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Birbach M, Fedorowicz M, Gałkowska EM, Powirska A, Kozłowski M, Mozol K, Wasiak A, Maruszewski B, Kansy A. Using cryopreserved allogeneic pericardium to repair congenital heart defects in children. Cell Tissue Bank 2024; 25:99-109. [PMID: 37792171 PMCID: PMC10902029 DOI: 10.1007/s10561-023-10089-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/01/2023] [Indexed: 10/05/2023]
Abstract
Patches prepared from autologous, allogeneic, or xenogeneic tissues are widely used in the repair of congenital heart defects in children. Since 2002, cryopreserved allogeneic pericardial patches have been prepared in our institution as an alternative to commercially available patches. This study retrospectively reviewed donor and patient data concerning cryopreservation time and the clinical use of the pericardium in 382 children who were operated on at a single center between 2004 and 2021. There were 177 donors: 98 males and 79 females. The median donor age was 13 years (range: 1 month to 53 years) and the median cryopreservation time was 72 days (range: 3-685). There were 382 pediatric patients: 224 males and 158 females. The median patient age was 1 month (range: 3 days to 17.8 years). The patches were used for primary surgeries in 228 patients and for reoperations in 154. The patches were implanted into the right heart or venous circulation in 209 patients, the left heart or arterial circulation in 246 patients, and both sides of the circulatory system in 73. Extracardiac patch implantation was performed in 339 patients, intracardiac in 79 patients, and both intracardiac and extracardiac in 36 patients. Our study presents a single-center experience in the use of cryopreserved allogeneic pericardium. The pericardium can be used on the systemic and pulmonary sides of the circulatory system, in either extracardiac or intracardiac positions. However, there is no uniform strategy for selecting the "patch of choice" for correcting congenital heart defects in children, especially since there are few studies comparing several types of patches.
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Affiliation(s)
- Mariusz Birbach
- Department of Pediatric Cardiothoracic Surgery, The Children's Memorial Health Institute, Aleja Dzieci Polskich 20, 04-730, Warsaw, Poland.
- Allograft Heart Valve Cryobank, The Children's Memorial Health Institute, Aleja Dzieci Polskich 20, 04-730, Warsaw, Poland.
| | - Maciej Fedorowicz
- Allograft Heart Valve Cryobank, The Children's Memorial Health Institute, Aleja Dzieci Polskich 20, 04-730, Warsaw, Poland
| | - Ewa M Gałkowska
- Allograft Heart Valve Cryobank, The Children's Memorial Health Institute, Aleja Dzieci Polskich 20, 04-730, Warsaw, Poland
| | - Agnieszka Powirska
- Allograft Heart Valve Cryobank, The Children's Memorial Health Institute, Aleja Dzieci Polskich 20, 04-730, Warsaw, Poland
| | - Michał Kozłowski
- Department of Pediatric Cardiothoracic Surgery, The Children's Memorial Health Institute, Aleja Dzieci Polskich 20, 04-730, Warsaw, Poland
| | - Krzysztof Mozol
- Department of Pediatric Cardiothoracic Surgery, The Children's Memorial Health Institute, Aleja Dzieci Polskich 20, 04-730, Warsaw, Poland
| | - Aleksandra Wasiak
- Department of Pediatric Cardiothoracic Surgery, The Children's Memorial Health Institute, Aleja Dzieci Polskich 20, 04-730, Warsaw, Poland
| | - Bohdan Maruszewski
- Department of Pediatric Cardiothoracic Surgery, The Children's Memorial Health Institute, Aleja Dzieci Polskich 20, 04-730, Warsaw, Poland
| | - Andrzej Kansy
- Department of Pediatric Cardiothoracic Surgery, The Children's Memorial Health Institute, Aleja Dzieci Polskich 20, 04-730, Warsaw, Poland
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Patukale AA, Marathe SP, Betts KS, Daley M, Shetty G, Anand A, Suna J, Andrews D, Karl TR, Brizard C, Venugopal P, Alphonso N. CardioCel® for repair of congenital heart defects: nationwide results of over 1000 implants. Eur J Cardiothorac Surg 2023; 64:ezad343. [PMID: 37846036 DOI: 10.1093/ejcts/ezad343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 09/09/2023] [Accepted: 10/13/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVES To assess the mid-term performance of CardioCel for the repair of congenital heart defects. METHODS Data were retrospectively collected from databases and hospital records in 3 congenital cardiac surgery centres in Australia. Kaplan-Meier curves and log-rank tests were used to test for associations between patient age, gender, patch type and site of implantation. Multivariable Cox regression was used to test whether any specific implantation site was associated with reintervention risk, after adjusting for age group, gender and patch type. RESULTS A total of 1184 CardioCel patches were implanted in 752 patients under the age of 18 years. Median age at implant was 12 months [interquartile range (IQR) 3.6-84]. Median follow-up was 2.1 years (IQR 0.6-4.6). Probability of freedom from CardioCel-related reintervention was 93% [95% confidence interval (CI) 91-95] at 1 year, 91% (95% CI 88-93) at 3 years and 88% (95% CI 85-91) at 5 years, respectively. On multivariable regression analysis, aortic valve repair had a higher incidence of reintervention [hazard ratio (HR) = 7.15, P = 0.008] compared to other sites. The probability of reintervention was higher in neonates (HR = 6.71, P = 0.0007), especially when used for augmentation of the pulmonary arteries (HR = 14.38, P = 0.029), as compared to other age groups. CONCLUSIONS CardioCel can be used for the repair of a variety of congenital heart defects. In our study, in patients receiving a CardioCel implant, reinterventions were higher when CardioCel was used to augment the pulmonary arteries in neonates and for aortic valve repair as compared to other sites.
