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Venna A, Öztürk M, Reitz J, Park IH, Hanabergh S, Selcuk A, Tongut A, Desai M, d'Udekem Y, Yerebakan C. The Use of the CardioCel 3D 60° Patch for Aortic Arch Reconstruction in Infancy-A Word of Caution. Ann Thorac Surg 2024:S0003-4975(24)00519-8. [PMID: 38936591 DOI: 10.1016/j.athoracsur.2024.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/05/2024] [Accepted: 06/05/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND There are limited data on outcomes after implantation of the CardioCel 3D 60° patch in great vessel repair. After anecdotally witnessing an increase in negative outcomes, we reviewed our experience using this patch in our neonate and infant patients undergoing aortic arch repair. METHODS Aortic arch repair with implantation of the CardioCel 3D 60° patch was performed in 24 patients between July 2018 and July 2021. Dominant cardiac morphologies were hypoplastic left heart syndrome (66%), atrioventricular canal defects (13%), and other (21%). Median age at implantation was 44 days (interquartile range [IQR], 6-112 days). Recurrent obstruction was defined as the need for reoperation or catheter intervention or recurrent peak pressure gradient of descending aorta ≥25 mm Hg on echocardiography. RESULTS Five deaths occurred after a median of 217 days (IQR, 69-239 days). Twelve patients (50%) had recurrent obstruction. Three patients (13%) required redo aortic arch operation after a median of 148 days (IQR, 128-193 day), with extensive fibrous coating of the patch interior causing obstruction. Eleven patients (46%) required at least 1 balloon angioplasty on their aorta after a median of 102 days (IQR, 83-130 days) after repair, and 3 needed >1 catheter intervention. The estimated probability of having recurrent obstruction was 85% at 6 months and 71% at the 1-year follow (P = .06). CONCLUSIONS Recurrent aortic obstruction occurred in half of our patients shortly after repair. The use of the CardioCel 3D 60° patch for aortic arch reconstruction in neonates and infants should be reevaluated.
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Affiliation(s)
- Alyssia Venna
- Division of Cardiac Surgery, Children's National Hospital, The George Washington University, Washington, DC
| | - Mahmut Öztürk
- Division of Cardiac Surgery, Children's National Hospital, The George Washington University, Washington, DC
| | - Justus Reitz
- Division of Cardiac Surgery, Children's National Hospital, The George Washington University, Washington, DC
| | - In Hye Park
- Division of Cardiac Surgery, Children's National Hospital, The George Washington University, Washington, DC
| | - Sofia Hanabergh
- Division of Cardiac Surgery, Children's National Hospital, The George Washington University, Washington, DC
| | - Arif Selcuk
- Division of Cardiac Surgery, Children's National Hospital, The George Washington University, Washington, DC
| | - Aybala Tongut
- Division of Cardiac Surgery, Children's National Hospital, The George Washington University, Washington, DC
| | - Manan Desai
- Division of Cardiac Surgery, Children's National Hospital, The George Washington University, Washington, DC
| | - Yves d'Udekem
- Division of Cardiac Surgery, Children's National Hospital, The George Washington University, Washington, DC
| | - Can Yerebakan
- Division of Cardiac Surgery, Children's National Hospital, The George Washington University, Washington, DC.
