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Fernández-Colino A, Jockenhoevel S. Advances in Engineering Venous Valves: The Pursuit of a Definite Solution for Chronic Venous Disease. TISSUE ENGINEERING PART B-REVIEWS 2020; 27:253-265. [PMID: 32967586 DOI: 10.1089/ten.teb.2020.0131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Native venous valves enable proper return of blood to the heart. Under pathological conditions (e.g., chronic venous insufficiency), venous valves malfunction and fail to prevent backward flow. Clinically, this can result in painful swelling, varicose veins, edema, and skin ulcerations leading to a chronic wound situation. Surgical correction of venous valves has proven to drastically reduce these symptoms. However, the absence of intact leaflets in many patients limits the applicability of this strategy. In this context, the development of venous valve replacements represents an appealing approach. Despite acceptable results in animal models, no venous valve has succeeded in clinical trials, and so far no single prosthetic venous valve is commercially available. This calls for advanced materials and fabrication approaches to develop clinically relevant venous valves able to restore natural flow conditions in the venous circulation. In this study, we critically discuss the approaches attempted in the last years, and we highlight the potential of tissue engineering to offer new avenues for valve fabrication. Impact statement Venous valves prosthesis offer the potential to restore normal venous flow, and to improve the prospect of patients that suffer from chronic venous disease. Current venous valve replacements are associated with poor outcomes. A deeper understanding of the approaches attempted so far is essential to establish the next steps toward valve development, and importantly, tissue engineering constitutes a unique toolbox to advance in this quest.
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Affiliation(s)
- Alicia Fernández-Colino
- Department of Biohybrid & Medical Textiles (BioTex), AME-Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen, Germany
| | - Stefan Jockenhoevel
- Department of Biohybrid & Medical Textiles (BioTex), AME-Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen, Germany.,AMIBM-Aachen-Maastricht-Institute for Biobased Materials, Maastricht University, Geleen, Netherlands
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2
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Zervides C, Mahdi H, Staub RA, Jouni H. Prosthetic venous valves: Short history and advancements from 2012 to 2020. Phlebology 2020; 36:174-183. [PMID: 33021138 DOI: 10.1177/0268355520962451] [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: 11/17/2022]
Abstract
Chronic Venous Disease is estimated at 83.6% of the global population. Patients experience pain, discomfort and severe complications with few effective therapies being available. Current strategies for the treatment of malfunctioning venous valves are invasive with a high recurrence rate. A prosthetic venous valve replacement is imminent, possibly providing better outcomes and improved general quality of life. In this review, prosthetic venous valves history is presented and assesses the advantages and disadvantages of developed venous valves. Articles that discussed potential designs of prosthetic venous valves were examined. A systematic search produced thirty-five papers fitting the inclusion criteria. Our understanding of the ideal abilities required in prosthetic valves has evolved. Developed valves are reported for regurgitation, migration and leakage. Issues have been resolved, but we are still away from the ideal valve. Improvements within the last eight years provided information on the importance of sinuses and prosthetic to venous wall-size mismatch.
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Affiliation(s)
| | - Habib Mahdi
- University of Nicosia Medical School, Nicosia, Cyprus
| | | | - Hassan Jouni
- University of Nicosia Medical School, Nicosia, Cyprus
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Chen HY, Tien WS, Chambers SD, Dabiri D, Kassab GS. Search for an Optimal Design of a Bioprosthetic Venous Valve: In silico and in vitro Studies. Eur J Vasc Endovasc Surg 2019; 58:112-119. [PMID: 31133446 DOI: 10.1016/j.ejvs.2018.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 12/05/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE/BACKGROUND Valve incompetence is a progressive disease of the venous system that may eventually lead to venous hypertension, pain, and ulcers. There is a need for a venous valve prosthesis to replace incompetent valves. Computational and experimental investigations on venous valve design and associated haemodynamics will undoubtedly advance prosthesis design and treatments. Here, the objective is to investigate the effect of venous valve on the fluid and solid mechanics. The hypothesis is that there exists a valve geometry that maximises leaflet shear stress (LSS) but minimises leaflet intramural stress (LIS; i.e., minimise stress ratio = LIS/LSS). METHODS To address the hypothesis, fully dynamic fluid-structure interaction (FSI) models were developed. The entire cycle of valve opening and closure was simulated. The flow validation experiments were conducted using a stented venous valve prosthesis and a pulse duplicator flow loop. RESULTS Agreement between the output of FSI simulations and output of pulse duplicator was confirmed. The maximum flow rates were within 6% difference, and the total flow during the cycle was within 10% difference. The simulated high stress ratio region at the leaflet base (five times the leaflet average) predicted the disease location of the vast majority of explanted venous valves reported in clinical literature. The study found that the reduced valve height and leaflet dome shape resulted in optimal performance to provide the lowest stress ratio. CONCLUSION This study proposes an effective design of venous prostheses and elaborates on the correlations of venous valve with clinical observations.
