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Van Hecke M, Langenaeken T, Rega F, Roskams T, Meuris B. Validation of large animal models in mechanical valve research: a histologic comparison. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae070. [PMID: 38637938 PMCID: PMC11078892 DOI: 10.1093/icvts/ivae070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 03/15/2024] [Accepted: 04/17/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVES Mechanical valves still require life-long anticoagulation. Preclinical animal testing is a crucial step in the assessment of valves; however, the chosen animal model should be carefully considered, and a well-controlled animal model of mechanical valve thrombosis has not been established yet. In this study, a histopathologic comparison was performed to evaluate the representativity of pigs and sheep as large animal models in bileaflet mechanical valve thrombosis research. METHODS 10 pigs and 8 sheep were implanted with a bileaflet mechanical valve in pulmonary position. During follow-up, no anticoagulative therapy was administered. Pigs were sacrificed between 14 and 38 days for explantation and assessment of the valve. Sheep were sacrificed between 71 and 155 days. Thrombus samples were processed and (immuno)histochemical stainings were applied. A pathologist evaluated the samples morphologically and semiquantitatively and compared these samples to available slides from 3 human patients who underwent redo surgery for acute bileaflet mechanical valve thrombosis, caused by insufficient anticoagulation. RESULTS All pigs showed macroscopically evident thrombi on the mechanical valve surface at sacrifice. In contrast, none of the sheep showed any sign of thrombus formation. Histology showed a high fibrin content in thrombi of both human and porcine cases (3/3 vs 8/10). Porcine thrombi showed more cellular organization (0/3 vs 6/10), more calcification (0/3 vs 9/10) and more endothelialization (0/3 vs 6/10). Inflammatory cells were present in all samples and were considered physiological. CONCLUSIONS Contrary to sheep, pigs develop thrombi on their mechanical valves in the short-term if no anticoagulation is administered. Histologic comparison of human and porcine thrombi shows comparable findings. The pig model might serve interestingly for further research on valve thrombosis, if it shows not to be an overly aggressive model.
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Affiliation(s)
- Manon Van Hecke
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Tom Langenaeken
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Filip Rega
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Tania Roskams
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Bart Meuris
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
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2
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Wu Z, Zhou Z, Bian C, Guo L, Tong Z, Guo J, Qi L, Cui S, Zhang C, Chen Y, Huang W, Gu Y. In vivo evaluation of safety and performance of a tapered nitinol venous stent with inclined proximal end in an ovine iliac venous model. Sci Rep 2024; 14:7669. [PMID: 38561485 PMCID: PMC10984921 DOI: 10.1038/s41598-024-58237-x] [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: 08/22/2023] [Accepted: 03/26/2024] [Indexed: 04/04/2024] Open
Abstract
A tapered stent with inclined proximal end is designed for fitting the iliac anatomically. The aim of the present study was to evaluate the safety and performance of the new stent in ovine left iliac veins. The experiment was performed in 30 adult sheep, and one nitinol-based VENA-BT® iliac venous stent (KYD stent) was implanted into each animal's left common iliac vein. Follow-up in all sheep consisted of angiographic, macroscopic, and microscopic examinations at Day 0 (< 24 h), Day 30, Day 90, Day 180 and Day 360 post-stenting (six animals per each time-point). 30 healthy ~ 50 kg sheep were included in this study and randomly divided into five groups according to the follow-up timepoint. All stents were implanted successfully into the left ovine common iliac vein. No significant migration occurred at follow-up. There is no statistically significant difference between the groups (p > 0.05), indicating no serious lumen loss occurred during the follow-up period. Common iliac venous pressure was further measured and the results further indicated the lumen patency at follow-up. Histological examinations indicated that no vessel injury and wall rupture, stent damage, and luminal thrombus occurred. There was moderate inflammatory cell infiltration around the stent in Day-0 and Day-30 groups with the average inflammation score of 2.278 and 2.167, respectively. The inflammatory reaction was significantly reduced in Day-90, Day-180 and Day-360 groups and the average inflammation scores were 0.9444 (p < 0.001, Day-90 vs Day-0), 1.167 (p < 0.001, Day-180 vs Day-0) and 0.667 (p < 0.001, Day-90 vs Day-0), respectively. The microscopic examinations found that the stents were well covered by endothelial cells in all follow-up time points. The results suggested that the KYD stent is feasible and safe in animal model. Future clinical studies may be required to further evaluate its safety and efficacy.
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Affiliation(s)
- Zhongjian Wu
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Zhengtong Zhou
- Vascular Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Chunjing Bian
- General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lianrui Guo
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Zhu Tong
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Jianming Guo
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Lixing Qi
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Shijun Cui
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Chengchao Zhang
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Yilong Chen
- ShenZhen KYD Biomedical Technology Co. Ltd, Guangzhou, China
| | - Wei Huang
- ShenZhen KYD Biomedical Technology Co. Ltd, Guangzhou, China
| | - Yongquan Gu
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China.
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3
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He Y, Anderson B, Hu Q, Hayes RB, Huff K, Isaacson J, Warner KS, Hauser H, Greenberg M, Chandra V, Kauser K, Berceli SA. Photochemically Aided Arteriovenous Fistula Creation to Accelerate Fistula Maturation. Int J Mol Sci 2023; 24:ijms24087571. [PMID: 37108733 PMCID: PMC10142855 DOI: 10.3390/ijms24087571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/10/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Rates of arteriovenous fistula maturation failure are still high, especially when suboptimal size veins are used. During successful maturation, the vein undergoes lumen dilatation and medial thickening, adapting to the increased hemodynamic forces. The vascular extracellular matrix plays an important role in regulating these adaptive changes and may be a target for promoting fistula maturation. In this study, we tested whether a device-enabled photochemical treatment of the vein prior to fistula creation facilitates maturation. Sheep cephalic veins were treated using a balloon catheter coated by a photoactivatable molecule (10-8-10 Dimer) and carrying an internal light fiber. As a result of the photochemical reaction, new covalent bonds were created during light activation among oxidizable amino acids of the vein wall matrix proteins. The treated vein lumen diameter and media area became significantly larger than the contralateral control fistula vein at 1 week (p = 0.035 and p = 0.034, respectively). There was also a higher percentage of proliferating smooth muscle cells in the treated veins than in the control veins (p = 0.029), without noticeable intimal hyperplasia. To prepare for the clinical testing of this treatment, we performed balloon over-dilatation of isolated human veins and found that veins can tolerate up to 66% overstretch without notable histological damage.
