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Todesco M, Casarin M, Sandrin D, Astolfi L, Romanato F, Giuggioli G, Conte F, Gerosa G, Fontanella CG, Bagno A. Hybrid Materials for Vascular Applications: A Preliminary In Vitro Assessment. Bioengineering (Basel) 2024; 11:436. [PMID: 38790303 PMCID: PMC11117917 DOI: 10.3390/bioengineering11050436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/19/2024] [Accepted: 04/25/2024] [Indexed: 05/26/2024] Open
Abstract
The production of biomedical devices able to appropriately interact with the biological environment is still a great challenge. Synthetic materials are often employed, but they fail to replicate the biological and functional properties of native tissues, leading to a variety of adverse effects. Several commercial products are based on chemically treated xenogeneic tissues: their principal drawback is due to weak mechanical stability and low durability. Recently, decellularization has been proposed to bypass the drawbacks of both synthetic and biological materials. Acellular materials can integrate with host tissues avoiding/mitigating any foreign body response, but they often lack sufficient patency and impermeability. The present paper investigates an innovative approach to the realization of hybrid materials that combine decellularized bovine pericardium with polycarbonate urethanes. These hybrid materials benefit from the superior biocompatibility of the biological tissue and the mechanical properties of the synthetic polymers. They were assessed from physicochemical, structural, mechanical, and biological points of view; their ability to promote cell growth was also investigated. The decellularized pericardium and the polymer appeared to well adhere to each other, and the two sides were distinguishable. The maximum elongation of hybrid materials was mainly affected by the pericardium, which allows for lower elongation than the polymer; this latter, in turn, influenced the maximum strength achieved. The results confirmed the promising features of hybrid materials for the production of vascular grafts able to be repopulated by circulating cells, thus, improving blood compatibility.
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Affiliation(s)
- Martina Todesco
- Department of Civil, Environmental and Architectural Engineering, University of Padua, Via Marzolo 9, 35131 Padua, Italy
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria (CORIS), Veneto Region, Via Giustiniani 2, 35128 Padova, Italy
| | - Martina Casarin
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria (CORIS), Veneto Region, Via Giustiniani 2, 35128 Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, Giustiniani 2, 35128 Padua, Italy
| | - Deborah Sandrin
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria (CORIS), Veneto Region, Via Giustiniani 2, 35128 Padova, Italy
- Department of Physics and Astronomy ‘G. Galilei’, University of Padova, Via Marzolo 8, 35131 Padova, Italy
| | - Laura Astolfi
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria (CORIS), Veneto Region, Via Giustiniani 2, 35128 Padova, Italy
- Department of Neurosciences, University of Padua, Via Giustiniani, 2, 35128 Padua, Italy
| | - Filippo Romanato
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria (CORIS), Veneto Region, Via Giustiniani 2, 35128 Padova, Italy
- Department of Physics and Astronomy ‘G. Galilei’, University of Padova, Via Marzolo 8, 35131 Padova, Italy
- CNR-INFM TASC IOM National Laboratory, S.S. 14 Km 163.5, Basovizza, 34012 Trieste, Italy
| | - Germana Giuggioli
- Department of Prevention Veterinary Services, ULSS 3 Serenissima, P.le S.L Giustiniani 11/D Mestre, 30174 Venice, Italy
| | - Fabio Conte
- Department of Prevention Veterinary Services, ULSS 3 Serenissima, P.le S.L Giustiniani 11/D Mestre, 30174 Venice, Italy
| | - Gino Gerosa
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria (CORIS), Veneto Region, Via Giustiniani 2, 35128 Padova, Italy
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | | | - Andrea Bagno
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria (CORIS), Veneto Region, Via Giustiniani 2, 35128 Padova, Italy
- Department of Industrial Engineering, University of Padua, Via Marzolo 9, 35131 Padova, Italy
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Delcarro A, Coubeau L. Inferior vena cava reconstruction with non-fascial autologous peritoneum: Retrospective study and literature review. World J Surg 2024; 48:978-988. [PMID: 38502051 DOI: 10.1002/wjs.12127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/25/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Inferior vena cava (IVC) resection is essential for complete (R0) excision of some malignancies. However, the optimal material for IVC reconstruction remains unclear. Our objective is to demonstrate the efficacy, safety, and advantages of using Non-Fascial Autologous Peritoneum (NFAP) for IVC reconstruction. To conduct a literature review of surgical strategies for tumors involving the IVC. METHODS We reviewed all IVC reconstructions performed at our institution between 2015 and 2023. Preoperative, operative, postoperative, and follow-up data were collected and analyzed. RESULTS A total of 33 consecutive IVC reconstructions were identified: seven direct sutures, eight venous homografts (VH), and 18 NFAP. With regard to NFAP, eight tubular (mean length, 12.5 cm) and 10 patch (mean length, 7.9 cm) IVC reconstructions were performed. Resection was R0 in 89% of the cases. Two patients had Clavien-Dindo grade I complications, 2 grade II, 2 grade III and 2 grade V complications. The only graft-related complication was a case of early partial thrombosis, which was conservatively treated. At a mean follow-up of 25.9 months, graft patency was 100%. There were seven recurrences and six deaths. Mean overall survival (OS) was 23.4 months and mean disease-free survival (DFS) was 14.4 months. According to our results, no statistically significant differences were found between NFAP and VH. CONCLUSIONS NFAP is a safe and effective alternative for partial or complete IVC reconstruction and has many advantages over other techniques, including its lack of cost, wide and ready availability, extreme handiness, and versatility. Further comparative studies are required to determine the optimal technique for IVC reconstruction.