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Affiliation(s)
- Aditya A Patukale
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children's Hospital, Brisbane, Australia
- School of Clinical Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, Australia
- Queensland Paediatric Cardiac Research (QPCR), Brisbane, Australia
| | - Supreet P Marathe
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children's Hospital, Brisbane, Australia
- School of Clinical Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, Australia
- Queensland Paediatric Cardiac Research (QPCR), Brisbane, Australia
| | - Kim S Betts
- School of Population Health, Curtin University, Perth, Australia
| | - Michael Daley
- Queensland Paediatric Cardiac Research (QPCR), Brisbane, Australia
- The Prince Charles Hospital, Brisbane, Australia
| | - Gautham Shetty
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children's Hospital, Brisbane, Australia
- School of Clinical Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, Australia
- Queensland Paediatric Cardiac Research (QPCR), Brisbane, Australia
| | - Abhishek Anand
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children's Hospital, Brisbane, Australia
- School of Clinical Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, Australia
- Queensland Paediatric Cardiac Research (QPCR), Brisbane, Australia
| | - Jessica Suna
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children's Hospital, Brisbane, Australia
- School of Clinical Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, Australia
- Queensland Paediatric Cardiac Research (QPCR), Brisbane, Australia
| | - David Andrews
- Cardiothoracic Surgery Department, Perth Children's Hospital, Perth, Australia
| | - Tom R Karl
- School of Clinical Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, Australia
- Queensland Paediatric Cardiac Research (QPCR), Brisbane, Australia
| | - Christian Brizard
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
| | - Prem Venugopal
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children's Hospital, Brisbane, Australia
- School of Clinical Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, Australia
- Queensland Paediatric Cardiac Research (QPCR), Brisbane, Australia
| | - Nelson Alphonso
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children's Hospital, Brisbane, Australia
- School of Clinical Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, Australia
- Queensland Paediatric Cardiac Research (QPCR), Brisbane, Australia
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Lewies A, Botes L, van den Heever JJ, Dohmen PM, Smit FE. Monomeric glutaraldehyde fixation and amino acid detoxification of decellularized bovine pericardium for production of biocompatible tissue with tissue-guided regenerative potential. Heliyon 2023; 9:e19712. [PMID: 37809671 PMCID: PMC10559009 DOI: 10.1016/j.heliyon.2023.e19712] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 08/23/2023] [Accepted: 08/30/2023] [Indexed: 10/10/2023] Open
Abstract
The effect of monomeric glutaraldehyde fixation and amino acid detoxification on biocompatibility and tissue-guided regenerative potential of decellularized bovine pericardium was evaluated. The degree of cross-linking, porosity, enzymatic degradation, alpha-galactosyl content, the efficacy of detoxification, and cytotoxicity towards human epithelial cells were assessed. Tissue was subcutaneously implanted for eight weeks in male juvenile Sprague-Dawley rats, and mechanical properties, host cell infiltration, and calcification were evaluated. Three groups were compared i) decellularized tissue, ii) decellularized, monomeric glutaraldehyde fixed and amino acid detoxified tissue, and iii) commercial glutaraldehyde fixed non-decellularized tissue (Glycar®) (n = 6 rats per group). The fixation process gave a high degree of cross-linking (>85%), and was resistant to enzymatic degradation, with no significant effect on porosity. The detoxification process was effective, and the tissue was not toxic to mammalian cells in vitro. Tissue from both decellularized groups had significantly higher (p < 0.05) porosity and host cell infiltration in vivo. The process mitigated calcification. A non-significant decrease in the alpha-galactosyl content was observed, which increased when including the alpha-galactosidase enzyme. Mechanical properties were maintained. The fixation and detoxification process adequately removes free aldehyde groups and reduces toxicity, preventing enzymatic degradation and allowing for host cell infiltration while mitigating calcification and retaining the mechanical properties of the tissue. This process can be considered for processing decellularized bovine pericardium with tissue-guided regeneration potential for use in cardiovascular bioprostheses; however, methods of further reducing antigenicity, such as the use of enzymes, should be investigated.
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Affiliation(s)
- Angélique Lewies
- Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Lezelle Botes
- Department of Health Sciences, Central University of Technology, Free State, Bloemfontein, South Africa
| | | | - Pascal Maria Dohmen
- Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
- Department of Cardiac Surgery, Heart Centre Rostock, University of Rostock, Germany
| | - Francis Edwin Smit
- Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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Patukale AA, Suna J, Anand A, Betts KS, Karl TR, Venugopal P, Marathe SP, Alphonso N. Performance of CardioCel in Cardiac Surgery: A Systematic Review. World J Pediatr Congenit Heart Surg 2023; 14:211-219. [PMID: 36823973 DOI: 10.1177/21501351221149416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
A systematic review was performed for evaluation of the performance of CardioCel® in cardiac surgery. The review included all studies published from January 2013 to December 2020. We conclude that CardioCel is a strong, flexible tissue substitute with good handling characteristics and a low incidence of thrombosis, aneurysm formation, infection, or structural degeneration. It can be used for a variety of intracardiac and extracardiac repairs of congenital heart defects in all age groups with good durability at mid-term follow-up. However, the use of CardioCel in certain positions requires caution. Information on the long-term performance of CardioCel is lacking.
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Affiliation(s)
- Aditya A Patukale
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children's Hospital, Brisbane, Australia
- School of Clinical Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, Australia
- Centre for Child Health Research, University of Queensland, Brisbane, Australia
| | - Jessica Suna
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children's Hospital, Brisbane, Australia
- School of Clinical Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, Australia
- Centre for Child Health Research, University of Queensland, Brisbane, Australia
| | - Abhishek Anand
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children's Hospital, Brisbane, Australia
- School of Clinical Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, Australia
- Centre for Child Health Research, University of Queensland, Brisbane, Australia
| | - Kim S Betts
- School of Population Health, Curtin University, Perth, Australia
| | - Tom R Karl
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children's Hospital, Brisbane, Australia
- School of Clinical Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, Australia
- Centre for Child Health Research, University of Queensland, Brisbane, Australia
| | - Prem Venugopal
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children's Hospital, Brisbane, Australia
- School of Clinical Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, Australia
- Centre for Child Health Research, University of Queensland, Brisbane, Australia
| | - Supreet P Marathe
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children's Hospital, Brisbane, Australia
- School of Clinical Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, Australia
- Centre for Child Health Research, University of Queensland, Brisbane, Australia
| | - Nelson Alphonso
- Queensland Paediatric Cardiac Service (QPCS), Queensland Children's Hospital, Brisbane, Australia
- School of Clinical Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, Australia
- Centre for Child Health Research, University of Queensland, Brisbane, Australia
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Chernysheva MG, Chaschin IS, Badun GA, Vasil’ev VG, Mikheev IV, Shen T, Sinolits MA, Bakuleva NP. Novel nanodiamond coatings for durable xenogenic heart valve prostheses: Mechanical properties and in vivo stability. Colloids Surf A Physicochem Eng Asp 2023. [DOI: 10.1016/j.colsurfa.2022.130373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Li Q, Gao Y, Zhang J, Tang Y, Yangyong S, Wu L, Wu H, Shen M, Liu X, Han L, Xu Z. Crosslinking and functionalization of acellular patches via the self-assembly of copper@tea polyphenol nanoparticles. Regen Biomater 2022; 9:rbac030. [PMID: 35665201 PMCID: PMC9157057 DOI: 10.1093/rb/rbac030] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/01/2022] [Accepted: 04/17/2022] [Indexed: 11/13/2022] Open
Abstract
Decellularization is a promising technique to produce natural scaffolds for tissue engineering applications. However, non-crosslinked natural scaffolds disfavor application in cardiovascular surgery due to poor biomechanics and rapid degradation. Herein, we proposed a green strategy to crosslink and functionalize acellular scaffolds via the self-assembly of copper@tea polyphenol nanoparticles (Cu@TP NPs), and the resultant nanocomposite acellular scaffolds were named as Cu@TP-dBPs. The crosslinking degree, biomechanics, denaturation temperature and resistance to enzymatic degradation of Cu@TP-dBPs were comparable to those of glutaraldehyde crosslinked decellularized bovine pericardias (Glut-dBPs). Furthermore, Cu@TP-dBPs were biocompatible and had abilities to inhibit bacterial growth and promote the formation of capillary-like networks. Subcutaneous implantation models demonstrated that Cu@TP-dBPs were free of calcification and allowed for host cell infiltration at Day 21. Cardiac patch graft models confirmed that Cu@TP-dBP patches showed improved ingrowth of functional blood vessels and remodeling of extracellular matrix at Day 60. These results suggested that Cu@TP-dBPs not only had comparable biomechanics and biostability to Glut-dBPs, but also had several advantages over Glut-dBPs in terms of anticalcification, remodeling and integration capabilities. Particularly, they were functional patches possessing antibacterial and proangiogenic activities. These material properties and biological functions made Cu@TP-dBPs a promising functional acellular patch for cardiovascular applications.