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Prinzing A, Boehm J, Burri M, Schreyer J, Lange R, Krane M. Midterm results after aortic valve neocuspidization. JTCVS Tech 2024; 25:35-42. [PMID: 38899113 PMCID: PMC11184442 DOI: 10.1016/j.xjtc.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/21/2024] [Accepted: 02/11/2024] [Indexed: 06/21/2024] Open
Abstract
Objectives Aortic valve neocuspidization with autologous pericardium is gaining increasing attention as a surgical treatment option for aortic valve disease. However, little is known about midterm durability and valve-related events. Methods Patients undergoing aortic valve neocuspidization between 2016 and 2021 were included. Transthoracic echocardiography was performed before the operation, at discharge, and annually thereafter. Data were analyzed for incidences of structural valve deterioration, bioprosthetic valve failure, survival, freedom from reoperation, and hemodynamic performance. Results A total of 162 patients underwent aortic valve neocuspidization (mean age, 52.6 ± 16.6 years; range, 13-78 years); 114 (70.4%) were male. A total of 132 patients presented with a bicuspid aortic valve (81.5%) and 126 patients presented with aortic valve stenosis (77.8%). Concomitant procedures were performed in 63 patients (38.9%). Mean follow-up was 3.5 ± 1.2 years. At discharge, peak and mean pressure gradients were 15.6 ± 7.2 mm Hg and 8.4 ± 3.7 mm Hg, respectively, with a mean effective orifice area of 2.4 ± 0.8 cm2. After 5 years, peak and mean pressure gradients were 14.5 ± 4.6 mm Hg and 7.5 ± 2.2 mm Hg, respectively, with a mean effective orifice area of 2.3 ± 0.8 cm2. At 5 years, cumulative incidences of moderate and severe structural valve deterioration and bioprosthetic valve failure were 9.82% ± 3.87%, 6.96% ± 3.71%, and 12.1% ± 4.12%, respectively. Survival was 97.3% ± 1.4%, and freedom from reoperation was 91.3% ± 2.4%. Conclusions Aortic valve neocuspidization accomplishes low pressure gradients early after initial surgery and during follow-up. Survival in this young patient population is excellent. The main reason for reoperation is endocarditis, and rates for structural valve degeneration are low.
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Affiliation(s)
- Anatol Prinzing
- Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, School of Medicine & Health, Technical University of Munich, Munich, Germany
| | - Johannes Boehm
- Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, School of Medicine & Health, Technical University of Munich, Munich, Germany
| | - Melchior Burri
- Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, School of Medicine & Health, Technical University of Munich, Munich, Germany
| | - Julia Schreyer
- Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, School of Medicine & Health, Technical University of Munich, Munich, Germany
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, School of Medicine & Health, Technical University of Munich, Munich, Germany
| | - Markus Krane
- Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, School of Medicine & Health, Technical University of Munich, Munich, Germany
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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Suárez S, López-Campos JA, Fernández JR, Segade A. Nonlocal damage evaluation of a sigmoid-based damage model for fibrous biological soft tissues. Biomech Model Mechanobiol 2024; 23:655-674. [PMID: 38158483 DOI: 10.1007/s10237-023-01798-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/22/2023] [Indexed: 01/03/2024]
Abstract
The comprehension and modeling of the mechanical behavior of soft biological tissues are essential due to their clinical applications. This knowledge is essential for predicting tissue responses accurately and enhancing our ability to compute the behavior of biological structures and bio-prosthetic devices under specific loading conditions. The current research is centered on modeling the initiation and progression of soft tissues damage, which typically exhibit intricate anisotropic and nonlinear elastic characteristics. For this purpose, the following study presents a comparative analysis of the computational performance of two distinct damage modeling techniques. The first technique employs a well-established damage model, based on a piece-wise exponential damage function as proposed by Calvo et al. (Int J Numer Methods Eng 69:2036-2057, 2007. https://doi.org/10.1002/nme.1825 ). The second approach adopts a sigmoid function, as proposed by López-Campos et al. (Comput Methods Biomech Biomed Eng 23(6):213-223. https://doi.org/10.1080/10255842.2019.1710742 ). The aim of this study is to verify the validity of the López-Campos sigmoid-based damage model to be used in finite element simulation, the implementation of which is unknown. For this proposal, both models were implemented within a commercial Finite Element software package, and their responses to local and non-local damage algorithms were assessed in depth through two standard benchmark tests: a plate with a hole and a ball burst. The results of this study indicate that, for a wide range of cases, such as in-plane stresses, out-plane stresses, stress concentration and contact, all over large displacement conditions, the López-Campos damage model shows a good response to non-local algorithms achieving mesh independence and convergence in all these cases. The results obtained are in line with those obtained for the Calvo's damage model, showing, in addition, larger deformations under in-plane stress and stress concentration conditions and a lower number of iterations under out-plane stress and contact conditions. Consequently, the López-Campos' damage model emerges as a valuable and useful tool in the field of mechanical damage research in biological systems.