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Affiliation(s)
| | - Laurent Coubeau
- Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
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Frankel WC, Green SY, Amarasekara HS, Orozco-Sevilla V, Preventza O, LeMaire SA, Coselli JS. Early and late outcomes of surgical repair of mycotic aortic aneurysms: A 30-year experience. J Thorac Cardiovasc Surg 2024; 167:578-587. [PMID: 35643768 DOI: 10.1016/j.jtcvs.2022.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 02/17/2022] [Accepted: 03/16/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Mycotic aortic aneurysm and its associated complications are often catastrophic. In this study, we examined the early and late outcomes of surgical repair of mycotic aortic aneurysm at our center over the last 3 decades. METHODS We retrospectively reviewed our prospectively maintained aortic surgery database with supplemental adjudication of medical records. Aortic infection was confirmed through clinical, radiological, intraoperative, pathological, and treatment evidence. RESULTS Seventy-five patients (median age, 68 years; interquartile range, 62-74) who underwent surgical repair of a mycotic aortic aneurysm between 1992 and 2021 were included. Almost all patients (n = 72; 96%) presented with symptoms, including 26 patients (35%) with rupture, and many underwent urgent or emergency repair (n = 64; 85%). Sixty-one patients underwent open repair, and 14 patients underwent hybrid or endovascular repair. Infection-specific adjunct techniques included rifampin-soaked grafts (n = 16), omental pedicle flaps (n = 21), and antibiotic irrigation catheters (n = 8). There were 15 early deaths (20%), including 10 of the 26 patients (38%) who presented with rupture; however, persistent stroke, paraplegia or paraparesis, and renal failure necessitating dialysis were uncommon (each <5%). Almost all early survivors (52/60; 87%) were discharged with long-term antibiotic therapy. Estimated survival at 2, 6, and 10 years was 55.7% ± 5.8%, 39.0% ± 5.7%, and 26.9% ± 5.5%, respectively. CONCLUSIONS A substantial proportion of patients with mycotic aortic aneurysm present with rupture and generally require urgent or emergency repair. Operative mortality and complications are common, especially for patients who present with rupture, and late survival is poor.
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Affiliation(s)
- William C Frankel
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Susan Y Green
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Hiruni S Amarasekara
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Vicente Orozco-Sevilla
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex; CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Tex
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex; CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Tex
| | - Scott A LeMaire
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex; CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Tex; Cardiovascular Research Institute, Baylor College of Medicine, Houston, Tex.
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex; CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Tex; Cardiovascular Research Institute, Baylor College of Medicine, Houston, Tex
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Aljassam Y, Caputo M, Biglino G. Surgical Patching in Congenital Heart Disease: The Role of Imaging and Modelling. Life (Basel) 2023; 13:2295. [PMID: 38137896 PMCID: PMC10745019 DOI: 10.3390/life13122295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
In congenital heart disease, patches are not tailored to patient-specific anatomies, leading to shape mismatch with likely functional implications. The design of patches through imaging and modelling may be beneficial, as it could improve clinical outcomes and reduce the costs associated with redo procedures. Whilst attention has been paid to the material of the patches used in congenital surgery, this review outlines the current knowledge on this subject and isolated experimental work that uses modelling and imaging-derived information (including 3D printing) to inform the design of the surgical patch.