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Affiliation(s)
- Henry Y Chen
- California Medical Innovations Institute, San Diego, CA, USA
| | - Wei-Shin Tien
- Department of Biomedical Engineering, University of Washington, Seattle, WA, USA
| | | | - Dana Dabiri
- Department of Biomedical Engineering, University of Washington, Seattle, WA, USA
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Keiler J, Schulze M, Claassen H, Wree A. Human Femoral Vein Diameter and Topography of Valves and Tributaries: A Post Mortem Analysis. Clin Anat 2018; 31:1065-1076. [PMID: 30240062 DOI: 10.1002/ca.23224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 05/25/2018] [Accepted: 06/05/2018] [Indexed: 11/08/2022]
Abstract
The femoral vein (FV) is a clinically important vessel. Failure of its valves can lead to chronic venous insufficiency (CVI) with severe manifestations such as painful ulcers. Although they are crucial for identifying suitable implant sites for therapeutic valves, studies on the topography of FV tributaries and valves are rare. Moreover, the femoral vein diameter (FVD) must be known to assess the morphometric requirements for valve implants. To reassess the anatomical requirements for valve implants, 155 FVs from 82 human corpses were examined. FVDs and tributary and valve topographies were assessed using a laboratory straightedge. The FVD increased from 6 mm in the distal femoropopliteal vein to 11 mm in the iliofemoral vein proximal to the saphenofemoral junction (SFJ). Diameters were significantly bigger in males than females. Height correlated positively with FVD. Distal to the SFJ, within a distance of 38 cm, one to eight valves were present. Up to two valves were present within 10 cm proximal to the SFJ. Individual tributary and valve topography must be considered to ensure appropriate design and successful implantation of a venous valve for CVI therapy in the FV. A suitable implant site would be proximal to the SFJ via an infrainguinal transfemoral access. Clin. Anat. 31:1065-1076, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Jonas Keiler
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
| | - Marko Schulze
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
| | - Horst Claassen
- Department of Anatomy and Cell Biology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Andreas Wree
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
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Keiler J, Seidel R, Wree A. The femoral vein diameter and its correlation with sex, age and body mass index - An anatomical parameter with clinical relevance. Phlebology 2018; 34:58-69. [PMID: 29699449 DOI: 10.1177/0268355518772746] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The femoral vein diameter is a critical factor when assessing endoprosthetic valve size for the treatment of chronic venous insufficiency. To examine the previously stated correlation between body mass index and femoral vein diameter and to re-assess the anatomical and physiological demands for a valve implant for chronic venous insufficiency treatment, we measured the femoral vein diameter in 82 subjects. METHOD Femoral vein diameters (164 legs) were measured with B-mode sonography both in supine position at rest and in upright position during Valsalva maneuver. RESULT The mean femoral vein diameter differed significantly between supine position (13.6 ± 3.0 mm) and upright position (16.4 ± 2.6 mm). Males possessed a significant bigger diameter than females. A significant positive correlation between femoral vein diameter and body mass index was observed. CONCLUSION Assuming an increased femoral vein diameter due to obesity would further impair valve functionality by increasing distance between both valve cusps. For the development of artificial venous valves, it is crucial to consider patient- and condition-dependent vein dilation.
