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Mejia E, O’Neill K, Lozier JS, Bocks ML. Self-Expanding Transcatheter Pulmonary Valve Implant in the Right Pulmonary Artery. JACC Case Rep 2023; 14:101823. [PMID: 37152706 PMCID: PMC10157103 DOI: 10.1016/j.jaccas.2023.101823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 02/06/2023] [Accepted: 03/20/2023] [Indexed: 05/09/2023]
Abstract
Newer self-expanding transcatheter pulmonary valves (TPVs) are approved for the treatment of severe pulmonary regurgitation in patients with large right ventricular outflow tracts. We present a patient with Tetralogy of Fallot whose right ventricular outflow tract was too large for self-expanding TPV, who was treated successfully with a self-expanding TPV in the right pulmonary artery. (Level of Difficulty: Advanced.).
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Affiliation(s)
| | | | | | - Martin L. Bocks
- Address for correspondence: Dr Martin L. Bocks, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Suite 380, Cleveland, Ohio 44106, USA.
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2
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Lozier JS, Sati M, Cheifetz IM, Bocks ML. Update on percutaneous and perventricular device closure of congenital ventricular septal defect. Expert Rev Cardiovasc Ther 2023; 21:337-345. [PMID: 37096558 DOI: 10.1080/14779072.2023.2206566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
INTRODUCTION Ventricular septal defect is the most common congenital heart defect. Surgical repair has been standard therapy for symptomatic ventricular septal defects since the 1950's. Catheter-based device closure of ventricular septal defects emerged in the 1980's and has become a safe and effective alternative in select patients. AREAS COVERED This review focuses on patient selection and procedural techniques for device closure of ventricular septal defects, including percutaneous and hybrid perventricular approaches. The available devices used for these procedures, and outcomes of their use, are reviewed. EXPERT OPINION Percutaneous and perventricular device closure of ventricular septal defects is safe and effective in select patients. However, the majority of ventricular septal defects requiring closure continue to be managed with conventional surgery. Further development and investigation of transcatheter and hybrid surgical approaches for closing ventricular septal defects is required.
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Affiliation(s)
- John S Lozier
- Division of Pediatric Cardiology, Rainbow Babies and Children's Hospital, Cleveland, OH
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Maram Sati
- Division of Pediatric Cardiology, Rainbow Babies and Children's Hospital, Cleveland, OH
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Ira M Cheifetz
- Divisions of Pediatric Cardiac Critical Care and Cardiology, Rainbow Babies and Children's Hospital, Cleveland, OH
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Martin L Bocks
- Division of Pediatric Cardiology, Rainbow Babies and Children's Hospital, Cleveland, OH
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH
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Ramaraju H, McAtee AM, Akman RE, Verga AS, Bocks ML, Hollister SJ. Sterilization effects on poly(glycerol dodecanedioate): A biodegradable shape memory elastomer for biomedical applications. J Biomed Mater Res B Appl Biomater 2023; 111:958-970. [PMID: 36479954 DOI: 10.1002/jbm.b.35205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 10/31/2022] [Accepted: 11/15/2022] [Indexed: 12/13/2022]
Abstract
Biodegradable shape memory polymers provide unique regenerative medicine approaches in minimally invasive surgeries. Once heated, thermally responsive shape memory polymer devices can be compressed, programmed to fit within a small profile, delivered in the cold programmed state, and expanded when heated to body temperature. We have previously developed a biodegradable shape memory elastomer (SME), poly(glycerol dodecanedioate) (PGD), with transition temperatures near 37°C exhibiting nonlinear elastic properties like numerous soft tissues. Using SMEs in the clinic requires disinfection and sterilization methods that conserve physiochemical, thermomechanical, and shape recovery properties. We evaluated disinfection protocols using 70% ethanol and UV254 nm for research applications and ethylene oxide (EtO) gas sterilization for clinical applications. Samples disinfected with ethanol for 0.5 and 1 min showed no changes in physiochemical material properties, but after 15 min showed slower recovery rates than controls (p < .05). EtO sterilization at 54.4°C decreased transition temperatures and shape recovery rate compared to EtO sterilization at 37.8°C (p < .01) and controls (p < .05). Aging samples for 9 months in a vacuum desiccator significantly reduced shape recovery, and the recovery rate in EtO sterilized samples compared to controls (p < .001). Cytotoxicity testing (ISO-10993.5C:2012) revealed media extractions from EtO sterilized samples, sterilized at 37.8°C, and high-density polyethylene negative control samples exhibit lower cytotoxicity (IC50) than Ethanol 1 min, UV 2 h, and EtO 54.4°C. Cell viability of NIH3T3 fibroblasts on sterilized surfaces was equivalent on EtO 37.7°C, EtO 54.4°C and Ethanol sterilized substrates. Finally, chromogenic bacterial endotoxin testing showed endotoxin levels were below the FDA prescribed levels for devices contacting blood and lymphatic tissues for ethanol 1 min, UV 120 min, EtO 37.7°C, EtO 54.4°C. These findings outline various disinfection and sterilization processes for research and pre-clinical application and provide a pathway for developing custom sterilization cycles for the translation of biomedical devices utilizing PGD shape memory polymers.
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Affiliation(s)
- Harsha Ramaraju
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Annabel M McAtee
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Ryan E Akman
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Adam S Verga
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Martin L Bocks
- UH Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Scott J Hollister
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
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Barry OM, Gudausky TM, Balzer DT, Bocks ML, Boe BA, Callahan R, El-Said H, Farias MJ, Foerster S, Goldstein BH, Holzer RJ, Janssen D, Levy P, O'Byrne ML, Rahman G, Sathanandam S, Shahanavaz S, Whiteside W, Turner ME. Safety and Short-Term Outcomes for Infants < 2.5 kg Undergoing PDA Device Closure: A C3PO Registry Study. Pediatr Cardiol 2023:10.1007/s00246-023-03147-4. [PMID: 36995404 DOI: 10.1007/s00246-023-03147-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/11/2023] [Indexed: 03/31/2023]
Abstract
To evaluate short-term procedural outcomes and safety for infants < 2.5 kg who underwent catheterization with intended patent ductus arteriosus (PDA) device closure in a multi-center registry, as performance of this procedure becomes widespread. A multi-center retrospective review was performed using data from the Congenital Cardiac Catheterization Project on Outcomes (C3PO) registry. Data were collected for all intended cases of PDA closure in infants < 2.5 kg from April 2019 to December 2020 at 13 participating sites. Successful device closure was defined as device placement at the conclusion of the catheterization. Procedural outcomes and adverse events (AE) were described, and associations between patient characteristics, procedural outcomes and AEs were analyzed. During the study period, 300 cases were performed with a median weight of 1.0 kg (range 0.7-2.4). Successful device closure was achieved in 98.7% of cases with a 1.7% incidence of level 4/5 AEs, including one periprocedural mortality. Neither failed device placement nor adverse events were significantly associated with patient age, weight or institutional volume. Higher incidence of adverse events associated with patients who had non-cardiac problems (p = 0.017) and cases with multiple devices attempted (p = 0.064). Transcatheter PDA closure in small infants can be performed with excellent short-term outcomes and safety across institutions with variable case volume.