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Affiliation(s)
- Yousef Aljassam
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol BS2 8HW, UK;
| | - Massimo Caputo
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol BS2 8HW, UK;
- Cardiac Surgery, University Hospitals Bristol & Weston, NHS Foundation Trust, Bristol BS2 8HW, UK
| | - Giovanni Biglino
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol BS2 8HW, UK;
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Satchithanantham V, Babiker T, Riding G, Banihani M. A case of mycotic infrarenal abdominal aortic aneurysm after bacillus Calmette-Guérin immunotherapy for bladder cancer and a review of the literature. J Vasc Surg Cases Innov Tech 2023; 9:101213. [PMID: 37388673 PMCID: PMC10300401 DOI: 10.1016/j.jvscit.2023.101213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/24/2023] [Indexed: 07/01/2023] Open
Abstract
A 69-year-old patient presented with a 9-month history of constitutional symptoms and a 3-week history of increasing abdominal and back pain. He had a history of bacillus Calmette-Guérin immunotherapy for bladder cancer 9 months earlier. An infrarenal mycotic aneurysm was detected by positron emission tomography-computed tomography. His abdominal aorta was reconstructed using a tube graft tailored from a bovine pericardium sheet. We chose this graft because of its acellular nature and reduced risk of postoperative infection. The culture from the aortic wall yielded acid fast bacilli, and he was treated with antituberculosis medication. His postoperative recovery was uneventful, except for chylous ascites.
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Affiliation(s)
- Vinojan Satchithanantham
- Department of Vacular Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Fulwood, United Kingdom
- Department of Surgery, Faculty of Medicine, University of Jaffna, Jaffna, Srilanka
| | - Thamer Babiker
- Lancashire Teaching Hospitals NHS Foundation Trust, Fulwood, United Kingdom
| | - Graham Riding
- Lancashire Teaching Hospitals NHS Foundation Trust, Fulwood, United Kingdom
| | - Mohamed Banihani
- Lancashire Teaching Hospitals NHS Foundation Trust, Fulwood, United Kingdom
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Ahn JS, Mo H, Ahn S, Han A, Min S, Min SK, Ha J. Outcomes of vein reconstruction using bovine pericardial patch. Vascular 2023; 31:292-297. [PMID: 35403497 DOI: 10.1177/17085381211063035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The bovine pericardium is a good alternative material to the autogenous vein in vascular reconstruction. This study aimed to evaluate the results of angioplasty in venous reconstruction using bovine pericardium and identify the risk factors for significant complications. MATERIAL AND METHODS A retrospective review was performed of the demographic data, clinical characteristics, and complications of patients who underwent vessel repair using bovine pericardium between February 2012 and December 2020. Univariate analysis was used to compare complication frequencies within several categories. RESULTS There were 36 cases of patch angioplasty using bovine pericardium. The median age was 65 years; 61% of them were men. Of the 36 venous repairs, 31 (86.1%) were from cancer surgery and five (13.9%) were from iatrogenic injury. Patch shape was used in 27 cases (75.0%), while tube shape was used in nine cases (25.0%). The incidence of occlusion and partial thrombus was five (13.9%) and three (8.3%) cases, respectively. Of the nine tube-shaped angioplasties, four (44.4%) required reoperation due to early thrombosis (three cases) and hematoma (one case). CONCLUSION The use of a bovine pericardial patch in the reconstruction of a damaged vein from tumor invasion or iatrogenic injury is feasible. However, the complication rate of vessel patency remains substantial, especially in cases of iatrogenic injury or when a tube-shaped form is used for repair.