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Affiliation(s)
- Qin Li
- Department of Cardiovascular Lab, Institute of Cardiothoracic Surgery, Changhai Hospital, Shanghai, China
| | - Yuan Gao
- Institute of Cardiovascular Surgery, Changhai Hospital, Shanghai, China
| | - Jiajun Zhang
- Institute of Cardiovascular Surgery, Changhai Hospital, Shanghai, China
| | - Yangfeng Tang
- Institute of Cardiovascular Surgery, Changhai Hospital, Shanghai, China
| | - Shun Yangyong
- Department of Cardiovascular Lab, Institute of Cardiothoracic Surgery, Changhai Hospital, Shanghai, China
| | - Lujia Wu
- Department of Cardiovascular Lab, Institute of Cardiothoracic Surgery, Changhai Hospital, Shanghai, China
| | - Hao Wu
- Department of Cardiovascular Lab, Institute of Cardiothoracic Surgery, Changhai Hospital, Shanghai, China
| | - Meifang Shen
- Institute of Cardiovascular Surgery, Changhai Hospital, Shanghai, China
| | - Xiaohong Liu
- Department of Cardiovascular Lab, Institute of Cardiothoracic Surgery, Changhai Hospital, Shanghai, China
| | - Lin Han
- Institute of Cardiovascular Surgery, Changhai Hospital, Shanghai, China
| | - Zhiyun Xu
- Department of Cardiovascular Lab, Institute of Cardiothoracic Surgery, Changhai Hospital, Shanghai, China
- Institute of Cardiovascular Surgery, Changhai Hospital, Shanghai, China
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7
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Laughlin M, Kapales M, Thakali K, Girardot M, Jensen M. Glutaraldehyde fixation of venous valve tissue: A benchmark for alternative fixation methods. Phlebology 2022; 37:296-302. [DOI: 10.1177/02683555221077669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Bioprosthetic venous valves have yet to achieve long-term patency due to issues with calcification following implantation that is influenced by current xenograft fixation methods, most notably glutaraldehyde. The goal of this study was to investigate the effects of glutaraldehyde fixation on the functional properties of venous tissue to establish a benchmark for the evaluation of alternative fixation methods. Methods The degree of crosslinking was evaluated by determining shrink temperature and the stability of tissue with pronase and collagenase digestion. Results Glutaraldehyde fixation of venous tissue was confirmed by a significant difference in the shrink temperature between fresh and glutaraldehyde treated samples. Significant differences in the amount of tissue remaining following digestion were observed for venous versus cardiac tissue. Conclusions This study demonstrates the importance of tissue-specific evaluation in the development of alternative xenograft fixation methods to improve outcomes with bioprosthetic venous valves.
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Affiliation(s)
- Megan Laughlin
- Department of Biomedical Engineering, University of Arkansas Fayetteville, Fayetteville, AR, USA
| | - Makenzie Kapales
- Department of Biomedical Engineering, University of Arkansas Fayetteville, Fayetteville, AR, USA
| | - Keshari Thakali
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Arkansas Children’s Nutrition Center, Little Rock, AR, USA
| | | | - Morten Jensen
- Department of Biomedical Engineering, University of Arkansas Fayetteville, Fayetteville, AR, USA
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Botes L, Laker L, Dohmen PM, van den Heever JJ, Jordaan CJ, Lewies A, Smit FE. Advantages of decellularized bovine pericardial scaffolds compared to glutaraldehyde fixed bovine pericardial patches demonstrated in a 180-day implant ovine study. Cell Tissue Bank 2022; 23:791-805. [PMID: 35037183 DOI: 10.1007/s10561-021-09988-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 12/19/2021] [Indexed: 12/12/2022]
Abstract
Glutaraldehyde (GA)-fixed bovine pericardial patches remain the cardiovascular industry standard despite reports of degradation, thickening, inflammation, calcification and lack of tissue remodelling. Decellularization provides the opportunity to attenuate some of these immune-mediated processes. This study compared the mechanical and morphological integrity of bovine pericardium that is GA-fixated (Glycar® patches) or decellularized (BPS), using a proprietary protocol, following implantation in an ovine model. The impact of the processing methods on tissue strength and morphology was assessed prior to implantation. Pericardial patches were then implanted in the descending aorta and main pulmonary artery of juvenile sheep (n = 6 per group) for 180 days, and clinically evaluated using echocardiography. At explanation, patches were evaluated for strength, calcification and biological interaction. Histology demonstrated a wave-like appearance of well-separated collagen fibers for BPS scaffolds that provided pore sizes adequate to promote fibroblast infiltration. The collagen of the Glycar® patches showed loss of collagen fiber integrity, making the collagen densely compacted, contributing to insignificant recipient cell infiltration. The clinical performance of both groups was excellent, and echocardiography confirmed the absence of aneurysm formation, calcification and degeneration. Explanted Glycar® patches demonstrated cells in abundance within the fibrous encapsulation that separated the implant from the host tissue. More importantly, the fibrous encapsulation also contributed to patch thickening of both the explanted aorta and pulmonary patches. The decellularized pericardial scaffolds demonstrated recellularization, resistance to calcification, re-endothelialization and adequate strength after 180-day implantation. The proprietary decellularization protocol produced pericardial scaffolds that could be considered as an alternative to GA-fixed pericardial patches.
