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Singh SK, Kachel M, Castillero E, Xue Y, Kalfa D, Ferrari G, George I. Polymeric prosthetic heart valves: A review of current technologies and future directions. Front Cardiovasc Med 2023; 10:1137827. [PMID: 36970335 PMCID: PMC10034107 DOI: 10.3389/fcvm.2023.1137827] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/09/2023] [Indexed: 03/11/2023] Open
Abstract
Valvular heart disease is an important source of cardiovascular morbidity and mortality. Current prosthetic valve replacement options, such as bioprosthetic and mechanical heart valves are limited by structural valve degeneration requiring reoperation or the need for lifelong anticoagulation. Several new polymer technologies have been developed in recent years in the hope of creating an ideal polymeric heart valve substitute that overcomes these limitations. These compounds and valve devices are in various stages of research and development and have unique strengths and limitations inherent to their properties. This review summarizes the current literature available for the latest polymer heart valve technologies and compares important characteristics necessary for a successful valve replacement therapy, including hydrodynamic performance, thrombogenicity, hemocompatibility, long-term durability, calcification, and transcatheter application. The latter portion of this review summarizes the currently available clinical outcomes data regarding polymeric heart valves and discusses future directions of research.
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Affiliation(s)
- Sameer K. Singh
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital, College of Physicians and Surgeons of Columbia University, New York, NY, United States
| | - Mateusz Kachel
- Cardiovascular Research Foundation, New York, NY, United States
- American Heart of Poland, Center for Cardiovascular Research and Development, Katowice, Poland
| | - Estibaliz Castillero
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital, College of Physicians and Surgeons of Columbia University, New York, NY, United States
| | - Yingfei Xue
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital, College of Physicians and Surgeons of Columbia University, New York, NY, United States
| | - David Kalfa
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital, College of Physicians and Surgeons of Columbia University, New York, NY, United States
| | - Giovanni Ferrari
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital, College of Physicians and Surgeons of Columbia University, New York, NY, United States
| | - Isaac George
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital, College of Physicians and Surgeons of Columbia University, New York, NY, United States
- *Correspondence: Isaac George,
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Rezvova MA, Klyshnikov KY, Gritskevich AA, Ovcharenko EA. Polymeric Heart Valves Will Displace Mechanical and Tissue Heart Valves: A New Era for the Medical Devices. Int J Mol Sci 2023; 24:3963. [PMID: 36835389 PMCID: PMC9967268 DOI: 10.3390/ijms24043963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023] Open
Abstract
The development of a novel artificial heart valve with outstanding durability and safety has remained a challenge since the first mechanical heart valve entered the market 65 years ago. Recent progress in high-molecular compounds opened new horizons in overcoming major drawbacks of mechanical and tissue heart valves (dysfunction and failure, tissue degradation, calcification, high immunogenic potential, and high risk of thrombosis), providing new insights into the development of an ideal artificial heart valve. Polymeric heart valves can best mimic the tissue-level mechanical behavior of the native valves. This review summarizes the evolution of polymeric heart valves and the state-of-the-art approaches to their development, fabrication, and manufacturing. The review discusses the biocompatibility and durability testing of previously investigated polymeric materials and presents the most recent developments, including the first human clinical trials of LifePolymer. New promising functional polymers, nanocomposite biomaterials, and valve designs are discussed in terms of their potential application in the development of an ideal polymeric heart valve. The superiority and inferiority of nanocomposite and hybrid materials to non-modified polymers are reported. The review proposes several concepts potentially suitable to address the above-mentioned challenges arising in the R&D of polymeric heart valves from the properties, structure, and surface of polymeric materials. Additive manufacturing, nanotechnology, anisotropy control, machine learning, and advanced modeling tools have given the green light to set new directions for polymeric heart valves.