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Affiliation(s)
- Jong-Sung Ahn
- Division of Vascular Surgery, Department of Surgery, 58927Seoul National University College of Medicined, Jongno-gu, South Korea
| | - Hyejin Mo
- Department of Surgery, Seoul Metropolitan Government - 58927Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Sanghyun Ahn
- Division of Vascular Surgery, Department of Surgery, 58927Seoul National University College of Medicined, Jongno-gu, South Korea
| | - Ahram Han
- Division of Vascular Surgery, Department of Surgery, 58927Seoul National University College of Medicined, Jongno-gu, South Korea
| | - Sangil Min
- Division of Vascular Surgery, Department of Surgery, 58927Seoul National University College of Medicined, Jongno-gu, South Korea
| | - Seung-Kee Min
- Division of Vascular Surgery, Department of Surgery, 58927Seoul National University College of Medicined, Jongno-gu, South Korea
| | - Jongwon Ha
- Division of Vascular Surgery, Department of Surgery, 58927Seoul National University College of Medicined, Jongno-gu, South Korea.,Transplantation Research Institute, 58927Seoul National University College of Medicine, Seoul, South Korea
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Mechanical reinforcement of amniotic membranes for vesicovaginal fistula repair. J Mech Behav Biomed Mater 2023; 139:105680. [PMID: 36701851 DOI: 10.1016/j.jmbbm.2023.105680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/23/2022] [Accepted: 01/11/2023] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Amniotic membranes (AM) have shown its great potential in reconstructive surgery due to their regenerative capacity. However, AM is regarded to be relatively weak when applied for load-bearing purposes. This study aims to produce an AM-based scaffold that can withstand the mechanical loads applied in vesicovaginal fistula repair. Different strategies are investigated to improve the mechanical characteristics of AM. METHODS Single and multilayered AM, and composite constructs of AM with electrospun poly-4-hydroxybutyrate (P4HB) or bovine pericardial tissue combined with the use of fibrin glue, were mechanically tested in this study. Suture retention strength and mechanical characteristics (tensile stress, elongation, tangent modulus and maximum load) were assessed by uniaxial testing. The effect of degradation of the composite constructs on the mechanical characteristics was determined by uniaxial testing after 4 and 8 weeks. RESULTS Single and multilayered AM could not provide the mechanical requirements needed for surgical implantation (>2N load). AM was combined successfully with electrospun P4HB and bovine pericardium with the use of fibrin glue and were able to exceed the 2N load. CONCLUSION The composite constructs with AM showed sufficient mechanical characteristics for surgical implantation. Electrospun P4HB combined with AM seemed the most promising candidate since the mechanical characteristics of P4HB can be further modified to meet the requirements of the application site and the degradation of the P4HB allows a gradual transfer of load. Eventhough the scaffold is intended for fistula repair, it can potentially be applied in surgical reconstruction of other hollow organs by modifying the mechanical characteristics.
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Sun P, Wu H, Bai X, Zhang L, Zhang C, Wang X, Lou C, Li B, Li Z, Bai H. Decellularized fish swim bladder patch loaded with mesenchymal stem cells inhibits neointimal hyperplasia. J Biomed Mater Res B Appl Biomater 2023; 111:551-559. [PMID: 36200602 DOI: 10.1002/jbm.b.35172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/07/2022] [Accepted: 09/03/2022] [Indexed: 01/21/2023]
Abstract
We previously showed decellularized fish swim bladder can be used as vascular patch and tube graft in rats, mesenchymal stem cells (MSCs) have showed the capability to inhibit neointimal hyperplasia in different animal models. We hypothesized that decellularized fish swim bladder patch loaded with MSCs (bioinspired patch) can inhibit neointimal hyperplasia in a rat aortic patch angioplasty model. Rat MSCs were grown in vitro and flow cytometry was used to confirm their quality. 3.6 × 105 MSCs were mixed into 100 μl of sodium alginate (SA)/hyaluronic acid (HA) hydrogel, two layers of fish swim bladders (5 mm × 5 mm) were sutured together, bioinspired patch was created by injection of hydrogel with MSCs into the space between two layers of fish swim bladder patches. Decellularized rat thoracic aorta patch was used as control. Patches were harvested at days 1 and 14 after implantation. Samples were examined by histology, immunohistochemistry, and immunofluorescence. The decellularized rat thoracic aorta patch and the fish swim bladder patch had a similar healing process after implantation. The bioinspired patch had a similar structure like native aorta. Bioinspired patch showed a decreased neointimal thickness (p = .0053), fewer macrophages infiltration (p = .0090), and lower proliferation rate (p = .0291) compared to the double layers fish swim bladder patch group. Decellularized fish swim bladder patch loaded with MSCs can inhibit neointimal hyperplasia effectively. Although this is a preliminary animal study, it may have a potential application in large animals or clinical research.