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Affiliation(s)
- Oliver M Barry
- Division of Pediatric Cardiology, New York-Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, CHN-253, New York, NY, 10032, USA.
| | - Todd M Gudausky
- Division of Pediatric Cardiology, Medical College of Wisconsin and Herma Heart Institute at Children's Wisconsin, Milwaukee, WI, USA
| | | | | | - Brian A Boe
- Nationwide Children's Hospital, Columbus, OH, USA
| | | | | | | | - Susan Foerster
- Division of Pediatric Cardiology, Medical College of Wisconsin and Herma Heart Institute at Children's Wisconsin, Milwaukee, WI, USA
| | | | | | - Dana Janssen
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | | | | | | | | | | | | | - Mariel E Turner
- Division of Pediatric Cardiology, New York-Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, CHN-253, New York, NY, 10032, USA
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Ramaraju H, Massarella D, Wong C, Verga AS, Kish EC, Bocks ML, Hollister SJ. Percutaneous delivery and degradation of a shape memory elastomer poly(glycerol dodecanedioate) in porcine pulmonary arteries. Biomaterials 2023; 293:121950. [PMID: 36580715 DOI: 10.1016/j.biomaterials.2022.121950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/23/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
Shape memory biodegradable elastomers are an emergent class of biomaterials well-suited for percutaneous cardiovascular repair requiring nonlinear elastic materials with facile handling. We have previously developed a chemically crosslinked shape memory elastomer, poly (glycerol dodecanedioate) (PGD), exhibiting tunable transition temperatures around body temperature (34-38 °C), exhibiting nonlinear elastic properties approximating cardiac tissues, and favorable degradation rates in vitro. Degree of tissue coverage, degradation and consequent changes in polymer thermomechanical properties, and inflammatory response in preclinical animal models are unknown material attributes required for translating this material into cardiovascular devices. This study investigates changes in the polymer structure, tissue coverage, endothelialization, and inflammation of percutaneously implanted PGD patches (20 mm × 9 mm x 0.5 mm) into the branch pulmonary arteries of Yorkshire pigs for three months. After three months in vivo, 5/8 samples exhibited (100%) tissue coverage, 2/8 samples exhibited 85-95% tissue coverage, and 1/8 samples exhibited limited (<20%) tissue coverage with mild-moderate inflammation. PGD explants showed a (60-70%) volume loss and (25-30%) mass loss, and a reduction in polymer crosslinks. Lumenal and mural surfaces and the cross-section of the explant demonstrated evidence of degradation. This study validates PGD as an appropriate cardiovascular engineering material due to its propensity for rapid tissue coverage and uneventful inflammatory response in a preclinical animal model, establishing a precedent for consideration in cardiovascular repair applications.
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Affiliation(s)
- Harsha Ramaraju
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology Atlanta, GA 30312, USA.
| | - Danielle Massarella
- UH Rainbow Babies & Children's Hospital, Department of Pediatrics, Division of Pediatric, Cardiology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Courtney Wong
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology Atlanta, GA 30312, USA
| | - Adam S Verga
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology Atlanta, GA 30312, USA
| | - Emily C Kish
- UH Rainbow Babies & Children's Hospital, Department of Pediatrics, Division of Pediatric, Cardiology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Martin L Bocks
- UH Rainbow Babies & Children's Hospital, Department of Pediatrics, Division of Pediatric, Cardiology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Scott J Hollister
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology Atlanta, GA 30312, USA.
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Sikora-Jasinska M, Morath LM, Kwesiga MP, Plank ME, Nelson AL, Oliver AA, Bocks ML, Guillory RJ, Goldman J. In-vivo evaluation of molybdenum as bioabsorbable stent candidate. Bioact Mater 2022; 14:262-271. [PMID: 35310360 PMCID: PMC8897701 DOI: 10.1016/j.bioactmat.2021.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/13/2021] [Accepted: 11/05/2021] [Indexed: 12/19/2022] Open
Abstract
Biodegradable stents have tremendous theoretical potential as an alternative to bare metal stents and drug-eluting stents for the treatment of obstructive coronary artery disease. Any bioresorbable or biodegradable scaffold material needs to possess optimal mechanical properties and uniform degradation behavior that avoids local and systemic toxicity. Recently, molybdenum (Mo) has been investigated as a potential novel biodegradable material for this purpose. With its proven moderate degradation rate and excellent mechanical properties, Mo may represent an ideal source material for clinical cardiac and vascular applications. The present study was performed to evaluate the mechanical performance of metallic Mo in vitro and the biodegradation properties in vivo. The results demonstrated favorable mechanical behavior and a uniform degradation profile as desired for a new generation ultra-thin degradable endovascular stent material. Moreover, Mo implants in mouse arteries avoided the typical cellular response that contributes to restenosis. There was minimal neointimal hyperplasia over 6 months, an absence of excessive smooth muscle cell (SMC) proliferation or inflammation near the implant, and avoidance of significant harm to regenerating endothelial cells (EC). Qualitative inspection of kidney sections showed a potentially pathological remodeling of kidney Bowman's capsule and glomeruli, indicative of impaired filtering function and development of kidney disease, although quantifications of these morphological changes were not statistically significant. Together, the results suggest that the products of Mo corrosion may exert beneficial or inert effects on the activities of inflammatory and arterial cells, while exerting potentially toxic effects in the kidneys that warrant further investigation. Mo implants in mouse arteries avoided neointimal hyperplasia over 6 months. Quantification of CD31-labeled arterial sections showed an avoidance of significant harm to regenerating endothelial cells for the Mo implants. Qualitative inspection of kidney sections showed a potential pathological remodeling, indicative of possible impaired filtering function.