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Affiliation(s)
- Yong He
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida, Gainesville, FL 32611, USA
| | | | - Qiongyao Hu
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida, Gainesville, FL 32611, USA
| | - R B Hayes
- Alucent Biomedical Inc., Salt Lake City, UT 84108, USA
| | - Kenji Huff
- Alucent Biomedical Inc., Salt Lake City, UT 84108, USA
| | - Jim Isaacson
- Alucent Biomedical Inc., Salt Lake City, UT 84108, USA
| | | | - Hank Hauser
- Alucent Biomedical Inc., Salt Lake City, UT 84108, USA
| | | | - Venita Chandra
- Division of Vascular Surgery, Department of Surgery, Stanford University, Stanford, CA 94305, USA
| | | | - Scott A Berceli
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida, Gainesville, FL 32611, USA
- North Florida/South Georgia Veterans Health System, Gainesville, FL 32608, USA
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4
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Berk ZBK, Shah A, Sun W, Griffith BP, Wu ZJ. An ex vivo comparison of partial thromboplastin time and activated clotting time for heparin anticoagulation in an ovine model. Artif Organs 2022; 46:501-505. [PMID: 34698388 PMCID: PMC8882126 DOI: 10.1111/aor.14094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/14/2021] [Accepted: 10/13/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Sheep are a primary model of mechanical circulatory support (MCS) with heparin anticoagulation therapy frequently being monitored by activated clotting time (ACT) due to ease and cost. In patients undergoing long-term heparin therapy, other anticoagulation monitoring strategies, such as activated partial thromboplastin time (aPTT), have proven to be more reliable indicators for the adequacy of anticoagulation, frequently determined by heparin concentration. As there is a paucity of similar studies in sheep, we sought to investigate the correlation between heparin concentration and ACT and aPTT using whole sheep blood in an ex vivo model. METHODS Fresh whole blood was serially drawn from an adult female Dorset-hybrid sheep and aliquots were placed into tubes containing heparin saline solutions with concentrations ranging from 0 to 7.81 U heparin per mL of whole blood. ACT and aPTT values were measured on each of the samples. The experiment was performed four times with the same animal. A simple linear regression was performed to determine correlation, and subgroup analysis was performed on low versus high heparin concentrations typically seen in human patients on long-term MCS, such as extracorporeal membrane oxygenation (ECMO), versus cardiopulmonary bypass, respectively. RESULTS aPTT measurements versus the heparin concentration had an R2 = 0.7295. ACT measurements versus the heparin concentration had a R2 = 0.4628. aPTT measurements versus the ACT measurements had a R2 = 0.2974. The strength of the correlation between aPTT and heparin concentration increased at low heparin concentrations (R2 = 0.8392). CONCLUSION aPTT had a more reliable correlation to heparin concentration and thus anticoagulation level than ACT. This was particularly true at lower heparin concentrations, similar to ranges seen for patients on ECMO. The correlation between aPTT and ACT values was poor. Further in vivo studies should be performed to confirm our results.
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Affiliation(s)
- Zachary B. K. Berk
- Department of Surgery Division of Cardiac Surgery University of Maryland School of Medicine Baltimore Maryland USA
| | - Aakash Shah
- Department of Surgery Division of Cardiac Surgery University of Maryland School of Medicine Baltimore Maryland USA
| | - Wenji Sun
- Department of Surgery Division of Cardiac Surgery University of Maryland School of Medicine Baltimore Maryland USA
| | - Bartley P. Griffith
- Department of Surgery Division of Cardiac Surgery University of Maryland School of Medicine Baltimore Maryland USA
| | - Zhongjun J. Wu
- Department of Surgery Division of Cardiac Surgery University of Maryland School of Medicine Baltimore Maryland USA
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5
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Mariani S, Li T, Hegermann J, Bounader K, Hanke J, Meyer T, Jannsen-Peters H, Haverich A, Schmitto JD, Dogan G. Biocompatibility of an apical ring plug for left ventricular assist device explantation: Results of a feasibility pre-clinical study. Artif Organs 2021; 46:827-837. [PMID: 34904254 DOI: 10.1111/aor.14149] [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: 04/12/2021] [Revised: 09/29/2021] [Accepted: 12/08/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patients receiving left ventricle assist devices (LVADs) as bridge to recovery remain a minority with 1%-5% of LVADs explanted after improvement of myocardial function. Nevertheless, considering the growing population of patients supported with LVADs, an increasing demand of new explantation strategies is expected in the near future. A novel plug for LVAD explantation has been developed and its biocompatibility profile needs to be proved. This study tested the biocompatibility of this novel plug in an in vivo ovine model. METHODS Six adult Blackhead Persian female sheep received plug implantation on the cardiac apex via minimally invasive approach and were clinically observed up to 90 days. Echocardiography was performed to detect thrombus formation or further plug-related complications. After the observation period, euthanasia was performed and samples including the plug and the surrounding tissues were obtained to be analyzed with correlative light and electron microscopy. Organ necrosis, ischemia and peripheral embolism were investigated. RESULTS Three animals survived surgery and completed the follow-up time without experiencing clinical complications. Echocardiographic controls excluded the presence of an intracavitary thrombus in the left ventricle (LV). Autopsy confirmed no signs of local infection, LV thrombus or peripheral embolism. Light and electron microscopy revealed an intact epithelium covering a layer of connective tissue on the plug surface facing the heart lumen. CONCLUSIONS This novel apical plug for LVAD explantation allows for endothelial and connective tissue growth on its ventricular side within 90 days from surgery. Further studies are required to fully demonstrate the biocompatibility of this apical plug and investigate the optimal anticoagulation regimen to be applied after implantation.