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Affiliation(s)
- L Botes
- Department of Health Sciences, Central University of Technology, Free State (CUT) Private Bag X20539, Bloemfontein, 9300, South Africa.
| | - L Laker
- Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State (UFS), (Internal Box G32), P.O. Box 339, Bloemfontein, 9300, South Africa
| | - P M Dohmen
- Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State (UFS), (Internal Box G32), P.O. Box 339, Bloemfontein, 9300, South Africa.,Klinikdirektor (k), Klinik und Poliklinik für Herzchirurgie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - J J van den Heever
- Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State (UFS), (Internal Box G32), P.O. Box 339, Bloemfontein, 9300, South Africa
| | - C J Jordaan
- Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State (UFS), (Internal Box G32), P.O. Box 339, Bloemfontein, 9300, South Africa
| | - A Lewies
- Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State (UFS), (Internal Box G32), P.O. Box 339, Bloemfontein, 9300, South Africa
| | - F E Smit
- Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State (UFS), (Internal Box G32), P.O. Box 339, Bloemfontein, 9300, South Africa
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Liu Z, Wang Y, Xie F, Liu X, Li F, Dong N. Elimination of macrophages reduces glutaraldehyde-fixed porcine heart valve degeneration in mice subdermal model. Pharmacol Res Perspect 2021; 9:e00716. [PMID: 33523576 PMCID: PMC7849454 DOI: 10.1002/prp2.716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/21/2020] [Indexed: 01/01/2023] Open
Abstract
Glutaraldehyde-fixed porcine heart valve (GPHV) calcify and deteriorate over time. The aim of this study was to explore the roles macrophages play in mediating calcification and degeneration of the valve's connective tissue matrix. GPHV were implanted subcutaneously in the abdomens of C57BL/6 mice. The mice were equally divided into two study groups: (a) GPHV +phosphate buffered saline (PBS) liposomes, and (b) GPHV +clodronate liposomes. GPHV were collected for further analyses at 4 weeks post implant. Macrophages were almost depleted from the spleens of mice injected with clodronate liposomes as indicated by immunohistochemical staining. Furthermore, the expression of matrix metalloproteinase-2 (MMP-2), MMP-9, and proinflammatory cytokines like IL-1β, IL-6, MCP-1, MIP-1a, MIP-1b, were downregulated in the GPHV +Clodronate liposomal group compared with the GPHV+PBS liposomal group. Clodronate liposomal treatment led to significant decreases in the expression of RUNX2, ALP and OPN as well as less calcium deposits in GPHVs compared with PBS liposomal treatment. This finding indicated that infiltrating macrophages are critically involved in the development of calcification and deterioration in GPHVs. Macrophage depletion by clodronate liposomes decreased the extent of GPHV's calcification and deterioration.
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Affiliation(s)
- Zongtao Liu
- Department of Cardiovascular SurgeryUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Yixuan Wang
- Department of Cardiovascular SurgeryUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Fei Xie
- Department of Cardiovascular SurgeryUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Xing Liu
- Department of Cardiovascular SurgeryUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Fei Li
- Department of Cardiovascular SurgeryUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Nianguo Dong
- Department of Cardiovascular SurgeryUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
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Deutsch O, Bruehl F, Cleuziou J, Prinzing A, Schlitter AM, Krane M, Lange R. Histological examination of explanted tissue-engineered bovine pericardium following heart valve repair. Interact Cardiovasc Thorac Surg 2020; 30:64-73. [PMID: 31605480 DOI: 10.1093/icvts/ivz234] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 07/30/2019] [Accepted: 08/16/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Our goal was to present histopathological findings of human explants of a tissue-engineered bovine pericardium CardioCel (Admedus Regen Pty Ltd, Malaga, WA, Australia) used for heart valve repair in patients with congenital and acquired heart valve disease. METHODS Sixty patients underwent heart valve repair from May 2014 to November 2018 using CardioCel as a substitute for valve tissue. We identified 9 cases in which the CardioCel patch was explanted following valve repair and available for histomorphological analyses. CardioCel explants were evaluated histologically using haematoxylin and oeosin, Elastica van Gieson and immunohistochemical stains. RESULTS The indications for explantation were related to the CardioCel patch in 6 patients. Median time between the implantation and explantation was 242 (range 3-1247) days. We demonstrated a characteristic remodelling pattern with superficial coating of the tissue-engineered bovine pericardium by granulation tissue composed of histiocytes, few lymphocytes and fibrin. We had 2 cases with a multifocal nodular disruption, fragmentation and sclerosis of the decellularized collagen matrix with focal calcification after 795 and 1247 days in situ. CONCLUSIONS Our data suggest that the tissue-engineered CardioCel patch is initially tolerated in the valvular position in the majority of patients. However, we also experienced graft failures that showed degeneration with fragmentation of the collagen matrix and even 2 cases with focal calcification evident from the histopathological analysis. Further analyses of mid- and long-term performance are mandatory.
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Affiliation(s)
- Oliver Deutsch
- Department of Cardiovascular Surgery, German Heart Centre Munich, Munich, Germany.,INSURE-Institute for Translational Cardiac Surgery, German Heart Centre Munich, Munich, Germany
| | - Frido Bruehl
- Institute for Pathology, Technical University Munich, Munich, Germany
| | - Julie Cleuziou
- INSURE-Institute for Translational Cardiac Surgery, German Heart Centre Munich, Munich, Germany.,Department of Congenital and Pediatric Heart Surgery, German Heart Centre Munich, Munich, Germany
| | - Anatol Prinzing
- Department of Cardiovascular Surgery, German Heart Centre Munich, Munich, Germany.,INSURE-Institute for Translational Cardiac Surgery, German Heart Centre Munich, Munich, Germany
| | | | - Markus Krane
- Department of Cardiovascular Surgery, German Heart Centre Munich, Munich, Germany.,INSURE-Institute for Translational Cardiac Surgery, German Heart Centre Munich, Munich, Germany
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Centre Munich, Munich, Germany.,INSURE-Institute for Translational Cardiac Surgery, German Heart Centre Munich, Munich, Germany
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Bell D, Betts K, Justo R, Forde N, Venugopal P, Corno AF, Smith P, Caputo M, Marsico R, Karl TR, Alphonso N. Multicenter Experience With 500 CardioCel Implants Used for the Repair of Congenital Heart Defects. Ann Thorac Surg 2019; 108:1883-1888. [DOI: 10.1016/j.athoracsur.2019.04.085] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/14/2019] [Accepted: 04/24/2019] [Indexed: 10/26/2022]
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12
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Chivers SC, Pavy C, Vaja R, Quarto C, Ghez O, Daubeney PEF. The Ozaki Procedure With CardioCel Patch for Children and Young Adults With Aortic Valve Disease: Preliminary Experience – a Word of Caution. World J Pediatr Congenit Heart Surg 2019; 10:724-730. [DOI: 10.1177/2150135119878108] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background: The Ozaki procedure is a surgical technique for patients with significant aortic stenosis or regurgitation or both where valve repair cannot be performed. Individual cusps are cut from glutaraldehyde-treated autologous pericardium or bovine pericardium and implanted into the aortic valve position. Encouraging results have been reported within the adult population. There are limited published data on success of this procedure in younger patients. Methods: We present a series of five children and young adults who underwent the Ozaki procedure with neoaortic valve cusps made from CardioCel, a decellularized bovine pericardial patch treated with a monomeric glutaraldehyde. Results: There were no complications in the initial postoperative period and short inpatient stay. At a mean follow-up of 29.6 months (range: 22-36 months), 4 patients had no evidence of stenosis and 3 patients had trivial or no regurgitation from the neoaortic valve. Overall, two patients had complications related to the valve and underwent reintervention during the follow-up period with a Ross procedure. One of these patients who was not taking long-term anticoagulation experienced a transient ischemic attack. Conclusions: Our experience demonstrates that the Ozaki procedure with CardioCel in pediatric and young adult patients should be approached with caution. Further research with larger groups of pediatric patients, comparison of different graft materials, and longer follow-up is required to ascertain long-term success in children.