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Affiliation(s)
- Sofía Suárez
- CINTECX, Department of Mechanical Engineering, Universidade de Vigo, Campus As Lagoas, Marcosende, 36310, Vigo, Pontevedra, Spain.
- Design and Numerical Simulation Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Hospital Álvaro Cunqueiro, Carretera Clara Campoamor 341, Tecnical Building 2º Floor, 36312, Vigo, Pontevedra, Spain.
| | - Jose A López-Campos
- CINTECX, Department of Mechanical Engineering, Universidade de Vigo, Campus As Lagoas, Marcosende, 36310, Vigo, Pontevedra, Spain
- Design and Numerical Simulation Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Hospital Álvaro Cunqueiro, Carretera Clara Campoamor 341, Tecnical Building 2º Floor, 36312, Vigo, Pontevedra, Spain
| | - Jose R Fernández
- Design and Numerical Simulation Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Hospital Álvaro Cunqueiro, Carretera Clara Campoamor 341, Tecnical Building 2º Floor, 36312, Vigo, Pontevedra, Spain
- Department of Applied Mathematics I, Industrial Engineering School, Universidade de Vigo, Campus As Lagoas, Marcosende, 36310, Vigo, Pontevedra, Spain
| | - Abraham Segade
- CINTECX, Department of Mechanical Engineering, Universidade de Vigo, Campus As Lagoas, Marcosende, 36310, Vigo, Pontevedra, Spain
- Design and Numerical Simulation Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Hospital Álvaro Cunqueiro, Carretera Clara Campoamor 341, Tecnical Building 2º Floor, 36312, Vigo, Pontevedra, Spain
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Bhende VV, Sharma TS, Krishnakumar M, Ramaswamy AS, Bilgi K, Pathan SR. Beyond Synthetics: Promising Outcomes With the Invengenx® Bovine Pericardial Patch for Ventricular Septal Defect Repair in a Young Pediatric Population. Cureus 2024; 16:e55530. [PMID: 38444930 PMCID: PMC10913133 DOI: 10.7759/cureus.55530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 03/07/2024] Open
Abstract
Ventricular septal defects (VSDs) are a prevalent congenital heart anomaly demanding safe and lasting interventions. This paper explores the application of Invengenx® bovine pericardial patch (Tisgenx, Irvine, California), a promising biomaterial, in VSD repair. We present two case studies: a seven-month-old infant and a three-year-old child undergoing VSD closure using autologous and bovine pericardial patches, respectively. Both patients tolerated the procedures well, experiencing no intra-operative complications and demonstrating excellent postoperative recovery. Echocardiography postoperatively showed no complications and improved clinical outcomes. Notably, the pericardial patches exhibited excellent integration and suture retention, highlighting their durability and compatibility with the growing heart. These cases establish the feasibility and effectiveness of the Invengenx® pericardial patch for VSD repair. The favorable outcomes in terms of safety and efficacy support the potential of this biomaterial as a valuable alternative in pediatric cardiac surgery, particularly for complex VSDs or patients with contraindications to synthetic patches. Further research is crucial to unlock the full potential of bovine pericardium as a durable and advantageous option for VSD repair in a broader range of pediatric patients.