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Affiliation(s)
- Silvia Mariani
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.,Cardio-Thoracic Surgery Department, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Tong Li
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan Hegermann
- Institute of Functional and Applied Anatomy, Research Core Unit Electron Microscopy, Hannover Medical School, Hannover, Germany
| | - Karl Bounader
- Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Jasmin Hanke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | | | | | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan D Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Günes Dogan
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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6
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Cysyk JP, Lukic B, Joseph Brian C, Newswanger R, Jhun CS, Izer J, Flory H, Reibson J, Doxtater B, Weiss W, Rosenberg G. Miniaturized Fontan Circulation Assist Device: Chronic In Vivo Evaluation. ASAIO J 2021; 67:1240-1249. [PMID: 33883510 DOI: 10.1097/mat.0000000000001439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We have miniaturized and optimized our implantable rotary blood pump developed to provide long-term mechanical right heart support for patients who have failing Fontan circulation. The objective of this study was to evaluate the miniaturized Fontan circulation assist device (mini-FCAD) during 30-day sheep studies (n = 5). A complete right heart bypass was performed and all return flow was supported by the pump. Postoperatively, unfractionated heparin was given to maintain thromboelastography R times of 2× normal. The first two studies were terminated on day 0 and day 4 due to complications. In the final three studies, the animals remained healthy and were electively terminated at 30 ± 2 days. Pump flow was between 5 and 7 lpm, left atrial pressure remained normal, and inlet pressures were between 3 and 18 mm Hg with no incidents of suction. There was no evidence of hemolysis, end organ or pulmonary dysfunction, thromboembolic events, nor thermal damage to the surrounding tissue. Explanted devices from two studies were free of thrombi and in the third study there were unattached thrombi on the SVC inlet of the rotor. The mini-FCAD was successfully tested in vivo as a right heart replacement device demonstrating adequate circulatory support and normal physiologic pulmonary and venous pressures.
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Affiliation(s)
- Joshua P Cysyk
- From the Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Branka Lukic
- From the Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Clark Joseph Brian
- From the Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
- Department of Pediatrics, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Ray Newswanger
- From the Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Choon-Sik Jhun
- From the Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Jenelle Izer
- Department of Comparative Medicine, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Heidi Flory
- From the Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - John Reibson
- From the Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Bradley Doxtater
- From the Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - William Weiss
- From the Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Gerson Rosenberg
- From the Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
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7
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Kengelbach-Weigand A, Thielen C, Bäuerle T, Götzl R, Gerber T, Körner C, Beier JP, Horch RE, Boos AM. Personalized medicine for reconstruction of critical-size bone defects - a translational approach with customizable vascularized bone tissue. NPJ Regen Med 2021; 6:49. [PMID: 34413320 PMCID: PMC8377075 DOI: 10.1038/s41536-021-00158-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/29/2021] [Indexed: 02/07/2023] Open
Abstract
Tissue engineering principles allow the generation of functional tissues for biomedical applications. Reconstruction of large-scale bone defects with tissue-engineered bone has still not entered the clinical routine. In the present study, a bone substitute in combination with mesenchymal stem cells (MSC) and endothelial progenitor cells (EPC) with or without growth factors BMP-2 and VEGF-A was prevascularized by an arteriovenous (AV) loop and transplanted into a critical-size tibia defect in the sheep model. With 3D imaging and immunohistochemistry, we could show that this approach is a feasible and simple alternative to the current clinical therapeutic option. This study serves as proof of concept for using large-scale transplantable, vascularized, and customizable bone, generated in a living organism for the reconstruction of load-bearing bone defects, individually tailored to the patient's needs. With this approach in personalized medicine for the reconstruction of critical-size bone defects, regeneration of parts of the human body will become possible in the near future.
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Affiliation(s)
- Annika Kengelbach-Weigand
- grid.411668.c0000 0000 9935 6525Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Carolina Thielen
- grid.411668.c0000 0000 9935 6525Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Tobias Bäuerle
- grid.5330.50000 0001 2107 3311Institute of Radiology, Preclinical Imaging Platform Erlangen (PIPE), University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Rebekka Götzl
- grid.411668.c0000 0000 9935 6525Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany ,grid.412301.50000 0000 8653 1507Present Address: Department of Plastic Surgery, Hand Surgery, Burn Center, University Hospital RWTH Aachen, Aachen, Germany
| | - Thomas Gerber
- grid.10493.3f0000000121858338Institute of Physics, University of Rostock, Rostock, Germany
| | - Carolin Körner
- grid.5330.50000 0001 2107 3311Department of Materials Science and Engineering, Institute of Science and Technology of Metals, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Justus P. Beier
- grid.411668.c0000 0000 9935 6525Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany ,grid.412301.50000 0000 8653 1507Present Address: Department of Plastic Surgery, Hand Surgery, Burn Center, University Hospital RWTH Aachen, Aachen, Germany
| | - Raymund E. Horch
- grid.411668.c0000 0000 9935 6525Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Anja M. Boos
- grid.411668.c0000 0000 9935 6525Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany ,grid.412301.50000 0000 8653 1507Present Address: Department of Plastic Surgery, Hand Surgery, Burn Center, University Hospital RWTH Aachen, Aachen, Germany
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8
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Jalaie H, Schleimer K, Toonder IM, Gombert A, Afify M, Doganci S, Modabber A, Razavi MK, Barbati ME. Effect of Stent Strut Interval on Neointima Formation After Venous Stenting in an Ovine Model. Eur J Vasc Endovasc Surg 2021; 62:276-283. [PMID: 34053840 DOI: 10.1016/j.ejvs.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 03/22/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The impact of stent design on venous patency is not well studied. The purpose of this study was to investigate the effect of stent material burden on endothelial coverage of stented venous segments, which may contribute to vessel healing and patency. METHODS Segmented self expanding bare nitinol stents (18 × 50 mm) comprising 5 mm long attached metallic rings separated by 2, 5, or 8 mm gaps were implanted in the inferior vena cava (IVC) of 10 sheep. These stents were designed and manufactured for the purposes of this study. At six, 12, and 24 weeks after implantation the animals were euthanised and the stented vessels harvested for histomorphometric analysis. Three sections from the metallic part as well as the gaps between the struts were reviewed for quantification of endothelialisation after six, 12, and 24 weeks. The intimal thickness over and between the stent struts was measured. The endothelialisation score (graded from 1 for complete luminal endothelialisation to 5 for absence of endothelial cells) was determined. RESULTS All stents were successfully deployed and all 10 sheep survived until the time of harvesting. Macroscopic inspection after 24 weeks showed only partial endothelialisation over stents with 2 mm and 5 mm skipped segments, whereas the stents with 8 mm skipped segments were totally incorporated into the vein wall. After 24 weeks, the mean (SD) neointimal thicknesses over stent struts with 2 mm, 5 mm, and 8 mm skipped segments were 254.0 (51.6), 182.2 (98.1), and 194.6 (101.1) μm, respectively. Comparison of endothelialisation scores of stents over time showed statistically significantly better endothelialisation over stents with 8 mm gaps after 12 and 24 weeks. CONCLUSION Stent designs providing structural support to veins with larger gaps between the scaffold material appear to lead to faster and more complete endothelialisation as well as a thinner intimal layer.