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Affiliation(s)
- Maria A. Rezvova
- Research Institute for Complex Issues of Cardiovascular Diseases, 650002 Kemerovo, Russia
| | - Kirill Y. Klyshnikov
- Research Institute for Complex Issues of Cardiovascular Diseases, 650002 Kemerovo, Russia
| | | | - Evgeny A. Ovcharenko
- Research Institute for Complex Issues of Cardiovascular Diseases, 650002 Kemerovo, Russia
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A New Detergent for the Effective Decellularization of Bovine and Porcine Pericardia. Biomimetics (Basel) 2022; 7:biomimetics7030104. [PMID: 35997424 PMCID: PMC9397045 DOI: 10.3390/biomimetics7030104] [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: 07/07/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 12/10/2022] Open
Abstract
Human and animal pericardia are among the most widely exploited materials suitable to repair damaged tissues in the cardiovascular surgery context. Autologous, xenogeneic (chemically treated) and homologous pericardia are largely utilized, but they do exhibit some crucial drawbacks. Any tissue treated with glutaraldehyde is known to be prone to calcification in vivo, lacks regeneration potential, has limited durability, and can result in cytotoxicity. Moreover, autologous tissues have limited availability. Decellularized biological tissues represent a promising alternative: decellularization removes cellular and nuclear components from native tissues and makes them suitable for repopulation by autologous cells upon implantation into the body. The present work aims to assess the effects of a new detergent, i.e., Tergitol, for decellularizing bovine and porcine pericardia. The decellularization procedure successfully removed cells, while preserving the histoarchitecture of the extracellular matrix. No cytotoxic effect was observed. Therefore, decellularized pericardia showed potential to be used as scaffold for cardiovascular tissue regeneration.
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Jin C, Zhao L, Wu Z, Li B, Liu R, He H, Wang L, Wang W. Comparison on the properties of bovine pericardium and porcine pericardium used as leaflet materials of transcatheter heart valve. Artif Organs 2021; 46:427-438. [PMID: 34545589 DOI: 10.1111/aor.14074] [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: 04/29/2021] [Revised: 08/06/2021] [Accepted: 09/13/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND In order to obtain the smaller delivery diameter, porcine pericardium had been used as a substitute material of bovine pericardium for the leaflet materials of transcatheter heart valve (THV). However, the differences between them had not been fully studied. Therefore, this study compared the microstructure, biochemical and mechanical properties of two materials and hydrodynamics of THV made by the two materials in detail. METHODS In this study, firstly, the microstructure of pericardium was analyzed by staining and scanning electron microscope; secondly, the biochemical properties of pericardium after different processes were compared by heat shrinkage temperature test, free amino and carboxyl concentration test, enzyme degradation test, subcutaneous implantation calcification analysis in rats; finally, the mechanical properties were evaluated by uniaxial tensile test before and after the pericardium being crimped, and then, the hydrodynamics of THV was studied according to the ISO5840 standard. RESULTS Compared with bovine pericardium, after the same process, porcine pericardium showed a looser and tinier fiber bundle, a similar free carboxyl concentration, a lower resistance to enzyme degradation, a significantly lower calcification, bearing capacity and damage after being crimped, a better hydrodynamic and adaption with lower cardiac output and deformation of implantation position. Meanwhile the dehydration process of pericardium almost had preserved all the biochemical advantages of two materials. CONCLUSION In this study, porcine and bovine pericardium showed some significant differences in biochemical, mechanical properties and hydrodynamics. According to the results, it was presumed that the thinner porcine pericardium might be more suitable for THV of right heart system. Meanwhile, more attention should be taken for the calcification of THV made by the bovine pericardium.
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Affiliation(s)
- Chang Jin
- Research Center for Biomedical Engineering, Medical Innovation & Research Division, Chinese PLA General Hospital, Beijing, China.,Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Chinese PLA General Hospital, Beijing, China
| | - Li Zhao
- Research Center for Biomedical Engineering, Medical Innovation & Research Division, Chinese PLA General Hospital, Beijing, China.,Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Chinese PLA General Hospital, Beijing, China
| | - Zebin Wu
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beihang University, Beijing, China
| | - Bin Li
- Research Center for Biomedical Engineering, Medical Innovation & Research Division, Chinese PLA General Hospital, Beijing, China.,Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Chinese PLA General Hospital, Beijing, China
| | - Ronghui Liu
- Research Center for Biomedical Engineering, Medical Innovation & Research Division, Chinese PLA General Hospital, Beijing, China.,Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Chinese PLA General Hospital, Beijing, China
| | - Hongping He
- Research Center for Biomedical Engineering, Medical Innovation & Research Division, Chinese PLA General Hospital, Beijing, China.,Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Chinese PLA General Hospital, Beijing, China