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Affiliation(s)
- Sian C. Chivers
- Royal Brompton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Carine Pavy
- Royal Brompton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Ricky Vaja
- Royal Brompton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Cesare Quarto
- Royal Brompton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Olivier Ghez
- Royal Brompton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Piers E. F. Daubeney
- Royal Brompton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College, London, United Kingdom
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Pavy C, Michielon G, Robertus JL, Lacour-Gayet F, Ghez O. Initial 2-year results of CardioCel® patch implantation in children. Interact Cardiovasc Thorac Surg 2019; 26:448-453. [PMID: 29069409 DOI: 10.1093/icvts/ivx295] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 08/03/2017] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES We present the initial 2-year results of CardioCel® patch (Admedus Regen Pty Ltd, Perth, WA, Australia) implantation in paediatric patients with congenital heart diseases. METHODS This was a single-centre retrospective study with prospectively collected data of all patients aged 18 years and under operated for congenital heart disease. The patch was introduced in 2014, with clinical practice committee approval and a special consent in case of an Ozaki procedure. Standard follow-up was performed with systematic clinical exams and echocardiograms. In case of reoperation or graft failure, the patch was removed and sent for a histological examination. RESULTS Between March 2014 and April 2016, 101 patients had surgical repair using a CardioCel patch. The mean age was 22 (±36.3) months, and the mean weight was 9.7 (±10.3) kg. No infections and no intraoperative implantation difficulties were associated with the patch. The median follow-up period was 212 (range 4-726) days. The overall 30-day postoperative mortality was 3.8% (n = 4), none of which were related to graft failure. Five children were reoperated because of graft failure, 4 of whom had the patch implanted for aortic and were aged less than 10 days. The indications for patch implantation in the aortic position were aortopulmonary window, truncus arteriosus, coarctation and aortic arch hypoplasia repair. The median time between the first and the second operation for graft failure was 245 (range 5-480) days. CONCLUSIONS Our experience shows that the patch is well tolerated in the septal, valvar and pulmonary artery positions. However, we experienced graft failures in infants in the aortic position.
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Affiliation(s)
- Carine Pavy
- Department of Cardiac Surgery, Royal Brompton Hospital, London, UK
| | - Guido Michielon
- Department of Cardiac Surgery, Royal Brompton Hospital, London, UK
| | | | | | - Olivier Ghez
- Department of Cardiac Surgery, Royal Brompton Hospital, London, UK
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Preservation strategies for decellularized pericardial scaffolds for off-the-shelf availability. Acta Biomater 2019; 84:208-221. [PMID: 30342283 DOI: 10.1016/j.actbio.2018.10.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/26/2018] [Accepted: 10/16/2018] [Indexed: 02/06/2023]
Abstract
Decellularized biological scaffolds hold great promise in cardiovascular surgery. In order to ensure off-the-shelf availability, routine use of decellularized scaffolds requires tissue banking. In this study, the suitability of cryopreservation, vitrification and freeze-drying for the preservation of decellularized bovine pericardial (DBP) scaffolds was evaluated. Cryopreservation was conducted using 10% DMSO and slow-rate freezing. Vitrification was performed using vitrification solution (VS83) and rapid cooling. Freeze-drying was done using a programmable freeze-dryer and sucrose as lyoprotectant. The impact of the preservation methods on the DBP extracellular matrix structure, integrity and composition was assessed using histology, biomechanical testing, spectroscopic and thermal analysis, and biochemistry. In addition, the cytocompatibility of the preserved scaffolds was also assessed. All preservation methods were found to be suitable to preserve the extracellular matrix structure and its components, with no apparent signs of collagen deterioration or denaturation, or loss of elastin and glycosaminoglycans. Biomechanical testing, however, showed that the cryopreserved DBP displayed a loss of extensibility compared to vitrified or freeze-dried scaffolds, which both displayed similar biomechanical behavior compared to non-preserved control scaffolds. In conclusion, cryopreservation altered the biomechanical behavior of the DBP scaffolds, which might lead to graft dysfunction in vivo. In contrast to cryopreservation and vitrification, freeze-drying is performed with non-toxic protective agents and does not require storage at ultra-low temperatures, thus allowing for a cost-effective and easy storage and transport. Due to these advantages, freeze-drying is a preferable method for the preservation of decellularized pericardium. STATEMENT OF SIGNIFICANCE: Clinical use of DBP scaffolds for surgical reconstructions or substitutions requires development of a preservation technology that does not alter scaffold properties during long-term storage. Conclusive investigation on adverse impacts of the preservation methods on DBP matrix integrity is still missing. This work is aiming to close this gap by studying three potential preservation technologies, cryopreservation, vitrification and freeze-drying, in order to achieve the off-the-shelf availability of DBP patches for clinical application. Furthermore, it provides novel insights for dry-preservation of decellularized xenogeneic scaffolds that can be used in the routine clinical cardiovascular practice, allowing the surgeon the opportunity to choose an ideal implant matching with the needs of each patient.