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Affiliation(s)
- Houman Jalaie
- Clinic of Vascular and Endovascular Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Karina Schleimer
- Clinic of Vascular and Endovascular Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Irwin M Toonder
- Clinic of Vascular and Endovascular Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Alexander Gombert
- Clinic of Vascular and Endovascular Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Mamdouh Afify
- Clinic of Cardiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Suat Doganci
- Department of Cardiovascular Surgery, University of Health Sciences, Ankara, Turkey
| | - Ali Modabber
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | | | - Mohammad E Barbati
- Clinic of Vascular and Endovascular Surgery, RWTH Aachen University Hospital, Aachen, Germany.
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9
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Significant differences in single-platelet biophysics exist across species but attenuate during clot formation. Blood Adv 2021; 5:432-437. [PMID: 33496738 DOI: 10.1182/bloodadvances.2020003755] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/06/2020] [Indexed: 12/14/2022] Open
Abstract
Key Points
Human, canine, ovine, and porcine platelets exhibit disparate biophysical signatures, whereas human and murine platelets are similar. Multiple biophysical parameters integrate during clot formation, measured by bulk clot contraction, and attenuate biophysical differences.
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10
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Fang S, Ahlmann AH, Langhorn L, Hussein K, Sørensen JA, Guan X, Sheikh SP, Riber LP, Andersen DC. Small diameter polycaprolactone vascular grafts are patent in sheep carotid bypass but require antithrombotic therapy. Regen Med 2021; 16:117-130. [PMID: 33764157 DOI: 10.2217/rme-2020-0171] [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] [Indexed: 12/11/2022] Open
Abstract
Background: Polycaprolactone (PCL) scaffolds exhibit high biocompatibility and are attractive as vascular conduits. Materials & methods: PCL tubes were cultivated in bioreactor with human adipose regenerative cells to assess ex vivo cytocompatibility, whereas in vivo PCL tube patency was evaluated in sheep carotid bypass with and without antithrombotic treatment. Results: Ex vivo results revealed increasing adipose regenerative cells on PCL using dynamic bioreactor culturing. In vivo data showed that 67% (2/3) of grafts in the antithrombotic group were patent at day 28, while 100% (3/3) of control grafts were occluded already during the first week due to thrombosis. Histology showed that patent PCL grafts were recellularized by host cells. Conclusion: PCL tubes may work as small diameter vascular scaffolds under antithrombotic treatment.
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Affiliation(s)
- Shu Fang
- Laboratory of Molecular & Cellular Cardiology, Department of Clinical Biochemistry & Pharmacology, Odense University Hospital, J. B. Winsløws Vej 25, Odense C 5000, Denmark.,The Danish Regenerative Center, Odense University Hospital, J. B. Winsløws Vej 4, Odense C 5000, Denmark.,Institute of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, Odense C 5000, Denmark
| | - Alexander Høgsted Ahlmann
- Laboratory of Molecular & Cellular Cardiology, Department of Clinical Biochemistry & Pharmacology, Odense University Hospital, J. B. Winsløws Vej 25, Odense C 5000, Denmark.,Institute of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, Odense C 5000, Denmark
| | - Louise Langhorn
- Biomedical Laboratory, University of Southern Denmark, J.B. Winsløws Vej 23, Odense C 5000, Denmark
| | - Kamal Hussein
- Laboratory of Molecular & Cellular Cardiology, Department of Clinical Biochemistry & Pharmacology, Odense University Hospital, J. B. Winsløws Vej 25, Odense C 5000, Denmark.,The Danish Regenerative Center, Odense University Hospital, J. B. Winsløws Vej 4, Odense C 5000, Denmark.,Department of Animal Surgery, Faculty of Veterinary Medicine, Assiut University, Assiut 71526, Egypt
| | - Jens Ahm Sørensen
- Institute of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, Odense C 5000, Denmark.,Department of Plastic Surgery, Odense University Hospital, J.B. Winsløws Vej 4, Odense C 5000, Denmark
| | - Xiaowei Guan
- Department of Photonics Engineering, Technical University of Denmark, Ørsteds Plads Building 345A, Kongens Lyngby 2800, Denmark
| | - Søren Paludan Sheikh
- Laboratory of Molecular & Cellular Cardiology, Department of Clinical Biochemistry & Pharmacology, Odense University Hospital, J. B. Winsløws Vej 25, Odense C 5000, Denmark.,The Danish Regenerative Center, Odense University Hospital, J. B. Winsløws Vej 4, Odense C 5000, Denmark.,Institute of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, Odense C 5000, Denmark
| | - Lars Peter Riber