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Affiliation(s)
- Vishal V Bhende
- Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND
| | - Tanishq S Sharma
- Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND
| | | | - Anikode S Ramaswamy
- Pathology, People's Education Society (PES) Institute of Medical Sciences and Research, Kuppam, IND
| | - Kanchan Bilgi
- Neuroanesthesiology, People Tree Hospitals, Bengaluru, IND
| | - Sohilkhan R Pathan
- Clinical Research Services (CRS), Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna Hospital, Bhaikaka University, Karamsad, IND
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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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Dittfeld C, Welzel C, König U, Jannasch A, Alexiou K, Blum E, Bronder S, Sperling C, Maitz MF, Tugtekin SM. Hemocompatibility tuning of an innovative glutaraldehyde-free preparation strategy using riboflavin/UV crosslinking and electron irradiation of bovine pericardium for cardiac substitutes. BIOMATERIALS ADVANCES 2023; 147:213328. [PMID: 36764200 DOI: 10.1016/j.bioadv.2023.213328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/17/2023] [Accepted: 02/01/2023] [Indexed: 02/09/2023]
Abstract
Hemocompatibility tuning was adopted to explore and refine an innovative, GA-free preparation strategy combining decellularization, riboflavin/UV crosslinking, and low-energy electron irradiation (SULEEI) procedure. A SULEEI-protocol was established to avoid GA-dependent deterioration that results in insufficient long-term aortic valve bioprosthesis durability. Final SULEEI-pericardium, intermediate steps and GA-fixed reference pericardium were exposed in vitro to fresh human whole blood to elucidate effects of preparation parameters on coagulation and inflammation activation and tissue histology. The riboflavin/UV crosslinking step showed to be less efficient in inactivating extracellular matrix (ECM) protein activity than the GA fixation, leading to tissue-factor mediated blood clotting. Intensifying the riboflavin/UV crosslinking with elevated riboflavin concentration and dextran caused an enhanced activation of the complement system. Yet activation processes induced by the previous protocol steps were quenched with the final electron beam treatment step. An optimized SULEEI protocol was developed using an intense and extended, trypsin-containing decellularization step to inactivate tissue factor and a dextran-free, low riboflavin, high UV crosslinking step. The innovative and improved GA-free SULEEI-preparation protocol results in low coagulant and low inflammatory bovine pericardium for surgical application.
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Affiliation(s)
- Claudia Dittfeld
- Department of Cardiac Surgery, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Heart Centre Dresden, Germany.
| | - Cindy Welzel
- Department of Cardiac Surgery, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Heart Centre Dresden, Germany
| | - Ulla König
- Fraunhofer Institute for Organic Electronics, Electron Beam and Plasma Technology FEP, Dresden, Germany
| | - Anett Jannasch
- Department of Cardiac Surgery, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Heart Centre Dresden, Germany
| | - Konstantin Alexiou
- Department of Cardiac Surgery, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Heart Centre Dresden, Germany
| | - Ekaterina Blum
- Fraunhofer Institute for Organic Electronics, Electron Beam and Plasma Technology FEP, Dresden, Germany
| | - Saskia Bronder
- Fraunhofer Institute for Organic Electronics, Electron Beam and Plasma Technology FEP, Dresden, Germany
| | - Claudia Sperling
- Leibniz-Institut für Polymerforschung Dresden e.V., Institute Biofunctional Polymer Materials, Dresden, Germany
| | - Manfred F Maitz
- Leibniz-Institut für Polymerforschung Dresden e.V., Institute Biofunctional Polymer Materials, Dresden, Germany
| | - Sems-Malte Tugtekin
- Department of Cardiac Surgery, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Heart Centre Dresden, Germany
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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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Ingeniería de tejidos en población pediátrica: una esperanza para el tratamiento de enfermedades valvulares mitrales congénitas. CIRUGIA CARDIOVASCULAR 2023. [DOI: 10.1016/j.circv.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Kehara H, Minakata K, McCarthy J, Sunagawa G, Mangukia C, Brann S, Zhao H, Boova R, Toyoda Y. Early and late results of mitral valve repair with anterior leaflet patch augmentation. Interact Cardiovasc Thorac Surg 2022; 35:6595026. [PMID: 35640545 PMCID: PMC9373942 DOI: 10.1093/icvts/ivac144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/14/2022] [Accepted: 05/24/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
OBJECTIVES
The aim of this study was to determine the long-term results of mitral valve (MV) repair with anterior leaflet patch augmentation.
METHODS
Between 2012 and 2015, 45 patients underwent MV repair using the anterior leaflet patch augmentation technique at our institution. The mean age of the patients was 65.9 ± 13.0 years (16 males). We reviewed the MV pathology and the surgical techniques used and assessed the early and late results.