| | - Lizhen Wang
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beihang University, Beijing, China
| | - Weidong Wang
- Research Center for Biomedical Engineering, Medical Innovation & Research Division, Chinese PLA General Hospital, Beijing, China.,Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Chinese PLA General Hospital, Beijing, China
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Schlachtenberger G, Doerr F, Brezina A, Menghesha H, Heldwein MB, Bennink G, Menger MD, Moussavian M, Hekmat K, Wahlers T. Perigraft reaction and incorporation of porcine and bovine pericardial patches. Interact Cardiovasc Thorac Surg 2020; 32:638-647. [PMID: 33313856 DOI: 10.1093/icvts/ivaa308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/21/2020] [Accepted: 11/06/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Bovine and porcine pericardial patches are frequently used in cardiothoracic and vascular surgery. There are no guidelines recommending the usage of these patches for particular surgical approaches. However, these 2 materials supposedly possess different properties. The clinical advantage of porcine compared with bovine patches remains controversial. In this experimental study, we analysed the incorporation and vascularization of bovine and porcine pericardial patches during the initial phase after implantation. METHODS Bovine and porcine pericardial patches were implanted into the dorsal skinfold chamber of C57BL/6 mice (n = 8 per group) to study vascularization and inflammation at the implantation site using repetitive intravital fluorescence microscopy over a 14-day period. At the end of the in vivo experiments, CD-31-positive cells were determined to evaluate the vascularization by immunohistochemistry. Furthermore, cell proliferation and apoptosis were analysed immunohistochemically. RESULTS Implanted bovine patches exhibited an enhanced vascularization, as indicated by a significantly higher number of CD-31-positive cells and micro-vessels (23.2 ± 4.3 vs 16.5 ± 5.8 mm-2; P = 0.001). Furthermore, bovine patches showed a slightly but not significantly higher functional capillary density. Both patches induced a moderate leukocytic inflammatory host tissue response, and neither bovine nor porcine patches significantly affected apoptosis and cell proliferation at the implantation site. CONCLUSIONS Bovine and porcine pericardial patches are similarly suitable for surgery. Bovine patches exhibited an improved vascularization during the first 14 days after implantation. This may result in a quicker and improved incorporation into the surrounding tissue compared with porcine pericardial patches.
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Affiliation(s)
| | - Fabian Doerr
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Annamaria Brezina
- Department of Anesthesiology and Intensive Care Medicine, Kerpenerstr 62, 50937 Cologne, Germany.,Institute for Clinical and Experimental Surgery, Saarland University Kirberger Strasse, 66421 Homburg/Saar, Germany
| | - Hruy Menghesha
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Matthias B Heldwein
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Gerardus Bennink
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Michael D Menger
- Institute for Clinical and Experimental Surgery, Saarland University Kirberger Strasse, 66421 Homburg/Saar, Germany
| | - Mohammed Moussavian
- Department of Surgery, Centre Hospitalier Emile Mayrisch (CHEM), Esch-sur-Alzette, Luxembourg
| | - Khosro Hekmat
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
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Zhuravleva IY, Karpova EV, Oparina LA, Poveschenko OV, Surovtseva MA, Titov AT, Ksenofontov AL, Vasilieva MB, Kuznetsova EV, Bogachev-Prokophiev AV, Trofimov BA. Cross-linking method using pentaepoxide for improving bovine and porcine bioprosthetic pericardia: A multiparametric assessment study. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 118:111473. [PMID: 33255052 DOI: 10.1016/j.msec.2020.111473] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/14/2020] [Accepted: 08/31/2020] [Indexed: 12/16/2022]
Abstract
Bioprosthetic heart valves made from bovine pericardium (BP) and porcine pericardium (PP) preserved with glutaraldehyde (GA) are commonly used in valve surgeries but prone to calcification in many patients. In this study, we compared BP and PP preserved with GA, ethylene glycol diglycidyl ether (DE), and 1,2,3,4,6-penta-O-{1-[2-(glycidyloxy)ethoxy]ethyl}-d-glucopyranose (PE). We studied the stabilities of DE and PE in preservation media along with the amino acid (AA) compositions, Fourier-transform infrared spectra, mechanical properties, surface morphologies, thermal stability, calcification, and the cytocompatibility of BP and PP treated with 0.625% GA, 5% DE, 2% PE, and alternating 5% DE and 2% PE for 3 + 11 d and 10 + 10 d, respectively. Both epoxides were stable in the water-buffer solutions (pH 7.4). DE provided high linkage densities in BP and PP owing to reactions with Hyl, Lys, His, Arg, Ser, and Tyr. PE reacted weakly with these AAs but strongly with Met. High cross-linking density obtained using the 10 d + 10 d method provided satisfactory thermal stability of biomaterials. The epoxy preservations improved cytocompatibility and resistance to calcification. PE enhanced the stress/strain properties of the xenogeneic pericardia, perhaps by forming nanostructures that were clearly visualised in BP using scanning electron microscopy. The DE + PE combination, in an alternating cross-linking manner, thus constitutes a promising option for developing bioprosthetic pericardia.