- Institute of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, Odense C 5000, Denmark.,Department of Cardiothoracic & Vascular Surgery, Odense University Hospital, J.B. Winsløws Vej 4, Odense C 5000, Denmark
| | - Ditte Caroline Andersen
- Laboratory of Molecular & Cellular Cardiology, Department of Clinical Biochemistry & Pharmacology, Odense University Hospital, J. B. Winsløws Vej 25, Odense C 5000, Denmark.,The Danish Regenerative Center, Odense University Hospital, J. B. Winsløws Vej 4, Odense C 5000, Denmark.,Institute of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, Odense C 5000, Denmark
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11
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Riboldi SA, Tozzi M, Bagardi M, Ravasio G, Cigalino G, Crippa L, Piccolo S, Nahal A, Spandri M, Catto V, Tironi M, Greco FG, Remuzzi A, Acocella F. A Novel Hybrid Silk Fibroin/Polyurethane Arteriovenous Graft for Hemodialysis: Proof-of-Concept Animal Study in an Ovine Model. Adv Healthc Mater 2020; 9:e2000794. [PMID: 32914588 DOI: 10.1002/adhm.202000794] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/17/2020] [Indexed: 12/25/2022]
Abstract
To solve the problem of vascular access failure, a novel semi-degradable hybrid vascular graft, manufactured by electrospinning using silk fibroin and polyurethane (Silkothane), has been previously developed and characterized in vitro. This proof-of-concept animal study aims at evaluating the performances of Silkothane grafts in a sheep model of arteriovenous shunt, in terms of patency and short-term remodeling. Nine Silkothane grafts are implanted between the common carotid artery and the external jugular vein of nine sheep, examined by palpation three times per week, by echo-color Doppler every two weeks, and euthanized at 30, 60, and 90 days (N = 3 per group). At sacrifice, grafts are harvested and submitted for histopathology and/or scanning electron microcopy (SEM). No cases of graft-related complications are recorded. Eight of nine sheep (89%) show 100% primary unassisted patency at the respective time of sacrifice (flow rate 1.76 ± 0.61 L min-1 , one case of surgery-related thrombosis excluded). Histopathology and SEM analysis evidence signs of inflammation and pseudointima inside the graft lumen, especially at the venous anastomosis; however, endoluminal stenosis never impairs the functionality of the shunt and coverage by endothelial cells is observed. In this model, Silkothane grafts grant safety and 100% patency up to 90 days.
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Affiliation(s)
| | - Matteo Tozzi
- Department of Medicine and Surgery Università degli Studi dell'Insubria Varese 21100 Italy
| | - Mara Bagardi
- Department of Veterinary Medicine Università degli Studi di Milano Milano 20122 Italy
| | - Giuliano Ravasio
- Department of Veterinary Medicine Università degli Studi di Milano Milano 20122 Italy
| | - Giorgio Cigalino
- Centre for Clinical Veterinary Medicine and Experimental Zootechnics Università degli Studi di Milano Milano 20122 Italy
| | - Luca Crippa
- Department of Medicine and Surgery Università degli Studi di Milano Bicocca Milano 20126 Italy
| | - Solange Piccolo
- Department of Medicine and Surgery Università degli Studi dell'Insubria Varese 21100 Italy
| | - Amal Nahal
- Department of Medicine and Surgery Università degli Studi dell'Insubria Varese 21100 Italy
| | | | | | - Matteo Tironi
- Department of Bioengineering IRCCS Istituto di Ricerche Farmacologiche Mario Negri Bergamo 24126 Italy
| | | | - Andrea Remuzzi
- Department of Management, Information and Production Engineering Università degli Studi di Bergamo Bergamo 24129 Italy
| | - Fabio Acocella
- Department of Health, Animal Science and Food Safety Università degli Studi di Milano Milano 20122 Italy
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12
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De Potter T, Yodfat O, Shinar G, Neta A, Reddy VY, Neuzil P, Veltkamp R, Connolly SJ. Permanent Bilateral Carotid Filters for Stroke Prevention in Atrial Fibrillation. Curr Cardiol Rep 2020; 22:144. [PMID: 32910288 PMCID: PMC7496024 DOI: 10.1007/s11886-020-01388-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Purpose of Review A novel permanent carotid filter device for percutaneous implantation was developed for the purpose of stroke prevention. In this review, we cover rationale, existing preclinical and clinical data, and potential future directions for research using such a device. Recent Findings The Vine™ filter was assessed for safety in sheep and in 2 observational human studies, the completed CAPTURE 1 (n = 25) and the ongoing CAPTURE 2 (planned n = 100). CAPTURE 1 has shown high procedural and long-term implant safety. A control group was not available for comparison. Summary A mechanical filter for permanent stroke prevention can be implanted bilaterally in the common carotid artery safely and efficiently. A randomized trial is planned for 2021 (n = 3500, INTERCEPT) to demonstrate superiority of a filter + anticoagulation strategy over anticoagulation alone in patients at high risk for ischemic stroke.