RESULTS
In terms of MV pathology, 43 patients (95.6%) had pure mitral regurgitation (MR) and 2 patients (4.4%) had mixed mitral stenosis and MR. Rheumatic changes were seen in 18 patients (40.0%). Postoperative echocardiography showed that 95.6% of patients had none to mild MR. During a median follow-up period of 5.5 years (range 0.1–8.3 years), there were 8 late deaths. Nine patients (20%) required reoperation. The mean interval between the initial operation and redo operation was 3.7 ± 3.1 years (range: 0.4–7.8 years). The causes of reoperation included patch dehiscence (n = 4), progression of mitral stenosis (n = 2), band dehiscence (n = 1), patch enlargement (n = 1) and unknown (n = 1). Eight patients underwent MV replacement and 1 underwent repeat MV repair. The freedom from reoperation at 3 and 5 years was 85.7 ± 6.7% and 81.2 ± 7.7%, respectively.
CONCLUSIONS
Anterior leaflet patch augmentation can provide excellent early results in the majority of the patients even in the presence of rheumatic pathology; however, we observed late reoperation in 20% of patients. Thus, this technique should be used with caution and careful follow-up with serial echocardiography is essential.
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Affiliation(s)
- Hiromu Kehara
- Division of Cardiovascular Surgery, Temple University and Lewis Katz School of Medicine , Philadelphia, PA, USA
| | - Kenji Minakata
- Division of Cardiovascular Surgery, Temple University and Lewis Katz School of Medicine , Philadelphia, PA, USA
| | - James McCarthy
- Division of Cardiovascular Surgery, Temple University and Lewis Katz School of Medicine , Philadelphia, PA, USA
| | - Gengo Sunagawa
- Division of Cardiovascular Surgery, Temple University and Lewis Katz School of Medicine , Philadelphia, PA, USA
| | - Chirantan Mangukia
- Division of Cardiovascular Surgery, Temple University and Lewis Katz School of Medicine , Philadelphia, PA, USA
| | - Stacey Brann
- Division of Cardiovascular Surgery, Temple University and Lewis Katz School of Medicine , Philadelphia, PA, USA
| | - Huaqing Zhao
- Center for Biostatistics and Epidemiology, Department of Biomedical Education and Data Science, Temple University and Lewis Katz School of Medicine , Philadelphia, PA, USA
| | - Robert Boova
- Division of Cardiovascular Surgery, Temple University and Lewis Katz School of Medicine , Philadelphia, PA, USA
| | - Yoshiya Toyoda
- Division of Cardiovascular Surgery, Temple University and Lewis Katz School of Medicine , Philadelphia, PA, USA
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10
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Abstract
Cardiovascular defects, injuries, and degenerative diseases often require surgical intervention and the use of implantable replacement material and conduits. Traditional vascular grafts made of synthetic polymers, animal and cadaveric tissues, or autologous vasculature have been utilized for almost a century with well-characterized outcomes, leaving areas of unmet need for the patients in terms of durability and long-term patency, susceptibility to infection, immunogenicity associated with the risk of rejection, and inflammation and mechanical failure. Research to address these limitations is exploring avenues as diverse as gene therapy, cell therapy, cell reprogramming, and bioengineering of human tissue and replacement organs. Tissue-engineered vascular conduits, either with viable autologous cells or decellularized, are the forefront of technology in cardiovascular reconstruction and offer many benefits over traditional graft materials, particularly in the potential for the implanted material to be adopted and remodeled into host tissue and thus offer safer, more durable performance. This review discusses the key advances and future directions in the field of surgical vascular repair, replacement, and reconstruction, with a focus on the challenges and expected benefits of bioengineering human tissues and blood vessels.
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Affiliation(s)
- Kaleb M. Naegeli
- Humacyte, Inc, Durham, NC (K.M.N., M.H.K., Y.L., J.W., E.A.H., L.E.N.)
| | - Mehmet H. Kural
- Humacyte, Inc, Durham, NC (K.M.N., M.H.K., Y.L., J.W., E.A.H., L.E.N.)
| | - Yuling Li
- Humacyte, Inc, Durham, NC (K.M.N., M.H.K., Y.L., J.W., E.A.H., L.E.N.)
| | - Juan Wang
- Humacyte, Inc, Durham, NC (K.M.N., M.H.K., Y.L., J.W., E.A.H., L.E.N.)
| | | | - Laura E. Niklason
- Department of Anesthesiology and Biomedical Engineering, Yale University, New Haven, CT (L.E.N.)