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Mejia E, George RS, Lozier JS, Bocks ML. Perventricular Transcatheter Pulmonary Valve Implantation in a Symptomatic 3-Year-Old Child With Repaired Tetralogy of Fallot. JACC Case Rep 2021; 3:712-714. [PMID: 34317611 PMCID: PMC8311154 DOI: 10.1016/j.jaccas.2020.12.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/24/2020] [Indexed: 11/04/2022]
Abstract
In select patients, transcatheter pulmonary valve replacement through a percutaneous approach can be challenging because of complicated anatomy or small patient size. In these patients, especially those weighing <20 kg, hybrid perventricular valve delivery may provide a preferred alternative approach. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Ernesto Mejia
- Department of Pediatric Cardiology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Renelle S George
- Department of Pediatric Cardiology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - John S Lozier
- Department of Pediatric Cardiology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Martin L Bocks
- Department of Pediatric Cardiology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
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Ramaraju H, Ul-Haque A, Verga AS, Bocks ML, Hollister SJ. Modulating nonlinear elastic behavior of biodegradable shape memory elastomer and small intestinal submucosa(SIS) composites for soft tissue repair. J Mech Behav Biomed Mater 2020; 110:103965. [PMID: 32957256 DOI: 10.1016/j.jmbbm.2020.103965] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/17/2020] [Accepted: 06/29/2020] [Indexed: 01/08/2023]
Abstract
Structural repair of soft tissue for regenerative therapies can be advanced by developing biocompatible and bioresorbable materials with mechanical properties similar to the tissue targeted for therapy. Developing new materials modeling soft tissue mechanics can mitigate many limitations of material based therapies, specifically concerning the mechanical stress and deformation the material imposes on surrounding tissue structures. However, many elastomeric materials used in soft tissue repair lack the ability to be delivered through minimally invasive surgical (MIS) or transcatheter routes and require open surgical approaches for placement and application. We have developed a biocompatible and fully biodegradable shape memory elastomer, poly-(glycerol dodecanedioate) (PGD), which fulfills the requirements for hyperelasticity and exhibits shape memory behavior to serve as a novel substrate material for regenerative therapy in minimally invasive clinical procedures. Our previous work demonstrated control over the tangent modulus at 12.5% compressive strain between 1 and 3 MPa by increasing the crosslinking density in the polymer. In order to improve control over a broader range of mechanical properties, nonlinear behavior, and toughness, we 1) varied PGD physical crosslink density, 2) incorporated sheets of porcine small intestinal submucosa (SIS, Cook Biotech, Inc.) with varying thickness, and 3) mixed lyophilized SIS particulates into PGD at different weight percentages. Tensile testing (ASTM D412a) revealed PGD containing SIS sheets of were stiffer than controls (p < 0.01). Incorporating lyophilized SIS particulates into PGD increased the strain to failure (p < 0.001) compared to PGD controls. Test specimens with 1 ply sheets had greater tear strength (ASTM D624c) compared to PGD tear specimens prepared control specimens (p < 0.001). However, incorporating SIS particulates decreased tear strength of PGD-SIS 0.5 wt% particulate composites (p < 0.01) compared to PGD controls. Incorporating 2 ply and 4 ply sheets and 0.5 wt% particulates into PGD decreased the fixity and recovery of composite materials compared to controls (p < 0.01). Nonlinear modeling of stress strain curves under uniaxial tension demonstrated tunability of PGD-SIS composite materials to model various nonlinear soft tissues. These findings support the use of shape memory PGD-SIS composite materials towards the design of implantable devices for a variety of soft tissue regeneration applications by minimally invasive surgery.
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Affiliation(s)
- Harsha Ramaraju
- Georgia Institute of Technology, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, GA, USA.
| | - Anum Ul-Haque
- Georgia Institute of Technology, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, GA, USA
| | - Adam S Verga
- Georgia Institute of Technology, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, GA, USA
| | - Martin L Bocks
- Case Western Reserve University, School of Medicine, Cleveland, OH, USA
| | - Scott J Hollister
- Georgia Institute of Technology, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, GA, USA
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Guillory RJ, Kolesar TM, Oliver AA, Stuart JA, Bocks ML, Drelich JW, Goldman J. Zn 2+-dependent suppression of vascular smooth muscle intimal hyperplasia from biodegradable zinc implants. Mater Sci Eng C Mater Biol Appl 2020; 111:110826. [PMID: 32279804 PMCID: PMC7962177 DOI: 10.1016/j.msec.2020.110826] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/04/2020] [Accepted: 03/07/2020] [Indexed: 11/18/2022]
Abstract
Biodegradable arterial implants based on zinc have been found to suppress neointimal hyperplasia, suggesting that biodegradable materials containing zinc may be used to construct vascular implants with a reduced rate of restenosis. However, the molecular mechanism has remained unclear. In this report, we show that zinc-containing materials can be used to prevent neointimal formation when implanted into the rat aorta. Indeed, neointimal cells were significantly more TUNEL positive and alpha-actin negative at the interface of biodegradable zinc vs. biostable platinum implants, in association with greater caspase-3 activity. Although zinc stimulated extensive neointimal smooth muscle cell (SMC) death, macrophage and proinflammatory markers CD68 and iNOS were not increased in neointimal tissue relative to biostable platinum control implants. Using arterial explants, ionic zinc was confirmed to promote SMC apoptosis by activating the caspase apoptotic signaling pathway. These observations suggest that zinc-containing materials can be used to construct vascular implants such as stents with reduced neointimal hyperplasia.
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Affiliation(s)
- Roger J Guillory
- Department of Biomedical Engineering, Michigan Technological University, USA.
| | - Timothy M Kolesar
- Department of Biomedical Engineering, Michigan Technological University, USA
| | - Alexander A Oliver
- Department of Biomedical Engineering, Michigan Technological University, USA
| | | | - Martin L Bocks
- Case Western Reserve University School of Medicine, UH Rainbow Babies & Children's Hospital, Cleveland, OH, USA
| | - Jaroslaw W Drelich
- Department of Materials Science and Engineering, Michigan Technological University, USA
| | - Jeremy Goldman
- Department of Biomedical Engineering, Michigan Technological University, USA.
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Ramaraju H, Solorio LD, Bocks ML, Hollister SJ. Degradation properties of a biodegradable shape memory elastomer, poly(glycerol dodecanoate), for soft tissue repair. PLoS One 2020; 15:e0229112. [PMID: 32084184 PMCID: PMC7034845 DOI: 10.1371/journal.pone.0229112] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 01/29/2020] [Indexed: 01/01/2023] Open
Abstract
Development of biodegradable shape memory elastomers (SMEs) is driven by the growing need for materials to address soft tissue pathology using a minimally invasive surgical approach. Composition, chain length and crosslinking of biocompatible polymers like PCL and PLA have been investigated to control mechanical properties, shape recovery and degradation rates. Depending on the primary mechanism of degradation, many of these polymers become considerably stiffer or softer resulting in mechanical properties that are inappropriate to support the regeneration of surrounding soft tissues. Additionally, concerns regarding degradation byproducts or residual organic solvents during synthesis accelerated interest in development of materials from bioavailable monomers. We previously developed a biodegradable SME, poly(glycerol dodecanoate) (PGD), using biologically relevant metabolites and controlled synthesis conditions to tune mechanical properties for soft tissue repair. In this study, we investigate the influence of crosslinking density on the mechanical and thermal properties of PGD during in vitro and in vivo degradation. Results suggest polymer degradation in vivo is predominantly driven by surface erosion, with no significant effects of initial crosslinking density on degradation time under the conditions investigated. Importantly, mechanical integrity is maintained during degradation. Additionally, shifts in melt transitions on thermograms indicate a potential shift in shape memory transition temperatures as the polymers degrade. These findings support the use of PGD for soft tissue repair and warrant further investigation towards tuning the molecular and macromolecular properties of the polymer to tailor degradation rates for specific clinical applications.