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Affiliation(s)
- Jonas Keiler
- 1 Department of Anatomy, Rostock University Medical Center, Rostock, Germany
| | - Ronald Seidel
- 2 Department of Anesthesiology and Intensive Care, Helios Medical Center, Schwerin, Germany
| | - Andreas Wree
- 1 Department of Anatomy, Rostock University Medical Center, Rostock, Germany
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Lu J, Huang HYS. Biaxial mechanical behavior of bovine saphenous venous valve leaflets. J Mech Behav Biomed Mater 2017; 77:594-599. [PMID: 29096125 DOI: 10.1016/j.jmbbm.2017.10.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 10/18/2017] [Accepted: 10/23/2017] [Indexed: 02/07/2023]
Abstract
Chronic venous disease is caused by chronic venous insufficiency (CVI), which results in significant symptoms such as venous ulcers, ankle eczema, leg swelling, etc. Venous valve incompetence is a major cause of CVI. When the valves of veins in the leg become incompetent (i.e., do not close properly), blood is able to flow backwards (i.e., reflux), which results in blood pooling in the lower extremities, distal venous hypertension, and CVI. Current clinical therapies, such as surgical venous valve reconstruction and bioprosthetic venous valve replacement, are highly invasive and only moderately successful. This is due, in part, to the scanty information available about venous valve leaflet structure and mechanical properties. To date, only one previous study by our research group has reported on the mechanical properties of venous valve leaflet tissue, and specifically in the case of jugular vein valves. In this study, we conducted equibiaxial tensile tests on bovine saphenous vein valve leaflet tissues to better understand their nonlinear, anisotropic mechanical behavior. By stretching the valvular tissues to 60% strain in both the circumferential and radial directions, we generated stress-strain curves for proximal (i.e., those closest to the heart) and distal (i.e., those furthest from the heart) valve leaflets. Histology and collagen assays were also conducted to study corresponding leaflet microstructures and the biochemical properties of the tissues. Results showed: (1) saphenous venous valve tissues possessed overall anisotropic properties. The tissues were stiffer in the circumferential direction than in the radial direction (p<0.01), and (2) saphenous venous valve tissues from the proximal end showed nonlinear isotropic mechanical properties, while those from the distal end showed nonlinear anisotropic mechanical properties. (3) Distal saphenous venous valve tissues appeared to be stiffer than proximal ones in the circumferential direction, p=0.04 (i.e., inter-valvular variability), and (4) the collagen concentration showed a decreasing trend from the proximal to the distal end. This study focuses on highly relevant animal (bovine) tissues to develop test protocols, establish biomechanical structure-function correlations, and to provide data critical to the design of clinical prosthetic venous valves. To the best of the author's knowledge, this is the first study reporting the biaxial mechanical properties of saphenous venous valve leaflet tissues and thus contributes toward refining our collective understanding of valvular tissue biomechanics.
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Affiliation(s)
- Jiaqi Lu
- North Carolina State University, Department of Mechanical and Aerospace Engineering, R3158 Engineering Bldg 3, Campus Box 7910, 911 Oval Drive, Raleigh, NC 27695, United States
| | - Hsiao-Ying Shadow Huang
- North Carolina State University, Department of Mechanical and Aerospace Engineering, R3158 Engineering Bldg 3, Campus Box 7910, 911 Oval Drive, Raleigh, NC 27695, United States..
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8
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Tien WH, Zhao X, Chen HY, Berwick ZC, Krieger JF, Chambers S, Dabiri D, Kassab GS. Role of vessel-to-prosthesis size mismatch in venous valve performance. J Vasc Surg Venous Lymphat Disord 2017; 5:105-113.e1. [DOI: 10.1016/j.jvsv.2016.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 08/05/2016] [Indexed: 10/20/2022]
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9
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Weber B, Hafner J, Willenberg T, Hoerstrup SP. Bioengineered valves for the venous circulation. Expert Rev Med Devices 2016; 13:1005-1011. [DOI: 10.1080/17434440.2016.1242408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Kehl D, Weber B, Hoerstrup SP. Bioengineered living cardiac and venous valve replacements: current status and future prospects. Cardiovasc Pathol 2016; 25:300-305. [PMID: 27167776 DOI: 10.1016/j.carpath.2016.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 02/19/2016] [Accepted: 03/08/2016] [Indexed: 12/13/2022] Open
Abstract
Valvular heart disease remains to be a major cause of death worldwide with increasing prevalence, mortality, and morbidity. Current heart valve replacements are associated with several limitations due to their nonviable nature. In this regard, heart valve tissue engineering has shown to represent a promising concept in order to overcome these limitations and replace diseased cardiac valves with living, autologous constructs. These bioengineered valves hold potential for in situ remodeling, growth, and repair throughout the patient's lifetime without the risk of thromboembolic complications and adverse immune responses. For the fabrication of tissue-engineered heart valves, several concepts have been established, the "classical" in vitro tissue engineering approach, the in situ tissue engineering approach, and alternative approaches including three-dimensional printing and electrospinning. Besides first attempts have been conducted in order to produce a tissue-engineered venous valve for the treatment of deep venous valve insufficiency. Here we review basic principals and current scientific status of valvular tissue engineering, including a critical discussion and outlook for the future.