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Affiliation(s)
- Irina Yu Zhuravleva
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, 15 Rechkunovskaya St., Novosibirsk 630055, Russia.
| | - Elena V Karpova
- N. Vorozhtsov Institute of Organic Chemistry of SB RAS, 9 Lavrentyev Avenue, Novosibirsk 630090, Russia
| | - Ludmila A Oparina
- A. Favorsky Institute of Chemistry SB RAS, 1 Favorsky St., Irkutsk 664033, Russia
| | - Olga V Poveschenko
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, 15 Rechkunovskaya St., Novosibirsk 630055, Russia
| | - Maria A Surovtseva
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, 15 Rechkunovskaya St., Novosibirsk 630055, Russia
| | - Anatoly T Titov
- V. Sobolev Institute of Geology and Mineralogy SB RAS, 3 Academician Koptyug Avenue, Novosibirsk 630090, Russia
| | - Alexander L Ksenofontov
- A. Belozersky Research Institute of Physico-Chemical Biology MSU, House 1, Building 40 Leninskye gory, Moscow 119992, Russia
| | - Maria B Vasilieva
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, 15 Rechkunovskaya St., Novosibirsk 630055, Russia
| | - Elena V Kuznetsova
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, 15 Rechkunovskaya St., Novosibirsk 630055, Russia
| | - Alexander V Bogachev-Prokophiev
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, 15 Rechkunovskaya St., Novosibirsk 630055, Russia
| | - Boris A Trofimov
- A. Favorsky Institute of Chemistry SB RAS, 1 Favorsky St., Irkutsk 664033, Russia
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In Vitro Durability and Stability Testing of a Novel Polymeric Transcatheter Aortic Valve. ASAIO J 2020; 66:190-198. [PMID: 30845067 DOI: 10.1097/mat.0000000000000980] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has emerged as an effective therapy for the unmet clinical need of inoperable patients with severe aortic stenosis (AS). Current clinically used tissue TAVR valves suffer from limited durability that hampers TAVR's rapid expansion to younger, lower risk patients. Polymeric TAVR valves optimized for hemodynamic performance, hemocompatibility, extended durability, and resistance to calcific degeneration offer a viable solution to this challenge. We present extensive in vitro durability and stability testing of a novel polymeric TAVR valve (PolyNova valve) using 1) accelerated wear testing (AWT, ISO 5840); 2) calcification susceptibility (in the AWT)-compared with clinically used tissue valves; and 3) extended crimping stability (valves crimped to 16 Fr for 8 days). Hydrodynamic testing was performed every 50M cycles. The valves were also evaluated visually for structural integrity and by scanning electron microscopy for evaluation of surface damage in the micro-scale. Calcium and phosphorus deposition was evaluated using micro-computed tomography (μCT) and inductive coupled plasma spectroscopy. The valves passed 400M cycles in the AWT without failure. The effective orifice area kept stable at 1.8 cm with a desired gradual decrease in transvalvular pressure gradient and regurgitation (10.4 mm Hg and 6.9%, respectively). Calcium and phosphorus deposition was significantly lower in the polymeric valve: down by a factor of 85 and 16, respectively-as compared to a tissue valve. Following the extended crimping testing, no tears nor surface damage were evident. The results of this study demonstrate the potential of a polymeric TAVR valve to be a viable alternative to tissue-based TAVR valves.
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Dokollari A, Bisleri G. Commentary: Leaflet perforation after transcatheter aortic valve implantation in calcified roots: When perfect can be the enemy of good? JTCVS Tech 2020; 3:99-100. [PMID: 34317832 PMCID: PMC8302942 DOI: 10.1016/j.xjtc.2020.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 05/13/2020] [Accepted: 05/21/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Gianluigi Bisleri
- Division of Cardiac Surgery, Queen's University, Kingston, Ontario, Canada
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Rassoli A, Li Y, Bao X, Kawecki F, Zhao X, Chappard D, Le-Bel G, Feng J, Weber B, Fatouraee N, Zhang Z, Jing Z, Germain L, Wang L, Guidoin R. Donkey pericardium as a select sourcing to manufacture percutaneous heart valves: Decellularization has not yet demonstrated any clear cut advantage to glutaraldehyde treatment. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2019. [DOI: 10.1016/j.medntd.2020.100029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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10
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Meng S, Mao J, Rouse EN, Le-Bel G, Bourget JM, Reed RR, Philippe E, How D, Zhang Z, Germain L, Guidoin R. The Red Kangaroo pericardium as a material source for the manufacture of percutaneous heart valves. Morphologie 2019; 103:37-47. [PMID: 30638803 DOI: 10.1016/j.morpho.2018.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 12/06/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The kangaroo pericardium might be considered to be a good candidate material for use in the manufacture of the leaflets of percutaneous heart valves based upon the unique lifestyle. The diet consists of herbs, forbs and strubs. The kangaroo pericardium holds an undulated structure of collagen. MATERIAL AND METHOD A Red Kangaroo was obtained after a traffic fatality and the pericardium was dissected. Four compasses were cut from four different sites: auricular (AUR), atrial (ATR), sternoperitoneal (SPL) and phrenopericardial (PPL). They were investigated by means of scanning electron microscopy, light microscopy and transmission electron microscopy. RESULTS All the samples showed dense and wavy collagen bundles without vascularisation from both the epicardium and the parietal pericardium. The AUR and the ATR were 150±25μm thick whereas the SPL and the PPL were thinner at 120±20μm. The surface of the epicardium was smooth and glistening. The filaments of collagen were well individualized without any aggregation, but the banding was poorly defined and somewhat blurry. CONCLUSION This detailed morphological analysis of the kangaroo pericardium illustrated a surface resistant to thrombosis and physical characteristics resistant to fatigue. The morphological characteristics of the kangaroo pericardium indicate that it represents an outstanding alternative to the current sources e.g., bovine and porcine. However, procurement of tissues from the wild raises supply and sanitary issues. Health concerns based upon sanitary uncertainty and reliability of supply of wild animals remain real problems.