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11
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Talaei-Khozani T, Yaghoubi A. An overview of post transplantation events of decellularized scaffolds. Transpl Immunol 2022; 74:101640. [PMID: 35667545 DOI: 10.1016/j.trim.2022.101640] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/29/2022] [Accepted: 05/31/2022] [Indexed: 12/19/2022]
Abstract
Regenerative medicine and tissue engineering are reasonable techniques for repairing failed tissues and could be a suitable alternative to organ transplantation. One of the most widely used methods for preparing bioscaffolds is the decellularization procedure. Although cell debris and DNA are removed from the decellularized tissues, important compositions of the extracellular matrix including proteins, proteoglycans, and glycoproteins are nearly preserved. Moreover, the obtained scaffolds have a 3-dimensional (3D) structure, appropriate naïve mechanical properties, and good biocompatibility. After transplantation, different types of host cells migrate to the decellularized tissues. Histological and immunohistochemical assessment of the different bioscaffolds after implantation reveals the migration of parenchymal cells, angiogenesis, as well as the invasion of inflammatory and giant foreign cells. In this review, the events after transplantation including angiogenesis, scaffold degradation, and the presence of immune and tissue-specific progenitor cells in the decellularized scaffolds in various hosts, are discussed.
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Affiliation(s)
- Tahereh Talaei-Khozani
- Histotomorphometry and stereology research center, Shiraz University of Medical Sciences, Shiraz, Iran; Tissue engineering lab, Anatomy Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Atefeh Yaghoubi
- Tissue engineering lab, Anatomy Department, Shiraz University of Medical Sciences, Shiraz, Iran.
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12
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Peivandi AD, Martens S, Heitplatz B, Guseva A, Mueller KM, Martens S. Industrial Processing Induces Pericardial Patch Degeneration. Front Surg 2022; 9:881433. [PMID: 35711712 PMCID: PMC9195290 DOI: 10.3389/fsurg.2022.881433] [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: 02/22/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAutologous pericardium is considered gold standard for various reconstructive surgical procedures in children. However, processed bovine, equine, and porcine pericardial tissue are also widely used. We investigated structural differences and analyzed alterations caused by industrial processing. Additionally human and equine pericardium explants, used during aortic valve reconstruction were analyzed.MethodsPericardial tissues (native, processed and explanted) were gathered and stained with HE and EvG to visualize collagen as well as elastic fibers. Fiber structures were visualized by light and polarization microscopy. Antibody staining against CD 3, CD 20, and CD 68 was performed to identify inflammation.ResultsNative pericardium of different species showed small differences in thickness, with bovine pericardium being the thickest [bovine: 390 μm (± 40.6 μm); porcine: 223 μm (± 30.1 μm); equine: 260 μm (± 28.4 μm)]. Juvenile pericardium was 277 μm (± 26.7 μm). Single collagen bundle diameter displayed variations (~3–20 μm). Parallel collagen fibers were densely packed with small inter-fibrillary space. After industrial tissue processing, loosening of collagen network with inter-fibrillary gapping was observed. Pericardium appeared thicker (mean values ranging from 257–670 μm). Processed tissue showed less birefringence under polarized light. All analyzed tissues showed a small number of elastic fibers. Fibrosis, calcification and inflammatory processes of autologous and equine pericardium were observed in patient explants.ConclusionNone of the analyzed tissues resembled the exact structure of the autologous pericardial explant. Degeneration of pericardium starts during industrial processing, suggesting a potential harm on graft longevity in children. A careful surgical approach prior to the implantation of xenografts is therefore needed.