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Affiliation(s)
- Peng Sun
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Haoliang Wu
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiche Bai
- Key Vascular Physiology and Applied Research Laboratory of Zhengzhou City, Zhengzhou, China.,The First Zhongyuan Middle School, Zhengzhou, China
| | - Liwei Zhang
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Cong Zhang
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xueyun Wang
- Department of Physiology, Medical School of Zhengzhou University, Zhengzhou, China
| | - Chunyang Lou
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bo Li
- Department of Physiology, Medical School of Zhengzhou University, Zhengzhou, China
| | - Zhuo Li
- Key Vascular Physiology and Applied Research Laboratory of Zhengzhou City, Zhengzhou, China.,Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hualong Bai
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Vascular Physiology and Applied Research Laboratory of Zhengzhou City, Zhengzhou, China
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Shao R, Li J, Wang L, Li X, Shu C. Progress in the application of patch materials in cardiovascular surgery. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2023; 48:285-293. [PMID: 36999476 PMCID: PMC10930349 DOI: 10.11817/j.issn.1672-7347.2023.220560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Indexed: 04/01/2023]
Abstract
The cardiovascular patch, served as artificial graft materials to replace heart or vascular tissue defect, is still playing a key role in cardiovascular surgeries. The defects of traditional cardiovascular patch materials may determine its unsatisfactory long-term effect or fatal complications after surgery. Recent studies on many new materials (such as tissue engineered materials, three-dimensional printed materials, etc) are being developed. Patch materials have been widely used in clinical procedures of cardiovascular surgeries such as angioplasty, cardiac atrioventricular wall or atrioventricular septum repair, and valve replacement. The clinical demand for better cardiovascular patch materials is still urgent. However, the cardiovascular patch materials need to adapt to normal coagulation mechanism and durability, promote short-term endothelialization after surgery, and inhibit long-term postoperative intimal hyperplasia, its research and development process is relatively complicated. Understanding the characteristics of various cardiovascular patch materials and their application in cardiovascular surgeries is important for the selection of new clinical surgical materials and the development of cardiovascular patch materials.
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Affiliation(s)
- Rubing Shao
- Department of Vascular Surgery, Second Xiangya Hospital, Central South University, Changsha 410011.
- Institute of Vascular Diseases, Central South University, Changsha 410011.
| | - Jiehua Li
- Department of Vascular Surgery, Second Xiangya Hospital, Central South University, Changsha 410011
- Institute of Vascular Diseases, Central South University, Changsha 410011
| | - Lunchang Wang
- Department of Vascular Surgery, Second Xiangya Hospital, Central South University, Changsha 410011
- Institute of Vascular Diseases, Central South University, Changsha 410011
| | - Xin Li
- Department of Vascular Surgery, Second Xiangya Hospital, Central South University, Changsha 410011.
- Institute of Vascular Diseases, Central South University, Changsha 410011.
| | - Chang Shu
- Department of Vascular Surgery, Second Xiangya Hospital, Central South University, Changsha 410011.
- Institute of Vascular Diseases, Central South University, Changsha 410011.
- Vascular Surgery Center, Fuwai Hospital, Chinese Academy of Medical Sciences & National Center for Cardiovascular Diseases, Beijing 100037, China.
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10
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Hsu JF, Lentz RB, Ziegler KR, Wong AK. Use of a bovine pericardial patch angioplasty for completion of a complicated end to side anastomosis of a recipient vessel in the free flap reconstruction of a radiated wound: A case report. Microsurgery 2023; 43:161-165. [PMID: 36571830 PMCID: PMC10108141 DOI: 10.1002/micr.31000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 11/13/2022] [Accepted: 12/14/2022] [Indexed: 12/27/2022]
Abstract
Soft tissue sarcomas treated by extensive surgical resection and adjuvant radiation can lead to large tissue deficits that require free flap repair. Significant radiation can further compromise vessels necessitating novel therapeutic approaches. We describe an 82-year-old man who presented with a posterior thigh sarcoma and underwent wide local tumor resection and immediate reconstruction with a microvascular free flap. Due to radiated recipient vessels, this case required bovine patch angioplasty as a conduit for end to side anastomosis. Initial resection and pathology revealed a large myxofibrosarcoma. Wide local resection and radiotherapy resulted in a large irradiated soft tissue defect of 26 x 15 x 4 cm with exposed, radiation damaged neurovascular structures, and a lack of available regional flap options. The planned free flap, a 30 x 8 cm skin island from the left latissimus dorsi muscle with end-to-side anastomosis to the popliteal artery was complicated by friability of the vessel wall and insufficient perfusion. Given the extent of resection and radiation, there were no alternative recipient vessels present within the field. A bovine pericardial patch angioplasty of 2.5 cm in length was performed to the diseased popliteal vessel and an end to side anastomosis was successfully performed between the thoracodorsal artery and the patch. Improved reperfusion of the free flap was noted immediately following anastomosis indicating completion of the anastomosis of our complicated recipient vessel. During the uncomplicated postoperative course, the flap had good perfusion with Doppler signals present, and incision sites intact at discharge from acute hospitalization. Recurrent sarcomas that have undergone extensive resection and radiotherapy pose significant reconstructive challenges. For defects that require free tissue reconstruction when there are limited options for healthy, recipient vessels, bovine pericardial patch angioplasty may act as a robust conduit for diseased vessels.