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Affiliation(s)
- Debora Kehl
- Institute for Regenerative Medicine, University of Zurich Center for Therapy Development/Good Manufacturing Practice, Moussonstrasse 13, CH-8044 Zurich, Switzerland
| | - Benedikt Weber
- Institute for Regenerative Medicine, University of Zurich Center for Therapy Development/Good Manufacturing Practice, Moussonstrasse 13, CH-8044 Zurich, Switzerland
| | - Simon Philipp Hoerstrup
- Institute for Regenerative Medicine, University of Zurich Center for Therapy Development/Good Manufacturing Practice, Moussonstrasse 13, CH-8044 Zurich, Switzerland.
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11
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Allcorn TE. Sonographers guide to venous surgery and treatments. SONOGRAPHY 2015. [DOI: 10.1002/sono.12019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Characterization of a Bioprosthetic Bicuspid Venous Valve Hemodynamics: Implications for Mechanism of Valve Dynamics. Eur J Vasc Endovasc Surg 2014; 48:459-64. [DOI: 10.1016/j.ejvs.2014.06.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 06/07/2014] [Indexed: 11/24/2022]
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13
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Role of Sinus in Prosthetic Venous Valve. Eur J Vasc Endovasc Surg 2014; 48:98-104. [DOI: 10.1016/j.ejvs.2014.03.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 03/25/2014] [Indexed: 11/20/2022]
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Weber B, Robert J, Ksiazek A, Wyss Y, Frese L, Slamecka J, Kehl D, Modregger P, Peter S, Stampanoni M, Proulx S, Falk V, Hoerstrup SP. Living-engineered valves for transcatheter venous valve repair. Tissue Eng Part C Methods 2014; 20:451-63. [PMID: 24156382 PMCID: PMC4026099 DOI: 10.1089/ten.tec.2013.0187] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 10/07/2013] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Chronic venous insufficiency (CVI) represents a major global health problem with increasing prevalence and morbidity. CVI is due to an incompetence of the venous valves, which causes venous reflux and distal venous hypertension. Several studies have focused on the replacement of diseased venous valves using xeno- and allogenic transplants, so far with moderate success due to immunologic and thromboembolic complications. Autologous cell-derived tissue-engineered venous valves (TEVVs) based on fully biodegradable scaffolds could overcome these limitations by providing non-immunogenic, non-thrombogenic constructs with remodeling and growth potential. METHODS Tri- and bicuspid venous valves (n=27) based on polyglycolic acid-poly-4-hydroxybutyrate composite scaffolds, integrated into self-expandable nitinol stents, were engineered from autologous ovine bone-marrow-derived mesenchymal stem cells (BM-MSCs) and endothelialized. After in vitro conditioning in a (flow) pulse duplicator system, the TEVVs were crimped (n=18) and experimentally delivered (n=7). The effects of crimping on the tissue-engineered constructs were investigated using histology, immunohistochemistry, scanning electron microscopy, grating interferometry (GI), and planar fluorescence reflectance imaging. RESULTS The generated TEVVs showed layered tissue formation with increasing collagen and glycosaminoglycan levels dependent on the duration of in vitro conditioning. After crimping no effects were found on the MSC level in scanning electron microscopy analysis, GI, histology, and extracellular matrix analysis. However, substantial endothelial cell loss was detected after the crimping procedure, which could be reduced by increasing the static conditioning phase. CONCLUSIONS Autologous living small-diameter TEVVs can be successfully fabricated from ovine BM-MSCs using a (flow) pulse duplicator conditioning approach. These constructs hold the potential to overcome the limitations of currently used non-autologous replacement materials and may open new therapeutic concepts for the treatment of CVI in the future.
