis, respectively. Among the plethora of approaches and stablished techniques for TEHV, utilization of different cell sources may confer of additional properties, desirable and not, which need to be considered before moving from the bench to the bedside. This review aims to provide a critical appraisal of current knowledge about calcific VHD and to discuss the pros and cons of the main cell sources tested in studies addressing in vitro TEHV.
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Affiliation(s)
- Eva Jover
- Bristol Medical School (Translational Health Sciences), Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Marco Fagnano
- Bristol Medical School (Translational Health Sciences), Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Gianni Angelini
- Bristol Medical School (Translational Health Sciences), Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Paolo Madeddu
- Bristol Medical School (Translational Health Sciences), Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
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Loger K, Engel A, Haupt J, Li Q, Lima de Miranda R, Quandt E, Lutter G, Selhuber-Unkel C. Cell adhesion on NiTi thin film sputter-deposited meshes. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2015; 59:611-616. [PMID: 26652414 DOI: 10.1016/j.msec.2015.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/10/2015] [Accepted: 10/02/2015] [Indexed: 02/04/2023]
Abstract
Scaffolds for tissue engineering enable the possibility to fabricate and form biomedical implants in vitro, which fulfill special functionality in vivo. In this study, free-standing Nickel–Titanium(NiTi) thin film mesheswere produced by means of magnetron sputter deposition.Meshes contained precisely defined rhombic holes in the size of 440 to 1309 μm2 and a strut width ranging from 5.3 to 9.2 μm. The effective mechanical properties of the microstructured superelastic NiTi thin film were examined by tensile testing. These results will be adapted for the design of the holes in the film. The influence of hole and strut dimensions on the adhesion of sheep autologous cells (CD133+) was studied after 24 h and after seven days of incubation. Optical analysis using fluorescence microscopy and scanning electron microscopy showed that cell adhesion depends on the structural parameters of the mesh. After 7 days in cell culture a large part of the mesh was covered with aligned fibrous material. Cell adhesion is particularly facilitated on meshes with small rhombic holes of 440 μm2 and a strut width of 5.3 μm. Our results demonstrate that free-standing NiTi thin film meshes have a promising potential for applicationsin cardiovascular tissue engineering, particularly for the fabrication of heart valves.
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Affiliation(s)
- K Loger
- Inorganic Functional Materials, Institute for Materials Science, Faculty of Engineering, University of Kiel, Germany
| | - A Engel
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - J Haupt
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Q Li
- Biocompatible Nanomaterials, Institute for Materials Science, Faculty of Engineering, University of Kiel, Germany
| | - R Lima de Miranda
- Inorganic Functional Materials, Institute for Materials Science, Faculty of Engineering, University of Kiel, Germany; ACQUANDAS GmbH, Kiel, Germany
| | - E Quandt
- Inorganic Functional Materials, Institute for Materials Science, Faculty of Engineering, University of Kiel, Germany
| | - G Lutter
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - C Selhuber-Unkel
- Biocompatible Nanomaterials, Institute for Materials Science, Faculty of Engineering, University of Kiel, Germany
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Abstract
Heart disease, including valve pathologies, is the leading cause of death worldwide. Despite the progress made thanks to improving transplantation techniques, a perfect valve substitute has not yet been developed: once a diseased valve is replaced with current technologies, the newly implanted valve still needs to be changed some time in the future. This situation is particularly dramatic in the case of children and young adults, because of the necessity of valve growth during the patient's life. Our review focuses on the current status of heart valve (HV) therapy and the challenges that must be solved in the development of new approaches based on tissue engineering. Scientists and physicians have proposed tissue-engineered heart valves (TEHVs) as the most promising solution for HV replacement, especially given that they can help to avoid thrombosis, structural deterioration and xenoinfections. Lastly, TEHVs might also serve as a model for studying human valve development and pathologies.