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Affiliation(s)
- Jerry F Hsu
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, California, USA.,Division of Plastic Surgery, City of Hope National Medical Center, Duarte, California, USA
| | - Rachel B Lentz
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, California, USA.,Division of Plastic Surgery, University of Washington, Seattle, Washington, USA
| | - Kenneth R Ziegler
- Division of Vascular Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Alex K Wong
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, California, USA.,Division of Plastic Surgery, City of Hope National Medical Center, Duarte, California, USA
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11
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Liesker DJ, Gareb B, Looman RS, Zeebregts CJ, Saleem BR. Reply. J Vasc Surg 2023; 77:666-667. [PMID: 36681492 DOI: 10.1016/j.jvs.2022.11.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 11/16/2022] [Indexed: 01/20/2023]
Affiliation(s)
- David J Liesker
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Barzi Gareb
- Department Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rick S Looman
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Clark J Zeebregts
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ben R Saleem
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Liesker DJ, Gareb B, Looman RS, Donners SJA, de Borst GJ, Zeebregts CJ, Saleem BR. Patch angioplasty during carotid endarterectomy using different materials has similar clinical outcomes. J Vasc Surg 2023; 77:559-566.e1. [PMID: 36208708 DOI: 10.1016/j.jvs.2022.09.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patch angioplasty during carotid endarterectomy (CEA) is commonly used to treat carotid artery stenosis. However, the choice of which patch to use remains a matter of debate. Autologous venous material has disadvantages such as wound-related problems at the harvest site and a prolonged intervention time. These limitations can be bypassed when synthetic or biological patches are used. Both materials have been associated with divergent advantages and disadvantages. Therefore, the aim of our study was to compare the long-term follow-up outcomes in patients who underwent CEA and closure with either a bovine pericardial patch (BPP) or polyester patch. METHODS A retrospective cohort study was conducted including all patients who underwent primary CEA and closure with a BPP or a polyester patch between January 2010 and December 2020 at our tertiary referral center. In 2015, the BPP was introduced as an alternative for polyester. The primary outcome was the occurrence of transient ischemic attack (TIA) or cerebrovascular accident (CVA) during follow-up and secondary outcomes included restenosis, reintervention, all-cause mortality, and patch infection. Cox proportional hazard models were used and hazard ratios with 95% confidence intervals were used to predict these outcomes. RESULTS We included 417 CEA patients; 254 patients (61%) received a BPP and 163 received (39%) a polyester patch. The mean age was 70.2 ± 8.7 years and 67% were male. The median follow-up time was 15 months (range, 12-27 months) for BPP and 42 months (range, 16-60 months) for polyester (P < .001). Postoperative hematoma (≤30 days) was significantly lower in the BPP cohort (2% BPP vs 6% polyester; P = .047). No other significant differences on short-term outcomes were found. Univariable Cox regression analyses showed no significant differences between the effect estimates of polyester and BPP on TIA or CVA (P = .106), restenosis (P = .211), reintervention (P = .549), or all-cause mortality (P = .158). No significant differences were found after adjusting for confounders in the multivariable analyses: TIA or CVA (P = .939), restenosis (P = .057), reintervention (P = .193) and all-cause mortality (P = .742). Three patients with a polyester patch had patch infection compared with none of the patients in the group who received a BPP. CONCLUSIONS This large retrospective study showed comparable safety and durability of both BPP and polyester suggesting that both patch types can be safely applied for CEA with patch angioplasty. Patch infection was rare and was absent in the BPP group.