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Affiliation(s)
- Tom De Potter
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, B-9300 Aalst, Belgium
| | | | | | | | - Vivek Y. Reddy
- Helmsley Electrophysiology Center, Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Petr Neuzil
- Department of Cardiology, Homolka Hospital, Prague, Czech Republic
| | - Roland Veltkamp
- Department of Brain Science, Imperial College London, London, UK
- Department of Neurology, Alfried Krupp Krankenhaus, Essen, Germany
- Department of Neurology, University Heidelberg, Heidelberg, Germany
| | - Stuart J. Connolly
- Population Health Research Institute, McMaster University, Hamilton, Ontario Canada
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13
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A Permanent Common Carotid Filter for Stroke Prevention in Atrial Fibrillation: Ex Vivo and In Vivo Pre-Clinical Testing. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1587-1593. [PMID: 32522397 DOI: 10.1016/j.carrev.2020.05.031] [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: 04/06/2020] [Revised: 05/21/2020] [Accepted: 05/21/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE A novel, permanent, bilateral, common carotid artery (CCA) coil filter implant was designed to capture stroke-producing emboli in atrial fibrillation patients. Under ultrasound guidance, it is automatically deployed through a 24-guage needle and is retrievable up to 4 h post-procedure. We assessed the feasibility, safety, and effectiveness of the CCA filter in pre-clinical testing. METHODS In a pulsatile flow simulator, the filter's embolic capture efficiency and integrity of simulated (1.2 mm diameter nylon balls) and actual thromboemboli were tested. Implant insertion, retrieval, and chronic safety were tested in sheep by ultrasound and X-ray. At termination, the CCAs were explanted and examined by pathology, histopathology and scanning electron microscopy. The fate of captured emboli was evaluated in sheep 3 weeks after upstream injection of autologous thromboemboli. RESULTS In the flow simulator, 10 filters captured 29 of 29 (100%) 1.2 mm diameter nylon balls. In the thromboemboli integrity test, all captured thromboemboli (99 of 99) were adherent to the filter, without fragmentation. All sheep (n = 30/60 implants) underwent successful CCA filter implantation. During follow-ups at 4, 12, 13, 23, and 31 weeks (6 sheep/12 implants at each follow-up), there were no (0%) major bleeds, CCA damage/stenosis, implant migration, flow obstruction, or thrombi detected by ultrasound. Two organized microthrombi (<100 μm) were observed by histopathology at the puncture site. After 3 weeks, autologous captured thromboemboli (n = 10) either completely regressed (5 of 5) or did not progress (5 of 5). CONCLUSION These favorable pre-clinical results prompt clinical testing of the CCA filter in stroke prevention clinical trials.
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14
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Lukic B, Clark JB, Izer JM, Cooper TK, Finicle HA, Cysyk J, Doxtater B, Yeager E, Reibson J, Newswanger RK, Leibich P, Bletcher K, Weiss WJ. Chronic Ovine Studies Demonstrate Low Thromboembolic Risk in the Penn State Infant Ventricular Assist Device. ASAIO J 2020; 65:371-379. [PMID: 30681440 DOI: 10.1097/mat.0000000000000945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Mechanical circulatory support for children under 6 years of age remains a challenge. This article describes the preclinical status and the results of recent animal testing with the Penn State Infant Left Ventricular Assist Device (VAD). The objectives have been to 1) demonstrate acceptably low thromboembolic risk to support Food and Drug Administration approval, 2) challenge the device by using minimal to no anticoagulation in order to identify any design or manufacturing weaknesses, and 3) improve our understanding of device thrombogenicity in the ovine animal model, using multicomponent measurements of the coagulation system and renal ischemia quantification, in order to better correlate animal results with human results.The Infant VAD was implanted as a left VAD (LVAD) in 18-29 kg lambs. Twelve LVAD and five surgical sham animals were electively terminated after approximately 30 or 60 days. Anticoagulation was by unfractionated heparin targeting thromboelastography R times of 2x normal (n = 6) or 1x normal (n = 6) resulting in negligible heparin activity as measured by anti-Xa assay (<0.1 IU/ml). Platelet inhibitors were not used.There were no clinically evident strokes or evidence of end organ dysfunction in any of the 12 electively terminated LVAD studies. The degree of renal ischemic lesions in device animals was not significantly different than that found in five surgical sham studies, demonstrating minimal device thromboembolism.In summary, these results in a challenging animal test protocol support the conclusion that the Penn State Infant VAD has a low thromboembolic risk and may allow lower levels of anticoagulation.
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Affiliation(s)
- Branka Lukic
- From the Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA
| | - J Brian Clark
- Pediatric Cardiothoracic Surgery, The Pennsylvania State University, College of Medicine, Penn State Children's Hospital, Hershey, PA
| | - Jenelle M Izer
- Department of Comparative Medicine, The Pennsylvania State University, College of Medicine, Hershey, PA
| | - Timothy K Cooper
- Department of Comparative Medicine, The Pennsylvania State University, College of Medicine, Hershey, PA.,Present address: Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, Maryland
| | - Heidi A Finicle
- From the Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA
| | - Johua Cysyk
- From the Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA
| | - Bradly Doxtater
- From the Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA
| | - Eric Yeager
- From the Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA
| | - John Reibson
- From the Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA
| | - Raymond K Newswanger
- From the Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA
| | - Patrick Leibich
- From the Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA
| | - Kirby Bletcher
- From the Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA
| | - William J Weiss
- From the Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA.,Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA
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15
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Reddy VY. Reply: Common Carotid Artery Filter to Prevent Stroke in Atrial Fibrillation: A Neurologist's and Neuroradiologist's Perspective. J Am Coll Cardiol 2020; 75:127-128. [PMID: 31918823 DOI: 10.1016/j.jacc.2019.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 11/04/2019] [Indexed: 11/27/2022]
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16
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Geelhoed WJ, van der Bogt KEA, Rothuizen TC, Damanik FFR, Hamming JF, Mota CD, van Agen MS, de Boer HC, Restrepo MT, Hinz B, Kislaya A, Poelma C, van Zonneveld AJ, Rabelink TJ, Moroni L, Rotmans JI. A novel method for engineering autologous non-thrombogenic in situ tissue-engineered blood vessels for arteriovenous grafting. Biomaterials 2019; 229:119577. [PMID: 31704466 DOI: 10.1016/j.biomaterials.2019.119577] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 10/14/2019] [Accepted: 10/22/2019] [Indexed: 12/15/2022]
Abstract
The durability of prosthetic arteriovenous (AV) grafts for hemodialysis access is low, predominantly due to stenotic lesions in the venous outflow tract and infectious complications. Tissue engineered blood vessels (TEBVs) might offer a tailor-made autologous alternative for prosthetic grafts. We have designed a method in which TEBVs are grown in vivo, by utilizing the foreign body response to subcutaneously implanted polymeric rods in goats, resulting in the formation of an autologous fibrocellular tissue capsule (TC). One month after implantation, the polymeric rod is extracted, whereupon TCs (length 6 cm, diameter 6.8 mm) were grafted as arteriovenous conduit between the carotid artery and jugular vein of the same goats. At time of grafting, the TCs were shown to have sufficient mechanical strength in terms of bursting pressure (2382 ± 129 mmHg), and suture retention strength (SRS: 1.97 ± 0.49 N). The AV grafts were harvested at 1 or 2 months after grafting. In an ex vivo whole blood perfusion system, the lumen of the vascular grafts was shown to be less thrombogenic compared to the initial TCs and ePTFE grafts. At 8 weeks after grafting, the entire graft was covered with an endothelial layer and abundant elastin expression was present throughout the graft. Patency at 1 and 2 months was comparable with ePTFE AV-grafts. In conclusion, we demonstrate the remodeling capacity of cellularized in vivo engineered TEBVs, and their potential as autologous alternative for prosthetic vascular grafts.