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Affiliation(s)
- Benedikt Weber
- Swiss Center for Regenerative Medicine, University Hospital of Zurich, Zurich, Switzerland
- Division of Surgical Research, University Hospital of Zurich, Zurich, Switzerland
- Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland
- Zurich Center of Integrated Human Physiology, University of Zurich, Zurich, Switzerland
| | - Jérôme Robert
- Swiss Center for Regenerative Medicine, University Hospital of Zurich, Zurich, Switzerland
- Division of Surgical Research, University Hospital of Zurich, Zurich, Switzerland
- Institute for Clinical Chemistry, University Hospital of Zurich, Zurich, Switzerland
- Zurich Center of Integrated Human Physiology, University of Zurich, Zurich, Switzerland
| | - Agnieszka Ksiazek
- Swiss Center for Regenerative Medicine, University Hospital of Zurich, Zurich, Switzerland
- Division of Surgical Research, University Hospital of Zurich, Zurich, Switzerland
- Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Yves Wyss
- Swiss Center for Regenerative Medicine, University Hospital of Zurich, Zurich, Switzerland
- Division of Surgical Research, University Hospital of Zurich, Zurich, Switzerland
- Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Laura Frese
- Swiss Center for Regenerative Medicine, University Hospital of Zurich, Zurich, Switzerland
- Division of Surgical Research, University Hospital of Zurich, Zurich, Switzerland
- Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Jaroslav Slamecka
- Swiss Center for Regenerative Medicine, University Hospital of Zurich, Zurich, Switzerland
- Division of Surgical Research, University Hospital of Zurich, Zurich, Switzerland
- Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Debora Kehl
- Swiss Center for Regenerative Medicine, University Hospital of Zurich, Zurich, Switzerland
- Division of Surgical Research, University Hospital of Zurich, Zurich, Switzerland
- Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Peter Modregger
- TOMACT Beamline, Swiss Light Source, Paul Scherrer Institute, Villigen, Switzerland
- School of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Silvia Peter
- TOMACT Beamline, Swiss Light Source, Paul Scherrer Institute, Villigen, Switzerland
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Marco Stampanoni
- TOMACT Beamline, Swiss Light Source, Paul Scherrer Institute, Villigen, Switzerland
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Steven Proulx
- Institute of Pharmaceutical Sciences, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - Volkmar Falk
- Division of Surgical Research, University Hospital of Zurich, Zurich, Switzerland
- Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Simon P. Hoerstrup
- Swiss Center for Regenerative Medicine, University Hospital of Zurich, Zurich, Switzerland
- Division of Surgical Research, University Hospital of Zurich, Zurich, Switzerland
- Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland
- Zurich Center of Integrated Human Physiology, University of Zurich, Zurich, Switzerland
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Sarvazyan N. Thinking Outside the Heart: Use of Engineered Cardiac Tissue for the Treatment of Chronic Deep Venous Insufficiency. J Cardiovasc Pharmacol Ther 2014; 19:394-401. [PMID: 24500906 DOI: 10.1177/1074248413520343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This article considers the use of autologous stem cell-derived cardiomyocytes as a novel means to aid venous return. The approach consists of creating external cuffs of engineered heart tissue around vein segments with incompetent or poorly competent valves. The engineered heart tissue cuff prevents distention of the impaired vein segments and aids unidirectional flow by its rhythmic contractions. There appear to be no fundamental limitations to this approach as feasibility of all of the individual components has already been shown. Here, we underline the clinical need for novel ways to treat chronic deep venous insufficiency, review previous research that enabled this approach, consider potential designs of engineered heart tissue cuffs, and outline its advantages and future challenges.
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Affiliation(s)
- Narine Sarvazyan
- Pharmacology and Physiology Department, The George Washington University School of Medicine and Health Sciences, Washington DC, USA
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