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Affiliation(s)
- David J Liesker
- Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - Barzi Gareb
- Department of Surgery Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Rick S Looman
- Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Simone J A Donners
- Department of Surgery (Division of Vascular Surgery), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gert J de Borst
- Department of Surgery (Division of Vascular Surgery), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Clark J Zeebregts
- Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ben R Saleem
- Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Ordóñez-Chávez GDC, Rodríguez-Fuentes N, Peñaloza-Cuevas R, Cervantes-Uc JM, Alcántara-Quintana LE, Maya-García IA, Herrera-Valencia VA, Mendiburu-Zavala CE. In vitro evaluation of crosslinked bovine pericardium as potential scaffold for the oral cavity. Biomed Mater Eng 2023; 34:561-575. [PMID: 37545206 PMCID: PMC10657658 DOI: 10.3233/bme-230027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/27/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Bovine pericardium (BP) is a scaffold widely used in soft tissues regeneration; however, its calcification in contact with glutaraldehyde, represent an opportunity for its application in hard tissues, such as bone in the oral cavity. OBJECTIVE To develop and to characterize decellularized and glutaraldehyde-crosslinked bovine pericardium (GC-BP) as a potential scaffold for guided bone regeneration GBR. METHODS BP samples from healthy animals of the bovine zebu breed were decellularized and crosslinked by digestion with detergents and glutaraldehyde respectively. The resulting cell-free scaffold was physical, chemical, mechanical, and biologically characterized thought hematoxylin and eosin staining, DNA quantification, scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), thermogravimetric analysis (TGA), differential scanning calorimetry (DSC), uniaxial tensile test, cell viability and live and dead assay in cultures of dental pulp stem cells (DPSCs). RESULTS The decellularization and crosslinking of BP appeared to induce conformational changes of the CLG molecules, which led to lower mechanical properties at the GC-BP scaffold, at the same time that promoted cell adhesion and viability of DPSCs. CONCLUSION This study suggests that the decellularized and GC-BP is a scaffold with the potential to be used promoting DPSCs recruitment, which has a great impact on the dental area.
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Affiliation(s)
| | - Nayeli Rodríguez-Fuentes
- CONACYT-Centro de Investigación Científica de Yucatán, Yucatan, Mexico
- Centro de Investigación Científica de Yucatán, Yucatan, Mexico
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Palmosi T, Tolomeo AM, Cirillo C, Sandrin D, Sciro M, Negrisolo S, Todesco M, Caicci F, Santoro M, Dal Lago E, Marchesan M, Modesti M, Bagno A, Romanato F, Grumati P, Fabozzo A, Gerosa G. Small intestinal submucosa-derived extracellular matrix as a heterotopic scaffold for cardiovascular applications. Front Bioeng Biotechnol 2022; 10:1042434. [PMID: 36578513 PMCID: PMC9792098 DOI: 10.3389/fbioe.2022.1042434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022] Open
Abstract
Structural cardiac lesions are often surgically repaired using prosthetic patches, which can be biological or synthetic. In the current clinical scenario, biological patches derived from the decellularization of a xenogeneic scaffold are gaining more interest as they maintain the natural architecture of the extracellular matrix (ECM) after the removal of the native cells and remnants. Once implanted in the host, these patches can induce tissue regeneration and repair, encouraging angiogenesis, migration, proliferation, and host cell differentiation. Lastly, decellularized xenogeneic patches undergo cell repopulation, thus reducing host immuno-mediated response against the graft and preventing device failure. Porcine small intestinal submucosa (pSIS) showed such properties in alternative clinical scenarios. Specifically, the US FDA approved its use in humans for urogenital procedures such as hernia repair, cystoplasties, ureteral reconstructions, stress incontinence, Peyronie's disease, penile chordee, and even urethral reconstruction for hypospadias and strictures. In addition, it has also been successfully used for skeletal muscle tissue reconstruction in young patients. However, for cardiovascular applications, the results are controversial. In this study, we aimed to validate our decellularization protocol for SIS, which is based on the use of Tergitol 15 S 9, by comparing it to our previous and efficient method (Triton X 100), which is not more available in the market. For both treatments, we evaluated the preservation of the ECM ultrastructure, biomechanical features, biocompatibility, and final bioinductive capabilities. The overall analysis shows that the SIS tissue is macroscopically distinguishable into two regions, one smooth and one wrinkle, equivalent to the ultrastructure and biochemical and proteomic profile. Furthermore, Tergitol 15 S 9 treatment does not modify tissue biomechanics, resulting in comparable to the native one and confirming the superior preservation of the collagen fibers. In summary, the present study showed that the SIS decellularized with Tergitol 15 S 9 guarantees higher performances, compared to the Triton X 100 method, in all the explored fields and for both SIS regions: smooth and wrinkle.