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Affiliation(s)
- Harsha Ramaraju
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - Loran D. Solorio
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Martin L. Bocks
- UH Rainbow Babies & Children’s Hospital, School of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Scott J. Hollister
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
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McElhinney DB, Aboulhosn JA, Dvir D, Whisenant B, Zhang Y, Eicken A, Ribichini F, Tzifa A, Hainstock MR, Martin MH, Kornowski R, Schubert S, Latib A, Thomson JD, Torres AJ, Meadows J, Delaney JW, Guerrero ME, Salizzoni S, El-Said H, Finkelstein A, George I, Gewillig M, Alvarez-Fuente M, Lamers L, Cheema AN, Kreutzer JN, Rudolph T, Hildick-Smith D, Cabalka AK, Boudjemline Y, Milani G, Bocks ML, Asnes JD, Mahadevan V, Himbert D, Goldstein BH, Fagan TE, Cheatham JP, Momenah TS, Kim DW, Colombo A, Ancona M, Butera G, Forbes TJ, Horlick E, Pedra C, Alfonsi J, Jones TK, Foerster S, Shahanavaz S, Crittendon I, Schranz D, Qureshi A, Thomas M, Kenny DP, Hoyer M, Bleiziffer S, Kefer J, Testa L, Gillespie M, Khan D, Pass RH, Abdel-Wahab M, Wijeysundera H, Casselman F, Moe T, Hayes N, Alli O, Nayak KR, Patel P, Piazza N, Seaman C, Windecker S, Kuo J, Ing FF, Makkar RR, Greif M, Cerillio AG, Champagnac D, Nietlispach F, Maisano F, Treede H, Seiffert M, Teles RC, Feuchtner G, Bonaros N, Bruschi G, Pesarini G. Mid-Term Valve-Related Outcomes After Transcatheter Tricuspid Valve-in-Valve or Valve-in-Ring Replacement. J Am Coll Cardiol 2019; 73:148-157. [DOI: 10.1016/j.jacc.2018.10.051] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 09/30/2018] [Accepted: 10/08/2018] [Indexed: 12/19/2022]
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Taggart NW, Cabalka AK, Eicken A, Aboulhosn JA, Thomson JD, Whisenant B, Bocks ML, Schubert S, Jones TK, Asnes JD, Fagan TE, Meadows J, Hoyer M, Martin MH, Ing FF, Turner DR, Latib A, Tzifa A, Windecker S, Goldstein BH, Delaney JW, Kuo JA, Foerster S, Gillespie M, Butera G, Shahanavaz S, Horlick E, Boudjemline Y, Dvir D, McElhinney DB. Outcomes of Transcatheter Tricuspid Valve-in-Valve Implantation in Patients With Ebstein Anomaly. Am J Cardiol 2018; 121:262-268. [PMID: 29153244 DOI: 10.1016/j.amjcard.2017.10.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 09/25/2017] [Accepted: 10/04/2017] [Indexed: 10/18/2022]
Abstract
We sought to describe the acute results and short- to medium-term durability of transcatheter tricuspid valve-in-valve (TVIV) implantation within surgical bioprostheses among patients with Ebstein anomaly (EA). Cases were identified from a voluntary, multicenter, international registry of 29 institutions that perform TVIV. Demographic, clinical, procedural, and follow-up data were analyzed. Eighty-one patients with EA underwent TVIV from 2008 to 2016. Thirty-four patients (42%) were New York Heart Association (NYHA) class 3/4 at time of TVIV. The most common indication for TVIV was the presence of moderate or severe tricuspid regurgitation (40%). Most patients received a Melody valve (64%). TVIV was ultimately successful in all patients, and there was no procedural mortality. Four patients (5%) developed acute valve thrombosis, 4 patients (5%) developed endocarditis, and 9 patients (11%) developed valve dysfunction not related to thrombosis or endocarditis. Eight patients (10%) underwent reintervention (2 transcatheter, 6 surgical) due to thrombosis (3), endocarditis (2), other valve dysfunction (2), and patient-prosthesis mismatch without valve dysfunction (1). Among 69 patients who were alive without reintervention at latest follow-up, 96% of those with NYHA status reported were class 1/2, a significant improvement from baseline (62% NYHA class 1/2, p <0.001). In conclusion, transcatheter TVIV offers a low-risk, minimally invasive alternative to surgical tricuspid valve re-replacement in patients with EA and a failing tricuspid valve bioprosthesis.
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Morray BH, McElhinney DB, Boudjemline Y, Gewillig M, Kim DW, Grant EK, Bocks ML, Martin MH, Armstrong AK, Berman D, Danon S, Hoyer M, Delaney JW, Justino H, Qureshi AM, Meadows JJ, Jones TK. Multicenter Experience Evaluating Transcatheter Pulmonary Valve Replacement in Bovine Jugular Vein (Contegra) Right Ventricle to Pulmonary Artery Conduits. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.116.004914. [DOI: 10.1161/circinterventions.116.004914] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 05/17/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Brian H. Morray
- From the Division of Cardiology, Seattle Children’s Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children’s Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of
| | - Doff B. McElhinney
- From the Division of Cardiology, Seattle Children’s Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children’s Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of
| | - Younes Boudjemline
- From the Division of Cardiology, Seattle Children’s Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children’s Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of
| | - Marc Gewillig
- From the Division of Cardiology, Seattle Children’s Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children’s Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of
| | - Dennis W. Kim
- From the Division of Cardiology, Seattle Children’s Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children’s Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of
| | - Elena K. Grant
- From the Division of Cardiology, Seattle Children’s Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children’s Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of
| | - Martin L. Bocks
- From the Division of Cardiology, Seattle Children’s Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children’s Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of
| | - Mary H. Martin
- From the Division of Cardiology, Seattle Children’s Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children’s Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of
| | - Aimee K. Armstrong
- From the Division of Cardiology, Seattle Children’s Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children’s Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of
| | - Darren Berman
- From the Division of Cardiology, Seattle Children’s Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children’s Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of
| | - Saar Danon
- From the Division of Cardiology, Seattle Children’s Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children’s Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of
| | - Mark Hoyer
- From the Division of Cardiology, Seattle Children’s Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children’s Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of
| | - Jeffrey W. Delaney
- From the Division of Cardiology, Seattle Children’s Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children’s Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of
| | - Henri Justino
- From the Division of Cardiology, Seattle Children’s Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children’s Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of
| | - Athar M. Qureshi
- From the Division of Cardiology, Seattle Children’s Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children’s Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of
| | - Jeffery J. Meadows
- From the Division of Cardiology, Seattle Children’s Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children’s Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of
| | - Thomas K. Jones
- From the Division of Cardiology, Seattle Children’s Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children’s Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of
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14
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Solorio LD, Bocks ML, Hollister SJ. Tailoring the physicochemical and shape memory properties of the biodegradable polymer poly(glycerol dodecanoate) via curing conditions. J Biomed Mater Res A 2017; 105:1618-1623. [PMID: 27935209 DOI: 10.1002/jbm.a.35973] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 10/18/2016] [Accepted: 11/28/2016] [Indexed: 01/28/2023]
Abstract
A major challenge in the repair and regeneration of soft tissue damage occurring as a result of aging, injury, or disease is recapitulating the biomechanical properties of the native tissue. Ideally, a candidate biomaterial for soft tissue engineering applications should be biocompatible, nonlinearly elastic to match soft tissue mechanical behavior, biodegradable to enable tissue remodeling, and tailorable to achieve a range of nonlinear elastic mechanical properties to match specific soft tissues. In addition, for cardiac and other applications, the biomaterial should have shape memory characteristics to facilitate minimally invasive and/or catheter-based delivery. Poly(glycerol dodecanoate) (PGD) is a shape memory material that has nonlinear elastic properties at body temperature and elastic-plastic behavior at room temperature. In this study, we investigated the effects of curing conditions on the nonlinear elastic, shape memory, and biocompatibility properties of PGD. Increased curing and crosslinking resulted in an increase in both the initial stiffness and the nonlinear strain stiffening behavior of PGD. After shape fixation at 60% strain, 100% shape recovery was achieved within 1 min at body temperature for all conditions tested. Polymer curing had no adverse effects on the cellular biocompatibility or non-hemolytic characteristics of PGD, indicating the potential suitability of these formulations for blood-contacting device applications. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 1618-1623, 2017.