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Affiliation(s)
- Armin Darius Peivandi
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
- *Correspondence: Armin Darius Peivandi
| | - Sven Martens
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Barbara Heitplatz
- Gerhard-Domagk-Institute of Pathology, University Hospital Muenster, Muenster, Germany
| | - Alena Guseva
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Klaus-Michael Mueller
- Gerhard-Domagk-Institute of Pathology, University Hospital Muenster, Muenster, Germany
| | - Sabrina Martens
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
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13
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An study on the influence of collagen fiber directions in TAVs performance using FEM. J Mech Behav Biomed Mater 2021; 126:104969. [PMID: 34844877 DOI: 10.1016/j.jmbbm.2021.104969] [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: 09/06/2021] [Revised: 10/21/2021] [Accepted: 11/06/2021] [Indexed: 11/23/2022]
Abstract
Transcatheter Aortic Valve Implantation (TAVI) or Replacement (TAVR) is a promising treatment for aortic valve stenosis, consisting of a procedure to replace a damaged native aortic valve by a bioprosthetic one. This replacement valve control the flow of blood using leaflets that are similar to the ones of a native aortic valve. Commonly manufactured using bovine or porcine pericardium, it is a tissue histologically composed of collagen fibers embedded into a nearly-isotropic matrix, where their distribution makes the pericardium behave as an anisotropic hyperelastic material. Because of such complicated behavior, bioprosthetic pericardium valves are, as expected, sensitive to the distribution and orientation of these fibers in such device. Therefore, the objective of this work is a thorough systematic study on the influence of these fibers' distribution. First, a Finite Element model of a bioprosthetic valve is generated; then, a material routine to accurately describe the behavior of pericardium is implemented in a commercial software package; in addition, a dedicated algorithm to specify the direction of fibers is developed. Finally, a systematic study on the influence that fiber orientations have on the overall behavior of the TAV is performed. As a result of this study, two extreme behaviors are highlighted depending on the preferential orientation of collagen fibers; namely, one with fibers in circumferential direction and the opposite with fibers in an axial orientation. Then, it is concluded that the behavior of fibers in circumferential direction is very sensitive to small variations of the orientation angle, whereas such orientation is not as determining when the aim is to achieve a behavior near to the one corresponding with axial orientation.
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14
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Grebenik EA, Gafarova ER, Istranov LP, Istranova EV, Ma X, Xu J, Guo W, Atala A, Timashev PS. Mammalian Pericardium-Based Bioprosthetic Materials in Xenotransplantation and Tissue Engineering. Biotechnol J 2020; 15:e1900334. [PMID: 32077589 DOI: 10.1002/biot.201900334] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 01/29/2020] [Indexed: 12/13/2022]
Abstract
Bioprosthetic materials based on mammalian pericardium tissue are the gold standard in reconstructive surgery. Their application range covers repair of rectovaginal septum defects, abdominoplastics, urethroplasty, duraplastics, maxillofacial, ophthalmic, thoracic and cardiovascular reconstruction, etc. However, a number of factors contribute to the success of their integration into the host tissue including structural organization, mechanical strength, biocompatibility, immunogenicity, surface chemistry, and biodegradability. In order to improve the material's properties, various strategies are developed, such as decellularization, crosslinking, and detoxification. In this review, the existing issues and long-term achievements in the development of bioprosthetic materials based on the mammalian pericardium tissue, aimed at a wide-spectrum application in reconstructive surgery are analyzed. The basic technical approaches to preparation of biocompatible forms providing continuous functioning, optimization of biomechanical and functional properties, and clinical applicability are described.
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Affiliation(s)
- Ekaterina A Grebenik
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, 119991, Russia
| | - Elvira R Gafarova
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, 119991, Russia
| | - Leonid P Istranov
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, 119991, Russia
| | - Elena V Istranova
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, 119991, Russia
| | - Xiaowei Ma
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing, 100190, P. R. China
| | - Jing Xu
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing, 100190, P. R. China
| | - Weisheng Guo
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing, 100190, P. R. China
| | - Anthony Atala
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, 27101, USA
| | - Peter S Timashev
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, 119991, Russia.,Institute of Photonic Technologies, Research center "Crystallography and Photonics" RAS, Moscow, 142190, Russia.,N. N. Semenov Institute of Chemical Physics, Russian Academy of Sciences, Moscow, 119991, Russia
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