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Affiliation(s)
- W J Geelhoed
- Department of Internal Medicine, Leiden University Medical Center, the Netherlands; Einthoven Laboratory of Vascular and Regenerative Medicine, the Netherlands
| | - K E A van der Bogt
- Department of Surgery, Leiden University Medical Center, the Netherlands
| | - T C Rothuizen
- Department of Internal Medicine, Leiden University Medical Center, the Netherlands
| | - F F R Damanik
- MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, the Netherlands
| | - J F Hamming
- Department of Surgery, Leiden University Medical Center, the Netherlands
| | - C D Mota
- MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, the Netherlands
| | - M S van Agen
- Department of Internal Medicine, Leiden University Medical Center, the Netherlands; Einthoven Laboratory of Vascular and Regenerative Medicine, the Netherlands
| | - H C de Boer
- Department of Internal Medicine, Leiden University Medical Center, the Netherlands; Einthoven Laboratory of Vascular and Regenerative Medicine, the Netherlands
| | - M Tobón Restrepo
- Division of Diagnostic Imaging, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
| | - B Hinz
- Laboratory of Tissue Repair and Regeneration, Faculty of Dentistry, University of Toronto, Canada
| | - A Kislaya
- Laboratory for Aero and Hydrodynamics, Delft University of Technology, Delft, the Netherlands
| | - C Poelma
- Laboratory for Aero and Hydrodynamics, Delft University of Technology, Delft, the Netherlands
| | - A J van Zonneveld
- Department of Internal Medicine, Leiden University Medical Center, the Netherlands; Einthoven Laboratory of Vascular and Regenerative Medicine, the Netherlands
| | - T J Rabelink
- Department of Internal Medicine, Leiden University Medical Center, the Netherlands
| | - L Moroni
- MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, the Netherlands
| | - J I Rotmans
- Department of Internal Medicine, Leiden University Medical Center, the Netherlands.
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17
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Kengelbach-Weigand A, Lotz L, Schmid R, Lang W, Beckmann MW, Hoffmann I, Horch RE, Renner SP, Dittrich R, Boos AM, Hildebrandt T. Intra- and Postoperative Blood Flow Monitoring in a Sheep Model of Uterus Transplantation. In Vivo 2019; 33:325-336. [PMID: 30804109 DOI: 10.21873/invivo.11478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 01/24/2019] [Accepted: 01/28/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND The introduction of the opportunity to transplant a viable uterus into women for fulfilling their desire to have a child has awakened high expectations worldwide. MATERIALS AND METHODS A sheep model was used to evaluate tools for optimizing measurement of blood flow in uterine transplantation. Intraoperatively, blood flow was measured using unidirectional Doppler and indocyanine green (ICG) fluorescence imaging. Postoperatively, an implantable Doppler probe served as a tool for clinical monitoring the patency of anastomosed vessels. RESULTS ICG imaging showed complete vascularization of the uterus before and in short-term evaluation after surgery. The implantable Doppler probe proved to be highly suitable for assessing patency of vessels in a non-invasive way. Results of histology, and real-time polymerase chain reaction demonstrated viability of the transplanted uterus. CONCLUSION Different methods to monitor vasculature patency have proven to be advantageous in supporting both surgeons and researchers in ensuring successful implementation of uterine transplantation.
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Affiliation(s)
- Annika Kengelbach-Weigand
- Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen (FAU), Erlangen, Germany
| | - Laura Lotz
- Department of Obstetrics and Gynecology, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen (FAU), Erlangen, Germany
| | - Rafael Schmid
- Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen (FAU), Erlangen, Germany
| | - Werner Lang
- Department of Vascular Surgery, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen (FAU), Erlangen, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynecology, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen (FAU), Erlangen, Germany
| | - Inge Hoffmann
- Department of Obstetrics and Gynecology, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen (FAU), Erlangen, Germany
| | - Raymund E Horch
- Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen (FAU), Erlangen, Germany
| | - Stefan P Renner
- Department of Obstetrics and Gynecology, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen (FAU), Erlangen, Germany
| | - Ralf Dittrich
- Department of Obstetrics and Gynecology, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen (FAU), Erlangen, Germany
| | - Anja M Boos
- Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen (FAU), Erlangen, Germany
| | - Thomas Hildebrandt
- Department of Obstetrics and Gynecology, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen (FAU), Erlangen, Germany
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18
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Izer JM, Wilson RP, Clark JB, Myers JL, Weiss WW, Ündar A. Animal Models for Pediatric Mechanical Circulatory Support Research at Penn State Health. Artif Organs 2018; 42:347-353. [PMID: 29667251 DOI: 10.1111/aor.13133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 01/04/2023]
Affiliation(s)
- Jenelle M Izer
- Department of Pediatrics, Pediatric Cardiovascular Research Center, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA.,Department of Comparative Medicine, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Ronald P Wilson
- Department of Pediatrics, Pediatric Cardiovascular Research Center, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA.,Department of Comparative Medicine, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Joseph B Clark
- Department of Pediatrics, Pediatric Cardiovascular Research Center, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA.,Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - John L Myers
- Department of Pediatrics, Pediatric Cardiovascular Research Center, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA.,Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - William W Weiss
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Akif Ündar
- Department of Pediatrics, Pediatric Cardiovascular Research Center, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA.,Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
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19
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Geelhoed WJ, Moroni L, Rotmans JI. Utilizing the Foreign Body Response to Grow Tissue Engineered Blood Vessels in Vivo. J Cardiovasc Transl Res 2017; 10:167-179. [PMID: 28205013 PMCID: PMC5437130 DOI: 10.1007/s12265-017-9731-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 01/23/2017] [Indexed: 12/21/2022]
Abstract
It is well known that the number of patients requiring a vascular grafts for use as vessel replacement in cardiovascular diseases, or as vascular access site for hemodialysis is ever increasing. The development of tissue engineered blood vessels (TEBV's) is a promising method to meet this increasing demand vascular grafts, without having to rely on poorly performing synthetic options such as polytetrafluoroethylene (PTFE) or Dacron. The generation of in vivo TEBV's involves utilizing the host reaction to an implanted biomaterial for the generation of completely autologous tissues. Essentially this approach to the development of TEBV's makes use of the foreign body response to biomaterials for the construction of the entire vascular replacement tissue within the patient's own body. In this review we will discuss the method of developing in vivo TEBV's, and debate the approaches of several research groups that have implemented this method.