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Affiliation(s)
- Loran D Solorio
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
| | - Martin L Bocks
- Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan Health System, Ann Arbor, Michigan
| | - Scott J Hollister
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan.,Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan.,Department of Surgery, University of Michigan, Ann Arbor, Michigan
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15
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Shah AH, Horlick EM, Eicken A, Asnes JD, Bocks ML, Boudjemline Y, Cabalka AK, Fagan TE, Schubert S, Mahadevan VS, Dvir D, Osten M, McElhinney DB. Transcatheter valve implantation for right atrium-to-right ventricle conduit obstruction or regurgitation after modified Björk-fontan procedure. Catheter Cardiovasc Interv 2016; 89:298-305. [DOI: 10.1002/ccd.26648] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 06/04/2016] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Thomas E. Fagan
- University of Tennessee Health Science Center and Le Bonheur Children's Hospital; Memphis Tennessee
| | | | | | | | - Mark Osten
- Toronto General Hospital; Toronto Canada
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16
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Joynt MR, Lu JC, Bocks ML, Crowley DC. Ruptured aneurysm of a major aortopulmonary collateral. Eur Heart J 2016; 37:1777. [DOI: 10.1093/eurheartj/ehv311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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17
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Boe BA, Rectenwald JE, Bocks ML. Severely regurgitant left ventricle to ascending aorta conduit in a failing fontan patient treated with a vascular endograft and melody transcatheter pulmonary valve via hybrid approach. Catheter Cardiovasc Interv 2016; 88:1113-1117. [PMID: 27184689 DOI: 10.1002/ccd.26578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/06/2016] [Accepted: 04/22/2016] [Indexed: 11/09/2022]
Abstract
A 28-year-old male with single ventricular heart disease status post Fontan palliation and subsequent placement of left ventricle to ascending aorta (LV-AAo) valved conduit developed ascites and edema. Diagnostic catheterization revealed elevated ventricular end diastolic pressures (EDP) secondary to severe LV-AAo conduit regurgitation. Given the unique anatomy, surgical access via the right axillary artery provided optimal route for transcatheter valve implantation within the conduit. The procedure resulted in significant hemodynamic improvement with no complications. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Brian A Boe
- Department of Pediatric Cardiology, Nationwide Children's Hospital, Columbus, Ohio
| | - John E Rectenwald
- Division of Vascular & Endovascular Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Martin L Bocks
- Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan C.S. Mott Children's Hospital Congenital Heart Center, Ann Arbor, Michigan
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18
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McElhinney DB, Cabalka AK, Aboulhosn JA, Eicken A, Boudjemline Y, Schubert S, Himbert D, Asnes JD, Salizzoni S, Bocks ML, Cheatham JP, Momenah TS, Kim DW, Schranz D, Meadows J, Thomson JD, Goldstein BH, Crittendon I, Fagan TE, Webb JG, Horlick E, Delaney JW, Jones TK, Shahanavaz S, Moretti C, Hainstock MR, Kenny DP, Berger F, Rihal CS, Dvir D. Transcatheter Tricuspid Valve-in-Valve Implantation for the Treatment of Dysfunctional Surgical Bioprosthetic Valves. Circulation 2016; 133:1582-93. [DOI: 10.1161/circulationaha.115.019353] [Citation(s) in RCA: 140] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 02/19/2016] [Indexed: 11/16/2022]
Abstract
Background—
Off-label use of transcatheter aortic and pulmonary valve prostheses for tricuspid valve-in-valve implantation (TVIV) within dysfunctional surgical tricuspid valve (TV) bioprostheses has been described in small reports.
Methods and Results—
An international, multicenter registry was developed to collect data on TVIV cases. Patient-related factors, procedural details and outcomes, and follow-up data were analyzed. Valve-in-ring or heterotopic TV implantation procedures were not included. Data were collected on 156 patients with bioprosthetic TV dysfunction who underwent catheterization with planned TVIV. The median age was 40 years, and 71% of patients were in New York Heart Association class III or IV. Among 152 patients in whom TVIV was attempted with a Melody (n=94) or Sapien (n=58) valve, implantation was successful in 150, with few serious complications. After TVIV, both the TV inflow gradient and tricuspid regurgitation grade improved significantly. During follow-up (median, 13.3 months), 22 patients died, 5 within 30 days; all 22 patients were in New York Heart Association class III or IV, and 9 were hospitalized before TVIV. There were 10 TV reinterventions, and 3 other patients had significant recurrent TV dysfunction. At follow-up, 77% of patients were in New York Heart Association class I or II (
P
<0.001 versus before TVIV). Outcomes did not differ according to surgical valve size or TVIV valve type.
Conclusions—
TVIV with commercially available transcatheter prostheses is technically and clinically successful in patients of various ages across a wide range of valve size. Although preimplantation clinical status was associated with outcome, many patients in New York Heart Association class III or IV at baseline improved. TVIV should be considered a viable option for treatment of failing TV bioprostheses.
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Affiliation(s)
- Doff B. McElhinney
- From Stanford University, Palo Alto, CA (D.B.M.); Mayo Clinic, Rochester, MN (A.K.C., C.J.R.); University of California Los Angeles (J.A.A.); German Heart Centre, Munich, Germany (A.E.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Deutsches Herzzentrum Berlin, Germany (S. Schubert, B.G.); Bichat Hospital, Paris, France (D.H.); Yale University, New Haven, CT (J.D.A.); Città della Salute e della Scienza, Molinette, Torino, Italy (S. Salizzoni); University of Michigan, Ann Arbor (M.L.B.)
| | - Allison K. Cabalka
- From Stanford University, Palo Alto, CA (D.B.M.); Mayo Clinic, Rochester, MN (A.K.C., C.J.R.); University of California Los Angeles (J.A.A.); German Heart Centre, Munich, Germany (A.E.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Deutsches Herzzentrum Berlin, Germany (S. Schubert, B.G.); Bichat Hospital, Paris, France (D.H.); Yale University, New Haven, CT (J.D.A.); Città della Salute e della Scienza, Molinette, Torino, Italy (S. Salizzoni); University of Michigan, Ann Arbor (M.L.B.)
| | - Jamil A. Aboulhosn
- From Stanford University, Palo Alto, CA (D.B.M.); Mayo Clinic, Rochester, MN (A.K.C., C.J.R.); University of California Los Angeles (J.A.A.); German Heart Centre, Munich, Germany (A.E.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Deutsches Herzzentrum Berlin, Germany (S. Schubert, B.G.); Bichat Hospital, Paris, France (D.H.); Yale University, New Haven, CT (J.D.A.); Città della Salute e della Scienza, Molinette, Torino, Italy (S. Salizzoni); University of Michigan, Ann Arbor (M.L.B.)