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Affiliation(s)
- S Meng
- Chongqing Key Lab of Catalysis and Functional Organic Molecules; College of Environment and Biotechnology, Chongqing Technology and Business University, Chongqing, PR China
| | - J Mao
- Axe Médecine Régénératrice, Centre de Recherche du CHU and Département de Chirurgie, Faculté de Médecine, Université Laval, Québec Canada
| | - E N Rouse
- Department of Comparative Medicine, College of Veterinary of Tennessee, Knoxville, TN, USA
| | - G Le-Bel
- Axe Médecine Régénératrice, Centre de Recherche du CHU and Département de Chirurgie, Faculté de Médecine, Université Laval, Québec Canada
| | - J M Bourget
- Axe Médecine Régénératrice, Centre de Recherche du CHU and Département de Chirurgie, Faculté de Médecine, Université Laval, Québec Canada
| | - R R Reed
- Department of Comparative Medicine, College of Veterinary of Tennessee, Knoxville, TN, USA
| | - E Philippe
- Axe Médecine Régénératrice, Centre de Recherche du CHU and Département de Chirurgie, Faculté de Médecine, Université Laval, Québec Canada
| | - D How
- Peninsula College of Medicine and Dentistry (PCMD), Plymouth, Devon, UK
| | - Z Zhang
- Axe Médecine Régénératrice, Centre de Recherche du CHU and Département de Chirurgie, Faculté de Médecine, Université Laval, Québec Canada
| | - L Germain
- Axe Médecine Régénératrice, Centre de Recherche du CHU and Département de Chirurgie, Faculté de Médecine, Université Laval, Québec Canada
| | - R Guidoin
- Axe Médecine Régénératrice, Centre de Recherche du CHU and Département de Chirurgie, Faculté de Médecine, Université Laval, Québec Canada.
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Rotman OM, Bianchi M, Ghosh RP, Kovarovic B, Bluestein D. Principles of TAVR valve design, modelling, and testing. Expert Rev Med Devices 2018; 15:771-791. [PMID: 30318937 PMCID: PMC6417919 DOI: 10.1080/17434440.2018.1536427] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Transcatheter aortic valve replacement (TAVR) has emerged as an effective minimally-invasive alternative to surgical valve replacement in medium- to high-risk, elderly patients with calcific aortic valve disease and severe aortic stenosis. The rapid growth of the TAVR devices market has led to a high variety of designs, each aiming to address persistent complications associated with TAVR valves that may hamper the anticipated expansion of TAVR utility. AREAS COVERED Here we outline the challenges and the technical demands that TAVR devices need to address for achieving the desired expansion, and review design aspects of selected, latest generation, TAVR valves of both clinically-used and investigational devices. We further review in detail some of the up-to-date modeling and testing approaches for TAVR, both computationally and experimentally, and additionally discuss those as complementary approaches to the ISO 5840-3 standard. A comprehensive survey of the prior and up-to-date literature was conducted to cover the most pertaining issues and challenges that TAVR technology faces. EXPERT COMMENTARY The expansion of TAVR over SAVR and to new indications seems more promising than ever. With new challenges to come, new TAV design approaches, and materials used, are expected to emerge, and novel testing/modeling methods to be developed.
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Affiliation(s)
- Oren M. Rotman
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
| | - Matteo Bianchi
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
| | - Ram P. Ghosh
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
| | - Brandon Kovarovic
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
| | - Danny Bluestein
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
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