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15
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Bell D, Prabhu S, Betts K, Justo R, Venugopal P, Karl TR, Alphonso N. Durability of tissue-engineered bovine pericardium (CardioCel®) for a minimum of 24 months when used for the repair of congenital heart defects. Interact Cardiovasc Thorac Surg 2018; 28:284-290. [DOI: 10.1093/icvts/ivy246] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/05/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Douglas Bell
- UQ School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Sudesh Prabhu
- Paediatric Cardiac Surgery, Narayana Heath, Bengaluru, Karnataka, India
| | - Kim Betts
- Institute for Social Science Research, University of Queensland, Brisbane, QLD, Australia
| | - Robert Justo
- UQ School of Medicine, University of Queensland, Brisbane, QLD, Australia
- Queensland Paediatric Cardiac Services, LCCH, Brisbane, QLD, Australia
| | - Prem Venugopal
- Queensland Paediatric Cardiac Services, LCCH, Brisbane, QLD, Australia
| | - Tom R Karl
- UQ School of Medicine, University of Queensland, Brisbane, QLD, Australia
- Children’s Heart Institute, Johns Hopkins All Children’s Hospital, St Petersburg, FL, USA
| | - Nelson Alphonso
- UQ School of Medicine, University of Queensland, Brisbane, QLD, Australia
- Queensland Paediatric Cardiac Services, LCCH, Brisbane, QLD, Australia
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Nordmeyer S, Murin P, Schulz A, Danne F, Nordmeyer J, Kretzschmar J, Sumbadze D, Schmitt KRL, Miera O, Cho MY, Sinzobahamvya N, Berger F, Ovroutski S, Photiadis J. Results of aortic valve repair using decellularized bovine pericardium in congenital surgery. Eur J Cardiothorac Surg 2018; 54:986-992. [DOI: 10.1093/ejcts/ezy181] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 04/02/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sarah Nordmeyer
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Center Berlin, Berlin, Germany
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Murin
- Department of Surgery for Congenital Heart Disease and Paediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Antonia Schulz
- Department of Surgery for Congenital Heart Disease and Paediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Friederike Danne
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Johannes Nordmeyer
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Johanna Kretzschmar
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Daria Sumbadze
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | | | - Oliver Miera
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Mi-Young Cho
- Department of Surgery for Congenital Heart Disease and Paediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Nicodeme Sinzobahamvya
- Department of Surgery for Congenital Heart Disease and Paediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Felix Berger
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Stanislav Ovroutski
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Joachim Photiadis
- Department of Surgery for Congenital Heart Disease and Paediatric Cardiology, German Heart Center Berlin, Berlin, Germany
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Tissue processing techniques for fabrication of covered stents for small-diameter vascular intervention. Acta Biomater 2018; 65:248-258. [PMID: 29101018 DOI: 10.1016/j.actbio.2017.10.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 10/13/2017] [Accepted: 10/30/2017] [Indexed: 01/29/2023]
Abstract
Animal-derived pericardial tissue is a widely used biomaterial typically treated with glutaraldehyde (GA) to achieve immunological acceptance and long-term durability. However, GA fixation of biological tissue is associated with long-term failure due to degeneration and calcification. In this study, we evaluated two alternative tissue processing methods for the fabrication of pericardial tissue covered stents: detergent-based decellularization (decell) and limited exposure to GA (gentle-glut). Processed pericardial tissues were extensively characterized both in-vitro and in-vivo. Small-diameter covered stents were fabricated and the ability to seal perforation was evaluated in a flow circuit under physiological blood flow conditions. Results indicate that decell-treated tissue appeared with preserved architecture, tissue strength and stability. Gentle-glut tissue appeared with preserved architecture and increased tissue stability, compared to fresh, unprocessed tissue. Reduction of bioburden was demonstrated for both types of alternative treatments, as for GA fixation. Tensile testing demonstrated that both decell- and gentle-glut treated tissues respond better to low strain, as may occur during balloon inflation and stent deployment. Upon subcutaneous implantation in mice, gentle-glut and to a greater degree decell-treated tissue, elicit better host response, with evidence of active tissue remodeling and no detectable calcification, as compared with GA-treated tissue. Small-diameter stents covered with tissues from all groups successfully sealed perforation under physiological blood flow conditions in-vitro, without compromising flow. In summary, covered stents may perform better with pericardial tissue processed according to the methods described in this study. Adopting this methodology to other types of cardiovascular implants and tissues is also suggested. STATEMENT OF SIGNIFICANCE Pericardial tissue is a widely used biomaterial for cardiovascular implants, such as covered stents. The use of glutaraldehyde (GA) has become the method of choice for pericardial tissue fixation, making it immunologically acceptable in humans. However, GA-treated tissue is prone to several problems, such as degeneration and calcification that may lead to long-term failure. Here, we studied two alternative tissue processing techniques: fixative-free decellularization and limited exposure to GA. We've shown that both methods achieve better mechanical properties and promote better host acceptance, tissue remodeling and long-term durability. Since the availability of autologous tissue for transplantation is limited, these methods should be adopted for other types of cardiovascular devices, such as bioprosthetic valves, ultimately achieving better long-term results for patients.
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van Steenberghe M, Schubert T, Xhema D, Bouzin C, Guiot Y, Duisit J, Abdelhamid K, Gianello P. Enhanced vascular regeneration with chemically/physically treated bovine/human pericardium in rodents. J Surg Res 2017; 222:167-179. [PMID: 29273368 DOI: 10.1016/j.jss.2017.09.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/23/2017] [Accepted: 09/29/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Glutaraldehyde-treated pericardia for cardiovascular applications have poor long-term clinical results. The efficacy of a combined physical/chemical treatment to improve pericardium biocompatibility and vascular regeneration was assessed and compared with detergent treatment and two commercial bovine pericardia: PeriGuard (DGBP) and Edwards pericardium (nDGBP). The physical and chemical process was applied to bovine and human pericardia (DBP-DHP), and the detergent process was applied to bovine (DDBP). MATERIAL AND METHODS Native (NBP) and treated bovine tissues were assessed for decellularization (HE/DAPI/DNA/α-Gal and MHC-1 staining) and mechanical integrity ex vivo. Twenty Wistar rats received subcutaneous patches of each bovine tissue to assess immunogenic response up to 4 months (flow cytometry). Ten additional rats received four subcutaneous bovine-treated patches (one/condition) to evaluate the inflammatory reaction (CD3/CD68 immunostaining), calcification (von Kossa staining/calcium quantification), and integration assessment (Hematoxylin and eosin staining). Finally, 15 rodents received a patch on the aorta (DBP n = 5, DHP n = 5, and DGBP n = 5), and vascular biocompatibility and arterial wall regeneration were assessed after 4 months (CD3/CD68/CD31/ASMA and Miller staining). RESULTS DBP reached the higher level of decellularization, no immunogenic response whereas maintaining mechanical properties. DBP induced the lowest level grade of inflammation after 2 months (P < 0.05) concomitantly for better remodeling. No complications occurred with DBP and DHP where vascular regeneration was confirmed. Moreover, they induced a low level of CD3/CD68 infiltrations. CONCLUSIONS This process significantly reduces immunogenicity and improves biocompatibility of bovine and human pericardia for better vascular regeneration.