| | - Andreas Eicken
- From Stanford University, Palo Alto, CA (D.B.M.); Mayo Clinic, Rochester, MN (A.K.C., C.J.R.); University of California Los Angeles (J.A.A.); German Heart Centre, Munich, Germany (A.E.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Deutsches Herzzentrum Berlin, Germany (S. Schubert, B.G.); Bichat Hospital, Paris, France (D.H.); Yale University, New Haven, CT (J.D.A.); Città della Salute e della Scienza, Molinette, Torino, Italy (S. Salizzoni); University of Michigan, Ann Arbor (M.L.B.)
| | - Younes Boudjemline
- From Stanford University, Palo Alto, CA (D.B.M.); Mayo Clinic, Rochester, MN (A.K.C., C.J.R.); University of California Los Angeles (J.A.A.); German Heart Centre, Munich, Germany (A.E.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Deutsches Herzzentrum Berlin, Germany (S. Schubert, B.G.); Bichat Hospital, Paris, France (D.H.); Yale University, New Haven, CT (J.D.A.); Città della Salute e della Scienza, Molinette, Torino, Italy (S. Salizzoni); University of Michigan, Ann Arbor (M.L.B.)
| | - Stephan Schubert
- From Stanford University, Palo Alto, CA (D.B.M.); Mayo Clinic, Rochester, MN (A.K.C., C.J.R.); University of California Los Angeles (J.A.A.); German Heart Centre, Munich, Germany (A.E.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Deutsches Herzzentrum Berlin, Germany (S. Schubert, B.G.); Bichat Hospital, Paris, France (D.H.); Yale University, New Haven, CT (J.D.A.); Città della Salute e della Scienza, Molinette, Torino, Italy (S. Salizzoni); University of Michigan, Ann Arbor (M.L.B.)
| | - Dominique Himbert
- From Stanford University, Palo Alto, CA (D.B.M.); Mayo Clinic, Rochester, MN (A.K.C., C.J.R.); University of California Los Angeles (J.A.A.); German Heart Centre, Munich, Germany (A.E.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Deutsches Herzzentrum Berlin, Germany (S. Schubert, B.G.); Bichat Hospital, Paris, France (D.H.); Yale University, New Haven, CT (J.D.A.); Città della Salute e della Scienza, Molinette, Torino, Italy (S. Salizzoni); University of Michigan, Ann Arbor (M.L.B.)
| | - Jeremy D. Asnes
- From Stanford University, Palo Alto, CA (D.B.M.); Mayo Clinic, Rochester, MN (A.K.C., C.J.R.); University of California Los Angeles (J.A.A.); German Heart Centre, Munich, Germany (A.E.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Deutsches Herzzentrum Berlin, Germany (S. Schubert, B.G.); Bichat Hospital, Paris, France (D.H.); Yale University, New Haven, CT (J.D.A.); Città della Salute e della Scienza, Molinette, Torino, Italy (S. Salizzoni); University of Michigan, Ann Arbor (M.L.B.)
| | - Stefano Salizzoni
- From Stanford University, Palo Alto, CA (D.B.M.); Mayo Clinic, Rochester, MN (A.K.C., C.J.R.); University of California Los Angeles (J.A.A.); German Heart Centre, Munich, Germany (A.E.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Deutsches Herzzentrum Berlin, Germany (S. Schubert, B.G.); Bichat Hospital, Paris, France (D.H.); Yale University, New Haven, CT (J.D.A.); Città della Salute e della Scienza, Molinette, Torino, Italy (S. Salizzoni); University of Michigan, Ann Arbor (M.L.B.)
| | - Martin L. Bocks
- From Stanford University, Palo Alto, CA (D.B.M.); Mayo Clinic, Rochester, MN (A.K.C., C.J.R.); University of California Los Angeles (J.A.A.); German Heart Centre, Munich, Germany (A.E.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Deutsches Herzzentrum Berlin, Germany (S. Schubert, B.G.); Bichat Hospital, Paris, France (D.H.); Yale University, New Haven, CT (J.D.A.); Città della Salute e della Scienza, Molinette, Torino, Italy (S. Salizzoni); University of Michigan, Ann Arbor (M.L.B.)
| | - John P. Cheatham
- From Stanford University, Palo Alto, CA (D.B.M.); Mayo Clinic, Rochester, MN (A.K.C., C.J.R.); University of California Los Angeles (J.A.A.); German Heart Centre, Munich, Germany (A.E.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Deutsches Herzzentrum Berlin, Germany (S. Schubert, B.G.); Bichat Hospital, Paris, France (D.H.); Yale University, New Haven, CT (J.D.A.); Città della Salute e della Scienza, Molinette, Torino, Italy (S. Salizzoni); University of Michigan, Ann Arbor (M.L.B.)
| | - Tarek S. Momenah
- From Stanford University, Palo Alto, CA (D.B.M.); Mayo Clinic, Rochester, MN (A.K.C., C.J.R.); University of California Los Angeles (J.A.A.); German Heart Centre, Munich, Germany (A.E.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Deutsches Herzzentrum Berlin, Germany (S. Schubert, B.G.); Bichat Hospital, Paris, France (D.H.); Yale University, New Haven, CT (J.D.A.); Città della Salute e della Scienza, Molinette, Torino, Italy (S. Salizzoni); University of Michigan, Ann Arbor (M.L.B.)
| | - Dennis W. Kim
- From Stanford University, Palo Alto, CA (D.B.M.); Mayo Clinic, Rochester, MN (A.K.C., C.J.R.); University of California Los Angeles (J.A.A.); German Heart Centre, Munich, Germany (A.E.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Deutsches Herzzentrum Berlin, Germany (S. Schubert, B.G.); Bichat Hospital, Paris, France (D.H.); Yale University, New Haven, CT (J.D.A.); Città della Salute e della Scienza, Molinette, Torino, Italy (S. Salizzoni); University of Michigan, Ann Arbor (M.L.B.)
| | - Dietmar Schranz
- From Stanford University, Palo Alto, CA (D.B.M.); Mayo Clinic, Rochester, MN (A.K.C., C.J.R.); University of California Los Angeles (J.A.A.); German Heart Centre, Munich, Germany (A.E.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Deutsches Herzzentrum Berlin, Germany (S. Schubert, B.G.); Bichat Hospital, Paris, France (D.H.); Yale University, New Haven, CT (J.D.A.); Città della Salute e della Scienza, Molinette, Torino, Italy (S. Salizzoni); University of Michigan, Ann Arbor (M.L.B.)
| | - Jeffery Meadows
- From Stanford University, Palo Alto, CA (D.B.M.); Mayo Clinic, Rochester, MN (A.K.C., C.J.R.); University of California Los Angeles (J.A.A.); German Heart Centre, Munich, Germany (A.E.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Deutsches Herzzentrum Berlin, Germany (S. Schubert, B.G.); Bichat Hospital, Paris, France (D.H.); Yale University, New Haven, CT (J.D.A.); Città della Salute e della Scienza, Molinette, Torino, Italy (S. Salizzoni); University of Michigan, Ann Arbor (M.L.B.)