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Zhang S, Zhang F, Feng B, Fan Q, Yang F, Shang D, Sui J, Zhao H. Hematopoietic stem cell capture and directional differentiation into vascular endothelial cells for metal stent-coated chitosan/hyaluronic acid loading CD133 antibody. Tissue Eng Part A 2014; 21:1173-83. [PMID: 25404533 DOI: 10.1089/ten.tea.2014.0352] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
A series of metal stents coated with chitosan/hyaluronic acid (CS/HA) loading antibodies by electrostatic self-assembled method were prepared, and the types of cells captured by antibodies and their differentiation in vascular endothelial cells (ECs) evaluated by molecular biology and scanning electron microscope. The results showed that CD133 stent can selectively capture hematopoietic stem cells (HSC),which directionally differentiate into vascular ECs in peripheral blood by (CS/HA) induction, and simultaneously inhibit migration and proliferation of immune cells and vascular smooth muscle cells (MCs). CD34 stent can capture HSC, hematopoietic progenitor cells that differentiate into vascular ECs and immune cells, promoting smooth MCs growth, leading to thrombosis, inflammation, and rejection. CD133 stent can be implanted into miniature pig heart coronary and can repair vascular damage by capturing own HSC, thus contributing to the rapid natural vascular repair, avoiding inflammation and rejection, thrombosis and restenosis. These studies demonstrated that CD133 stent of HSC capture will be an ideal coated metal stent providing a new therapeutic approach for cardiovascular and cerebrovascular disease.
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Affiliation(s)
- Shixuan Zhang
- 1 State Key Laboratory of Fine Chemicals, School of Pharmaceutical Science and Technology, Dalian University of Technology , Dalian, China
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Le Huu A, Shum-Tim D. Tissue engineering of autologous heart valves: a focused update. Future Cardiol 2013; 10:93-104. [PMID: 24344666 DOI: 10.2217/fca.13.96] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The prevalence of valvular heart disease is expected to increase in the coming decades, with an associated rise in valve-related surgeries. Current options for valve prostheses remain limited, essentially confined to mechanical or biological valves. Neither selection provides an optimal balance between structural integrity and associated morbidity. Mechanical valves offer exceptional durability coupled with a considerable risk of thrombogenesis. Conversely, a biological prosthesis affords freedom from anticoagulation, but with a truncated valve lifespan. Tissue-engineered heart valves have been touted as a solution to this dilemma, by offering an immunopriviledged prosthesis combined with resistance from degeneration and the potential to grow. Although the reality of commercially available tissue-engineered heart valves remains distant, this article will highlight the cellular and clinical advancements in recent years.
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Affiliation(s)
- Alice Le Huu
- Division of Cardiac Surgery & Surgical Research, Department of Surgery, The Royal Victoria Hospital, McGill University Health Center, 687 Pine Avenue West, Suite S8.73b, Montreal, Quebec, H3A 1A1, Canada
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Emmert MY, Weber B, Falk V, Hoerstrup SP. Transcatheter tissue engineered heart valves. Expert Rev Med Devices 2013; 11:15-21. [PMID: 24308737 DOI: 10.1586/17434440.2014.864231] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Valvular heart disease represents a leading cause of mortality worldwide. Transcatheter heart valve replacement techniques have been recently introduced into the clinical routine expanding the treatment options for affected patients. However, despite this technical progress toward minimally invasive, transcatheter strategies, the available heart valve prostheses for these techniques are bioprosthetic and associated with progressive degeneration. To overcome such limitations, the concept of heart valve tissue engineering has been repeatedly suggested for future therapy concepts. Ideally, a clinically relevant heart valve tissue engineering concept would combine minimally invasive strategies for both, living autologous valve generation as well as valve implantation. Therefore, merging transcatheter techniques with living tissue engineered heart valves into a trascatheter tissue engineered heart valve concept could significantly improve current treatment options for patients suffering from valvular heart disease. This report provides an overview on transcatheter tissue engineered heart valves and summarizes available pre-clinical data.
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Affiliation(s)
- Maximilian Y Emmert
- Swiss Center for Regenerative Medicine, University of Zurich, Switzerland and
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