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Affiliation(s)
- Mathieu van Steenberghe
- Université catholique de Louvain (UCL), Secteur des Sciences de la Santé, Institut de Recherche expérimentale et clinique (IREC), Pôle de Chirurgie expérimentale et Transplantation (CHEX), Brussels, Belgium.
| | - Thomas Schubert
- Université catholique de Louvain (UCL), Secteur des Sciences de la Santé, Institut de Recherche expérimentale et clinique (IREC), Pôle de Chirurgie expérimentale et Transplantation (CHEX), Brussels, Belgium; Cliniques Universitaires Saint-Luc, Service d'orthopédie et de traumatologie de l'appareil locomoteur, Brussels, Belgium
| | - Daela Xhema
- Université catholique de Louvain (UCL), Secteur des Sciences de la Santé, Institut de Recherche expérimentale et clinique (IREC), Pôle de Chirurgie expérimentale et Transplantation (CHEX), Brussels, Belgium
| | - Caroline Bouzin
- Université catholique de Louvain, IREC Imaging Platform (2IP), Institut de Recherche expérimentale et clinique (IREC), Brussels, Belgium
| | - Yves Guiot
- Cliniques universitaires Saint-Luc, Service d'anatomopathologie, Brussels, Belgium
| | - Jérôme Duisit
- Université catholique de Louvain (UCL), Secteur des Sciences de la Santé, Institut de Recherche expérimentale et clinique (IREC), Pôle de Chirurgie expérimentale et Transplantation (CHEX), Brussels, Belgium
| | - Karim Abdelhamid
- Centre Hospitalier Universitaire Vaudois, polyclinique médicale universitaire, Lausanne, Switzerland
| | - Pierre Gianello
- Université catholique de Louvain (UCL), Secteur des Sciences de la Santé, Institut de Recherche expérimentale et clinique (IREC), Pôle de Chirurgie expérimentale et Transplantation (CHEX), Brussels, Belgium
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19
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Qiao WH, Liu P, Hu D, Al Shirbini M, Zhou XM, Dong NG. Sequential hydrophile and lipophile solubilization as an efficient method for decellularization of porcine aortic valve leaflets: Structure, mechanical property and biocompatibility study. J Tissue Eng Regen Med 2017; 12:e828-e840. [PMID: 27957807 DOI: 10.1002/term.2388] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 10/03/2016] [Accepted: 12/06/2016] [Indexed: 01/25/2023]
Abstract
Antigenicity of xenogeneic tissues is the major obstacle to increased use of these materials in clinical medicine. Residual xenoantigens in decellularized tissue elicit the immune response after implantation, causing graft failure. With this in mind, the potential use is proposed of three protein solubilization-based protocols for porcine aortic valve leaflets decellularization. It was demonstrated that hydrophile solubilization alone achieved incomplete decellularization; lipophile solubilization alone (LSA) completely removed all cells and two most critical xenoantigens - galactose-α(1,3)-galactose (α-Gal) and major histocompatibility complex I (MHC I) - but caused severe alterations of the structure and mechanical properties; sequential hydrophile and lipophile solubilization (SHLS) resulted in a complete removal of cells, α-Gal and MHC I, and good preservation of the structure and mechanical properties. In contrast, a previously reported method using Triton X-100, sodium deoxycholate and IGEPAL CA-630 resulted in a complete removal of all cells and MHC I, but with remaining α-Gal epitope. LSA- and SHLS-treated leaflets showed significantly reduced leucocyte activation (polymorphonuclear elastase) upon interaction with human blood in vitro. When implanted subdermally in rats for 6 weeks, LSA- or SHLS-treated leaflets were presented with more biocompatible implants and all four decellularized leaflets were highly resistant to calcification. These findings illustrate that the SHLS protocol could be considered as a promising decellularization method for the decellularization of xenogeneic tissues in tissue engineering and regenerative medicine. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Wei-Hua Qiao
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peng Liu
- Department of Cardiovascular Surgery, Henan Provincial People's Hospital, Henan Cardiovascular Disease Institute, Zhengzhou, China
| | - Dan Hu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mahmoud Al Shirbini
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xian-Ming Zhou
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nian-Guo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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20
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Prabhu S, Armes JE, Bell D, Justo R, Venugopal P, Karl T, Alphonso N. Histologic Evaluation of Explanted Tissue-Engineered Bovine Pericardium (CardioCel). Semin Thorac Cardiovasc Surg 2017; 29:356-363. [PMID: 29195576 DOI: 10.1053/j.semtcvs.2017.05.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2017] [Indexed: 11/11/2022]
Abstract
CardioCel is a bovine pericardium that is subjected to a novel anticalcification tissue-engineering process. We present the histopathologic findings of human explants of CardioCel that were used in operations for congenital heart disease in children. Six explants were identified from 140 patients undergoing CardioCel implants from October 2012 to March 2015. CardioCel explants were evaluated histologically using hematoxylin and eosin, Masson trichrome, and immunohistochemical staining. A variable inflammatory response was seen in the surrounding native tissue, but not within the CardioCel graft in any of the explants. A neointimal layer of varying thickness developed on the visceral surface of 5 CardioCel explants with endothelialization of the longest duration explant. A granulation tissue layer developed on the parietal surface of the graft (consistently thicker than the neointima). Maintained collagen fiber architecture (laminated) and variable fibroblastic invasion (which increased with the age of the implant) were identified in all 6 cases. Scattered capillary vessels were noted in the majority of the explants with new collagen fibers in one, suggesting early remodeling. Calcium was seen in 1 explant at the interface of the graft and inflammatory response on its parietal surface. Evidence of graft remodeling was noted in the majority of the explants without inflammatory cells or calcification within the explanted graft material. A noticeable feature was the differential thickness of the host reaction to the parietal compared with the visceral surface of the graft. We will continue to evaluate CardioCel as a cardiovascular substitute for extracardiac and intracardiac reconstructions.
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Affiliation(s)
- Sudesh Prabhu
- Queensland Paediatric Cardiac Services, Lady Cilento Children's Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia; Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Jane E Armes
- School of Medicine, University of Queensland, Brisbane, Australia; Mater Research Institute, University of Queensland, Brisbane, Australia; Department of Pathology, Mater Health Services, Brisbane, Australia
| | - Douglas Bell
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Robert Justo
- Queensland Paediatric Cardiac Services, Lady Cilento Children's Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia; Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Prem Venugopal
- Queensland Paediatric Cardiac Services, Lady Cilento Children's Hospital, Brisbane, Australia
| | - Tom Karl
- School of Medicine, University of Queensland, Brisbane, Australia; Cardiac Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Nelson Alphonso
- Queensland Paediatric Cardiac Services, Lady Cilento Children's Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia; Mater Research Institute, University of Queensland, Brisbane, Australia.