| | - John D.R. Thomson
- From Stanford University, Palo Alto, CA (D.B.M.); Mayo Clinic, Rochester, MN (A.K.C., C.J.R.); University of California Los Angeles (J.A.A.); German Heart Centre, Munich, Germany (A.E.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Deutsches Herzzentrum Berlin, Germany (S. Schubert, B.G.); Bichat Hospital, Paris, France (D.H.); Yale University, New Haven, CT (J.D.A.); Città della Salute e della Scienza, Molinette, Torino, Italy (S. Salizzoni); University of Michigan, Ann Arbor (M.L.B.)
| | - Bryan H. Goldstein
- From Stanford University, Palo Alto, CA (D.B.M.); Mayo Clinic, Rochester, MN (A.K.C., C.J.R.); University of California Los Angeles (J.A.A.); German Heart Centre, Munich, Germany (A.E.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Deutsches Herzzentrum Berlin, Germany (S. Schubert, B.G.); Bichat Hospital, Paris, France (D.H.); Yale University, New Haven, CT (J.D.A.); Città della Salute e della Scienza, Molinette, Torino, Italy (S. Salizzoni); University of Michigan, Ann Arbor (M.L.B.)
| | - Ivory Crittendon
- From Stanford University, Palo Alto, CA (D.B.M.); Mayo Clinic, Rochester, MN (A.K.C., C.J.R.); University of California Los Angeles (J.A.A.); German Heart Centre, Munich, Germany (A.E.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Deutsches Herzzentrum Berlin, Germany (S. Schubert, B.G.); Bichat Hospital, Paris, France (D.H.); Yale University, New Haven, CT (J.D.A.); Città della Salute e della Scienza, Molinette, Torino, Italy (S. Salizzoni); University of Michigan, Ann Arbor (M.L.B.)
| | - Thomas E. Fagan
- From Stanford University, Palo Alto, CA (D.B.M.); Mayo Clinic, Rochester, MN (A.K.C., C.J.R.); University of California Los Angeles (J.A.A.); German Heart Centre, Munich, Germany (A.E.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Deutsches Herzzentrum Berlin, Germany (S. Schubert, B.G.); Bichat Hospital, Paris, France (D.H.); Yale University, New Haven, CT (J.D.A.); Città della Salute e della Scienza, Molinette, Torino, Italy (S. Salizzoni); University of Michigan, Ann Arbor (M.L.B.)
| | - John G. Webb
- From Stanford University, Palo Alto, CA (D.B.M.); Mayo Clinic, Rochester, MN (A.K.C., C.J.R.); University of California Los Angeles (J.A.A.); German Heart Centre, Munich, Germany (A.E.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Deutsches Herzzentrum Berlin, Germany (S. Schubert, B.G.); Bichat Hospital, Paris, France (D.H.); Yale University, New Haven, CT (J.D.A.); Città della Salute e della Scienza, Molinette, Torino, Italy (S. Salizzoni); University of Michigan, Ann Arbor (M.L.B.)
| | - Eric Horlick
- From Stanford University, Palo Alto, CA (D.B.M.); Mayo Clinic, Rochester, MN (A.K.C., C.J.R.); University of California Los Angeles (J.A.A.); German Heart Centre, Munich, Germany (A.E.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Deutsches Herzzentrum Berlin, Germany (S. Schubert, B.G.); Bichat Hospital, Paris, France (D.H.); Yale University, New Haven, CT (J.D.A.); Città della Salute e della Scienza, Molinette, Torino, Italy (S. Salizzoni); University of Michigan, Ann Arbor (M.L.B.)
| | - Jeffrey W. Delaney
- From Stanford University, Palo Alto, CA (D.B.M.); Mayo Clinic, Rochester, MN (A.K.C., C.J.R.); University of California Los Angeles (J.A.A.); German Heart Centre, Munich, Germany (A.E.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Deutsches Herzzentrum Berlin, Germany (S. Schubert, B.G.); Bichat Hospital, Paris, France (D.H.); Yale University, New Haven, CT (J.D.A.); Città della Salute e della Scienza, Molinette, Torino, Italy (S. Salizzoni); University of Michigan, Ann Arbor (M.L.B.)
| | - Thomas K. Jones
- From Stanford University, Palo Alto, CA (D.B.M.); Mayo Clinic, Rochester, MN (A.K.C., C.J.R.); University of California Los Angeles (J.A.A.); German Heart Centre, Munich, Germany (A.E.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Deutsches Herzzentrum Berlin, Germany (S. Schubert, B.G.); Bichat Hospital, Paris, France (D.H.); Yale University, New Haven, CT (J.D.A.); Città della Salute e della Scienza, Molinette, Torino, Italy (S. Salizzoni); University of Michigan, Ann Arbor (M.L.B.)
| | - Shabana Shahanavaz
- From Stanford University, Palo Alto, CA (D.B.M.); Mayo Clinic, Rochester, MN (A.K.C., C.J.R.); University of California Los Angeles (J.A.A.); German Heart Centre, Munich, Germany (A.E.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Deutsches Herzzentrum Berlin, Germany (S. Schubert, B.G.); Bichat Hospital, Paris, France (D.H.); Yale University, New Haven, CT (J.D.A.); Città della Salute e della Scienza, Molinette, Torino, Italy (S. Salizzoni); University of Michigan, Ann Arbor (M.L.B.)
| | - Carolina Moretti
- From Stanford University, Palo Alto, CA (D.B.M.); Mayo Clinic, Rochester, MN (A.K.C., C.J.R.); University of California Los Angeles (J.A.A.); German Heart Centre, Munich, Germany (A.E.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Deutsches Herzzentrum Berlin, Germany (S. Schubert, B.G.); Bichat Hospital, Paris, France (D.H.); Yale University, New Haven, CT (J.D.A.); Città della Salute e della Scienza, Molinette, Torino, Italy (S. Salizzoni); University of Michigan, Ann Arbor (M.L.B.)
| | - Michael R. Hainstock
- From Stanford University, Palo Alto, CA (D.B.M.); Mayo Clinic, Rochester, MN (A.K.C., C.J.R.); University of California Los Angeles (J.A.A.); German Heart Centre, Munich, Germany (A.E.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Deutsches Herzzentrum Berlin, Germany (S. Schubert, B.G.); Bichat Hospital, Paris, France (D.H.); Yale University, New Haven, CT (J.D.A.); Città della Salute e della Scienza, Molinette, Torino, Italy (S. Salizzoni); University of Michigan, Ann Arbor (M.L.B.)
| | - Damien P. Kenny
- From Stanford University, Palo Alto, CA (D.B.M.); Mayo Clinic, Rochester, MN (A.K.C., C.J.R.); University of California Los Angeles (J.A.A.); German Heart Centre, Munich, Germany (A.E.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Deutsches Herzzentrum Berlin, Germany (S. Schubert, B.G.); Bichat Hospital, Paris, France (D.H.); Yale University, New Haven, CT (J.D.A.); Città della Salute e della Scienza, Molinette, Torino, Italy (S. Salizzoni); University of Michigan, Ann Arbor (M.L.B.)