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Affiliation(s)
- Wouter J Geelhoed
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands.,Eindhoven Laboratory of Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Lorenzo Moroni
- MERLN Institute for Technology Inspired Regenerative Medicine, Complex Tissue Regeneration, Maastricht University, Maastricht, The Netherlands
| | - Joris I Rotmans
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands. .,Eindhoven Laboratory of Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands.
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20
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Florescu MC, Foster KW, Sacks AR, Lof J, Stolze EA, Fry GM, Bumgardner DP, Tysinger T, Kuchta MJ, Runge HJ, Hadley WB, Morris MC. Sheep Model of Hemodialysis Arteriovenous Fistula Using Superficial Veins. Semin Dial 2015; 28:687-91. [DOI: 10.1111/sdi.12407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Marius C. Florescu
- Section of Nephrology; University of Nebraska Medical Center; Omaha Nebraska
| | - Kirk W. Foster
- Pathology Department; University of Nebraska Medical Center; Omaha Nebraska
| | - Andrew R. Sacks
- Section of Nephrology; University of Nebraska Medical Center; Omaha Nebraska
| | - John Lof
- Large Animal Laboratory; University of Nebraska Medical Center; Omaha Nebraska
| | - Elizabeth A. Stolze
- Large Animal Laboratory; University of Nebraska Medical Center; Omaha Nebraska
| | - Gretchen M. Fry
- Large Animal Laboratory; University of Nebraska Medical Center; Omaha Nebraska
| | - Derek P. Bumgardner
- Large Animal Laboratory; University of Nebraska Medical Center; Omaha Nebraska
| | - Tara Tysinger
- Vascular Laboratory; University of Nebraska Medical Center; Omaha Nebraska
| | - Melanie J. Kuchta
- Vascular Laboratory; University of Nebraska Medical Center; Omaha Nebraska
| | - Henry J. Runge
- UNEMED; University of Nebraska Medical Center; Omaha Nebraska
| | | | - Michael C. Morris
- Section of Kidney and Pancreas Transplant Surgery; University of Nebraska Medical Center; Omaha Nebraska
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21
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Weigand A, Beier JP, Hess A, Gerber T, Arkudas A, Horch RE, Boos AM. Acceleration of vascularized bone tissue-engineered constructs in a large animal model combining intrinsic and extrinsic vascularization. Tissue Eng Part A 2015; 21:1680-94. [PMID: 25760576 DOI: 10.1089/ten.tea.2014.0568] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
During the last decades, a range of excellent and promising strategies in Bone Tissue Engineering have been developed. However, the remaining major problem is the lack of vascularization. In this study, extrinsic and intrinsic vascularization strategies were combined for acceleration of vascularization. For optimal biomechanical stability of the defect site and simplifying future transition into clinical application, a primary stable and approved nanostructured bone substitute in clinically relevant size was used. An arteriovenous (AV) loop was microsurgically created in sheep and implanted, together with the bone substitute, in either perforated titanium chambers (intrinsic/extrinsic) for different time intervals of up to 18 weeks or isolated Teflon(®) chambers (intrinsic) for 18 weeks. Over time, magnetic resonance imaging and micro-computed tomography (CT) analyses illustrate the dense vascularization arising from the AV loop. The bone substitute was completely interspersed with newly formed tissue after 12 weeks of intrinsic/extrinsic vascularization and after 18 weeks of intrinsic/extrinsic and intrinsic vascularization. Successful matrix change from an inorganic to an organic scaffold could be demonstrated in vascularized areas with scanning electron microscopy and energy dispersive X-ray spectroscopy. Using the intrinsic vascularization method only, the degradation of the scaffold and osteoclastic activity was significantly lower after 18 weeks, compared with 12 and 18 weeks in the combined intrinsic-extrinsic model. Immunohistochemical staining revealed an increase in bone tissue formation over time, without a difference between intrinsic/extrinsic and intrinsic vascularization after 18 weeks. This study presents the combination of extrinsic and intrinsic vascularization strategies for the generation of an axially vascularized bone substitute in clinically relevant size using a large animal model. The additional extrinsic vascularization promotes tissue ingrowth and remodeling processes of the bone substitute. Extrinsic vessels contribute to faster vascularization and finally anastomose with intrinsic vasculature, allowing microvascular transplantation of the bone substitute after a shorter prevascularization time than using the intrinsic method only. It can be reasonably assumed that the usage of perforated chambers can significantly reduce the time until transplantation of bone constructs. Finally, this study paves the way for further preclinical testing for proof of the concept as a basis for early clinical applicability.
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Affiliation(s)
- Annika Weigand
- 1 Department of Plastic and Hand Surgery, University Hospital of Erlangen , Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
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