1
|
Tuladhar SR, Mulderrig S, Della Barbera M, Vedovelli L, Bottigliengo D, Tessari C, Jockenhoevel S, Gregori D, Thiene G, Korossis S, Mela P, Iop L, Gerosa G. Bioengineered percutaneous heart valves for transcatheter aortic valve replacement: a comparative evaluation of decellularised bovine and porcine pericardia. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 123:111936. [PMID: 33812574 DOI: 10.1016/j.msec.2021.111936] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 08/06/2020] [Accepted: 01/31/2021] [Indexed: 12/18/2022]
Abstract
Glutaraldehyde-treated, surgical bioprosthetic heart valves undergo structural degeneration within 10-15 years of implantation. Analogous preliminary results were disclosed for percutaneous heart valves (PHVs) realized with similarly-treated tissues. To improve long-term performance, decellularised scaffolds can be proposed as alternative fabricating biomaterials. The aim of this study was to evaluate whether bovine and porcine decellularised pericardia could be utilised to manufacture bioengineered percutaneous heart valves (bioPHVs) with adequate hydrodynamic performance and leaflet resistance to crimping damage. BioPHVs were fabricated by mounting acellular pericardia onto commercial stents. Independently from the pericardial species used for valve fabrication, bioPHVs satisfied the minimum hydrodynamic performance criteria set by ISO 5840-3 standards and were able to withstand a large spectrum of cardiac output conditions, also during extreme backpressure, without severe regurgitation, especially in the case of the porcine group. No macroscopic or microscopic leaflet damage was detected following bioPHV crimping. Bovine and porcine decellularized pericardia are both suitable alternatives to glutaraldehyde-treated tissues. Between the two types of pericardial species tested, the porcine tissue scaffold might be preferable to fabricate advanced PHV replacements for long-term performance. CONDENSED ABSTRACT: Current percutaneous heart valve replacements are formulated with glutaraldehyde-treated animal tissues, prone to structural degeneration. In order to improve long-term performance, bovine and porcine decellularised pericardia were utilised to manufacture bioengineered replacements, which demonstrated adequate hydrodynamic behaviour and resistance to crimping without leaflet architectural alteration.
Collapse
Affiliation(s)
- Sugat Ratna Tuladhar
- Cardiovascular Regenerative Medicine, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Shane Mulderrig
- Department of Biohybrid & Medical Textiles (BioTex), Institute for Applied Medical Engineering, Helmholtz Aachen, University Hospital RWTH Aachen, Aachen, Germany
| | - Mila Della Barbera
- Cardiovascular Pathology, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Luca Vedovelli
- Biostatistics, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Daniele Bottigliengo
- Biostatistics, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Chiara Tessari
- Cardiovascular Regenerative Medicine, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Stefan Jockenhoevel
- Department of Biohybrid & Medical Textiles (BioTex), Institute for Applied Medical Engineering, Helmholtz Aachen, University Hospital RWTH Aachen, Aachen, Germany
| | - Dario Gregori
- Biostatistics, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Gaetano Thiene
- Cardiovascular Pathology, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Sotiris Korossis
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany; Lower Saxony Centre for Biomedical Engineering, Implant Research and Development, Hannover Medical School, Hannover, Germany
| | - Petra Mela
- Department of Biohybrid & Medical Textiles (BioTex), Institute for Applied Medical Engineering, Helmholtz Aachen, University Hospital RWTH Aachen, Aachen, Germany
| | - Laura Iop
- Cardiovascular Regenerative Medicine, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy; L.I.F.E.LA.B., CORIS, Veneto Region, Padua, Italy
| | - Gino Gerosa
- Cardiovascular Regenerative Medicine, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy; L.I.F.E.LA.B., CORIS, Veneto Region, Padua, Italy.
| |
Collapse
|
2
|
Cressman S, Rheinboldt M, Klochko C, Nadig J, Spizarny D. Chest Radiographic Appearance of Minimally Invasive Cardiac Implants and Support Devices: What the Radiologist Needs to Know. Curr Probl Diagn Radiol 2018; 48:274-288. [PMID: 30033187 DOI: 10.1067/j.cpradiol.2018.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/01/2018] [Accepted: 05/18/2018] [Indexed: 11/22/2022]
Abstract
Minimally invasive implantable cardiac devices used in valve repair and replacement, cardiovascular support, and partial chamber and appendageal occlusion represent a burgeoning area of both bioengineering and clinical innovation. In addition to familiarizing the reader with the radiographic appearance of the most commonly utilized and encountered newer devices, this review will also address the relevant clinical and pathophysiological indications for usage and deployment as well as potentially encountered complications.
Collapse
Affiliation(s)
| | | | - Chad Klochko
- Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI
| | | | | |
Collapse
|
3
|
Thongprayoon C, Cheungpasitporn W, Srivali N, Kittanamongkolchai W, Sakhuja A, Greason KL, Kashani KB. The association between renal recovery after acute kidney injury and long-term mortality after transcatheter aortic valve replacement. PLoS One 2017; 12:e0183350. [PMID: 28817669 PMCID: PMC5560733 DOI: 10.1371/journal.pone.0183350] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 08/02/2017] [Indexed: 01/21/2023] Open
Abstract
Background This study aimed to examine the association between renal recovery status at hospital discharge after acute kidney injury (AKI) and long-term mortality following transcatheter aortic valve replacement (TAVR). Methods We screened all adult patients who survived to hospital discharge after TAVR for aortic stenosis at a quaternary referral medical center from January 1, 2008, through June 30, 2014. An AKI was defined as an increase in serum creatinine level of 0.3 mg/dL or a relative increase of 50% from baseline. Renal outcome at the time of discharge was evaluated by comparing the discharge serum creatinine level to the baseline level. Complete renal recovery was defined as no AKI at discharge, whereas partial renal recovery was defined as AKI without a need for renal replacement therapy at discharge. No renal recovery was defined as a need for renal replacement therapy at discharge. Results The study included 374 patients. Ninty-eight (26%) patients developed AKI during hospitalization: 55 (56%) had complete recovery; 39 (40%), partial recovery; and 4 (4%), no recovery. AKI development was significantly associated with increased risk of 2-year mortality (hazard ratio [HR], 2.20 [95% CI, 1.37–3.49]). For patients with AKI, the 2-year mortality rate for complete recovery was 34%; for partial recovery, 43%; and for no recovery, 75%; compared with 20% for patients without AKI (P < .001). In adjusted analysis, complete recovery (HR, 1.87 [95% CI, 1.03–3.23]); partial recovery (HR, 2.65 [95% CI, 1.40–4.71]) and no recovery (HR, 10.95 [95% CI, 2.59–31.49]) after AKI vs no AKI were significantly associated with increased risk of 2-year mortality. Conclusion The mortality rate increased for all patients with AKI undergoing TAVR. A reverse correlation existed for progressively higher risk of death and the extent of AKI recovery.
Collapse
Affiliation(s)
- Charat Thongprayoon
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Narat Srivali
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | | | - Ankit Sakhuja
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Kevin L. Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Kianoush B. Kashani
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States of America
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- * E-mail:
| |
Collapse
|
4
|
Harjai KJ, Grines CL, Paradis JM, Kodali S. Transcatheter aortic valve replacement: The year in review 2016. J Interv Cardiol 2017; 30:286. [DOI: 10.1111/joic.12394] [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
|