| | - Felix Berger
- From Stanford University, Palo Alto, CA (D.B.M.); Mayo Clinic, Rochester, MN (A.K.C., C.J.R.); University of California Los Angeles (J.A.A.); German Heart Centre, Munich, Germany (A.E.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Deutsches Herzzentrum Berlin, Germany (S. Schubert, B.G.); Bichat Hospital, Paris, France (D.H.); Yale University, New Haven, CT (J.D.A.); Città della Salute e della Scienza, Molinette, Torino, Italy (S. Salizzoni); University of Michigan, Ann Arbor (M.L.B.)
| | - Charanjit S. Rihal
- From Stanford University, Palo Alto, CA (D.B.M.); Mayo Clinic, Rochester, MN (A.K.C., C.J.R.); University of California Los Angeles (J.A.A.); German Heart Centre, Munich, Germany (A.E.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Deutsches Herzzentrum Berlin, Germany (S. Schubert, B.G.); Bichat Hospital, Paris, France (D.H.); Yale University, New Haven, CT (J.D.A.); Città della Salute e della Scienza, Molinette, Torino, Italy (S. Salizzoni); University of Michigan, Ann Arbor (M.L.B.)
| | - Danny Dvir
- From Stanford University, Palo Alto, CA (D.B.M.); Mayo Clinic, Rochester, MN (A.K.C., C.J.R.); University of California Los Angeles (J.A.A.); German Heart Centre, Munich, Germany (A.E.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Deutsches Herzzentrum Berlin, Germany (S. Schubert, B.G.); Bichat Hospital, Paris, France (D.H.); Yale University, New Haven, CT (J.D.A.); Città della Salute e della Scienza, Molinette, Torino, Italy (S. Salizzoni); University of Michigan, Ann Arbor (M.L.B.)
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Boe BA, Bocks ML, Armstrong AK. Contained rupture of patched right ventricular outflow tracts during balloon sizing for percutaneous pulmonary valve implantation. Catheter Cardiovasc Interv 2015; 87:768-72. [PMID: 26152592 DOI: 10.1002/ccd.26094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 05/28/2015] [Accepted: 06/14/2015] [Indexed: 11/10/2022]
Abstract
Transcatheter pulmonary valves are being used off-label to treat pulmonary insufficiency in patched right ventricular outflow tracts (RVOTs). We describe the first reported cases of patched RVOT rupture, during balloon sizing for percutaneous pulmonary valve implantation, in two patients with tetralogy of Fallot status post repair. Both RVOTs were too large for subsequent catheter-based intervention. The ruptures remained stable over time, and both patients were managed conservatively with follow-up imaging.
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Affiliation(s)
- Brian A Boe
- Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan C.S. Mott Children's Hospital Congenital Heart Center, Ann Arbor, Michigan
| | - Martin L Bocks
- Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan C.S. Mott Children's Hospital Congenital Heart Center, Ann Arbor, Michigan
| | - Aimee K Armstrong
- Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan C.S. Mott Children's Hospital Congenital Heart Center, Ann Arbor, Michigan
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Gray BW, El-Sabbagh A, Zakem SJ, Koch KL, Rojas-Pena A, Owens GE, Bocks ML, Rabah R, Bartlett RH, Mychaliska GB. Development of an artificial placenta V: 70 h veno-venous extracorporeal life support after ventilatory failure in premature lambs. J Pediatr Surg 2013; 48:145-53. [PMID: 23331807 PMCID: PMC4076781 DOI: 10.1016/j.jpedsurg.2012.10.030] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 10/13/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE An artificial placenta would change the paradigm of treating extremely premature infants. We hypothesized that using a veno-venous extracorporeal life support (VV-ECLS) artificial placenta after ventilatory failure would stabilize premature lambs and maintain normal fetal physiologic parameters for 70 h. METHODS A near-term neonatal lamb model (130 days; term=145) was used. The right jugular vein (drainage) and umbilical vein (reinfusion) were cannulated with 10-12 Fr cannulas. Lambs were then transitioned to an infant ventilator. After respiratory failure, the endotracheal tube was filled with amniotic fluid, and VV-ECLS total artificial placenta support (TAPS) was initiated. Lambs were maintained on TAPS for 70 h. RESULTS Six of seven lambs survived for 70 h. Mean ventilation time was 57 ± 22 min. During ventilation, mean MAP was 51 ± 14 mmHg, compared to 44 ± 14 mmHg during TAPS (p=0.001). Mean pH and lactate during ventilation were 7.06 ± 0.15 and 5.7 ± 2.3 mmol/L, compared to 7.33 ± 0.07 and 2.0 ± 1.8 mmol/L during TAPS (p<0.001 for both). pO(2) and pCO(2) remained within normal fetal parameters during TAPS, and mean carotid blood flow was 25 ± 7.5 mL/kg/min. Necropsy showed a patent ductus arteriosus and no intracranial hemorrhage in all animals. CONCLUSIONS The artificial placenta stabilized premature lambs after ventilatory failure and maintained fetal circulation, hemodynamic stability, gas exchange, and cerebral perfusion for 70 h.
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Affiliation(s)
- Brian W. Gray
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA,Section of Pediatric Surgery, University of Michigan, Ann Arbor, MI, USA,Corresponding author. 2207 Taubman Center, 1500 E Medical Center Dr, Ann Arbor, MI 48109. Tel.: +1 734 615 5357; fax: +1 734 615 4220. (B.W. Gray)
| | - Ahmed El-Sabbagh
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Sara J. Zakem
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Kelly L. Koch
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Gabe E. Owens
- Division of Pediatric Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Martin L. Bocks
- Division of Pediatric Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Raja Rabah
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | | | - George B. Mychaliska
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA,Section of Pediatric Surgery, University of Michigan, Ann Arbor, MI, USA
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Goldstein BH, Aiyagari R, Bocks ML, Armstrong AK. Hydrogel Expandable Coils for Vascular Occlusion in Congenital Cardiovascular Disease: A Single Center Experience. CONGENIT HEART DIS 2011; 7:212-8. [DOI: 10.1111/j.1747-0803.2011.00583.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bocks ML, Armstrong AK. Novel method for delivering the Amplatzer muscular VSD occluder in a patient with double outlet right ventricle after bidirectional Glenn procedure and pulmonary artery band. Catheter Cardiovasc Interv 2009; 74:488-93. [PMID: 19681125 DOI: 10.1002/ccd.21982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We report the first use of bilateral femoral venovenous rail creation for the delivery of an Amplatzer Muscular Ventricular Septal Defect Occluder in a patient with a large mid-to-apical muscular ventricular septal defect before Rastelli operation. The presence of a right-sided bidirectional Glenn shunt, a banded main pulmonary artery, and double outlet right ventricle anatomy precluded the use of standard delivery techniques. The patient underwent successful transcatheter device placement followed by Rastelli operation on the following day.
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Affiliation(s)
- Martin L Bocks
- Division of Pediatric Cardiology, University of Michigan Health System, Ann Arbor, Michigan 48109-5204, USA.
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