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21
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Meuris B, Ozaki S, Neethling W, De Vleeschauwer S, Verbeken E, Rhodes D, Verbrugghe P, Strange G. Trileaflet aortic valve reconstruction with a decellularized pericardial patch in a sheep model. J Thorac Cardiovasc Surg 2016; 152:1167-74. [DOI: 10.1016/j.jtcvs.2016.05.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/28/2016] [Accepted: 05/15/2016] [Indexed: 11/15/2022]
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Strange G, Brizard C, Karl TR, Neethling L. An evaluation of Admedus' tissue engineering process-treated (ADAPT) bovine pericardium patch (CardioCel) for the repair of cardiac and vascular defects. Expert Rev Med Devices 2014; 12:135-41. [PMID: 25431988 DOI: 10.1586/17434440.2015.985651] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Tissue engineers have been seeking the 'Holy Grail' solution to calcification and cytotoxicity of implanted tissue for decades. Tissues with all of the desired qualities for surgical repair of congenital heart disease (CHD) are lacking. An anti-calcification tissue engineering process (ADAPT TEP) has been developed and applied to bovine pericardium (BP) tissue (CardioCel, AdmedusRegen Pty Ltd, Perth, WA, Australia) to eliminate cytotoxicity, improve resistance to acute and chronic inflammation, reduce calcification and facilitate controlled tissue remodeling. Clinical data in pediatric patients, and additional pre-market authorized prescriber data demonstrate that CardioCel performs extremely well in the short term and is safe and effective for a range of congenital heart deformations. These data are supported by animal studies which have shown no more than normal physiologic levels of calcification, with good durability, biocompatibility and controlled healing.
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23
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Güvener M, Korun O, Demirtürk OS. Risk factors for systemic inflammatory response after congenital cardiac surgery. J Card Surg 2014; 30:92-6. [PMID: 25382731 DOI: 10.1111/jocs.12465] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study aims to assess the frequency of systemic inflammatory response syndrome (SIRS) following congenital heart surgery and risk factors associated with this clinical syndrome. METHODS Charts of all patients undergoing surgery for congenital heart disease in a single institution over a five-year period were analyzed retrospectively. The presence of SIRS was evaluated based on the criteria of the International Pediatric Sepsis Consensus Conference. RESULTS Of the 246 patients included in the study 22 (8.9%) had clinical parameters indicating SIRS. The patients in the SIRS group had significantly longer cardiopulmonary bypass time (105.14 ± 27.27 vs. 66.86 ± 26.64 min; p < 0.01), aortic cross clamp time (69.36 ± 21.52 vs. 44.30 ± 24.27 min; p < 0.01), higher postoperative alanine aminotransferase (1419.00 ± 3260.99 vs. 81.95 ± 808.61 U/L; p < 0.01) and aspartate aminotransferase (2137.14 ± 4905.40 vs. 171.33 ± 1303.21 U/L; p < 0.01), white blood cell counts (20,827 ± 3603 vs. 12,242 ± 3782/µL; p < 0.01) and lower body surface area (0.52 ± 0.32 vs. 0.71 ± 0.36 m(2) ; p < 0.05) compared to patients in the no-SIRS group. Binary logistic regression revealed cardiopulmonary bypass time (OR: 1.05, p < 0.05), low body weight (<10 kg) (OR: 2.44; p < 0.05), and preoperative diagnosis of right to left shunt congenital heart disease (OR: 8.06; p < 0.01) as independent predictors of SIRS. SIRS was also found to be a strong independent predictor of mortality (OR: 10.13, p < 0.01). CONCLUSIONS SIRS after congenital heart surgery is associated with increased mortality. Independent risk factors for SIRS in the patient population of the study were cardiopulmonary bypass time, body weight below 10 kg and preoperative diagnosis of right to left shunt congenital heart disease.
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Affiliation(s)
- Murat Güvener
- Department of Cardiovascular Surgery, Hacettepe University School of Medicine, Ankara, Turkey
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Brizard CP, Brink J, Horton SB, Edwards GA, Galati JC, Neethling WML. New engineering treatment of bovine pericardium confers outstanding resistance to calcification in mitral and pulmonary implantations in a juvenile sheep model. J Thorac Cardiovasc Surg 2014; 148:3194-201. [PMID: 25218528 DOI: 10.1016/j.jtcvs.2014.08.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 07/31/2014] [Accepted: 08/01/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To conduct a test of noninferiority for CardioCel (Admedus, Brisbane, Australia), a chemically engineered bovine pericardium over autologous pericardium treated intraoperatively with glutaraldehyde in a chronic juvenile sheep model of pulmonary valve (PV) and mitral valve (MV) reconstruction. METHODS We replaced the posterior leaflet of the MV and of 1 PV cusp with patches in ewes aged 10 months. There were 2 groups: CardioCel (n = 6) and control (n = 4). All valves were competent. Echocardiography was performed before euthanasia. The collected data were function, macroscopy, histology, and calcium contents. The primary end points were thickening and calcium content. RESULTS All animals survived until sacrifice after 7 months. The valves had normal echo. The macroscopic aspect of the valves was excellent. Examination of the slides for both groups revealed a continuous endothelium on both sides of the patch and a layer of new collagen developed on both sides between patch and endothelium and interstitial cells and smooth muscle cell in these layers. The patch had not thickened but the 2 layers of new collagen for the PV showed a median thickening of 37% in the CardioCel group and 111% in the control group (P = .01), and for the MV a thickening of 108% and 251%, respectively, was seen (P = .01). The median calcium content in the PV was 0.24 μg/mg (range, 0.19-0.30) in the CardioCel group versus 0.34 μg/mg (range, 0.24-0.62) in controls (P = .20). In the MV it was 0.46 μg/mg (range, 0.30-1.0) in the CardioCel group and 0.47 μg/mg (range, 0.29-1.9) in controls (P = 1.0). CONCLUSIONS In this growing lamb model the CardioCel patch allowed accurate valve repair at both systemic and pulmonary pressure. The mechanical properties of CardioCel after 7 months were preserved with a more controlled healing than the treated autologous pericardium and without calcification.
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Affiliation(s)
- Christian P Brizard
- Cardiac Surgery Department, Royal Childrens Hospital, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia.
| | - Johann Brink
- Cardiac Surgery Department, Royal Childrens Hospital, Melbourne, Victoria, Australia
| | - Steven B Horton
- Cardiac Surgery Department, Royal Childrens Hospital, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Glenn Anthony Edwards
- School of Veterinary Science, University of Melbourne, Parkville, Victoria, Australia
| | - John C Galati
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Mathematics and Statistics, La Trobe University, Melbourne, Victoria, Australia
| | - William M L Neethling
- Fremantle Heart Institute, Fremantle Hospital, School of Surgery, University of Western Australia, Perth, Western Australia, Australia; Department of Cardiothoracic Surgery, Fremantle Hospital, School of Surgery, University of Western Australia, Perth, Western Australia, Australia
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