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Affiliation(s)
- Tiziana Palmosi
- Laboratory of Cardiovascular Medicine, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy,L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria (CORIS), Veneto Region Padua, Italy
| | - Anna Maria Tolomeo
- Laboratory of Cardiovascular Medicine, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy,L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria (CORIS), Veneto Region Padua, Italy
| | - Carmine Cirillo
- Telethon Institute of Genetics and Medicine (TIGEM), Pozzuoli, Italy
| | - Debora Sandrin
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria (CORIS), Veneto Region Padua, Italy,Optics and Bioimaging Lab, Department of Physics and Astronomy, Fondazione Istituto di Ricerca Pediatrica Città della Speranza, University of Padova, Padua, Italy
| | | | - Susanna Negrisolo
- Laboratory of Immunopathology and Molecular Biology of the Kidney, Department of Women’s and Children’s Health, University of Padova, Padua, Italy
| | - Martina Todesco
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria (CORIS), Veneto Region Padua, Italy,Department of Industrial Engineering, University of Padova, Padua, Italy
| | | | - Michele Santoro
- Telethon Institute of Genetics and Medicine (TIGEM), Pozzuoli, Italy
| | - Eleonora Dal Lago
- Department of Industrial Engineering, University of Padova, Padua, Italy
| | | | - Michele Modesti
- Department of Industrial Engineering, University of Padova, Padua, Italy
| | - Andrea Bagno
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria (CORIS), Veneto Region Padua, Italy,Department of Industrial Engineering, University of Padova, Padua, Italy
| | - Filippo Romanato
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria (CORIS), Veneto Region Padua, Italy,Department of Physics and Astronomy “G. Galilei”, University of Padova, Padua, Italy
| | - Paolo Grumati
- Telethon Institute of Genetics and Medicine (TIGEM), Pozzuoli, Italy,Department of Clinical Medicine and Surgery, University of Napoli Federico II, Naples, Italy
| | - Assunta Fabozzo
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria (CORIS), Veneto Region Padua, Italy,Cardiac Surgery Unit, Hospital University of Padova, Padua, Italy,*Correspondence: Assunta Fabozzo,
| | - Gino Gerosa
- Laboratory of Cardiovascular Medicine, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy,L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria (CORIS), Veneto Region Padua, Italy,Cardiac Surgery Unit, Hospital University of Padova, Padua, Italy
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Mudigonda J, Onohara D, Amedi A, Suresh KS, Kono T, Corporan D, Padala M. In vivo efficacy of a polymer layered decellularized matrix composite as a cell honing cardiovascular tissue substitute. Mater Today Bio 2022; 17:100451. [DOI: 10.1016/j.mtbio.2022.100451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/22/2022] [Accepted: 10/03/2022] [Indexed: 11/25/2022] Open
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Long-Term Outcomes following Common Femoral Endarterectomy. J Clin Med 2022; 11:jcm11226873. [PMID: 36431350 PMCID: PMC9697575 DOI: 10.3390/jcm11226873] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/08/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022] Open
Abstract
Thromboendarterectomy of the common femoral artery (CFA) for occlusive disease is a crucial procedure in vascular surgery. As an outcome reference for emerging endovascular procedures and new devices, we need more robust evidence of the outcome of this gold standard technique. The purpose of this study was to report 10-year results after femoral endarterectomy (FEA). A retrospective review of medical records at our institution identified eighty consecutive patients (91 limbs) who underwent FEA for CFA lesions. Indications for FEA included 50 limbs (55%) for intermittent claudication (IC) and 39 limbs (43%) with chronic limb-threatening ischemia (CLTI). Two limbs (2%) underwent FEA to prevent hemodynamic steal during extra-anatomical bypass. Adjunctive procedures included endovascular therapy in 32%. CFAs were closed with patch angioplasty in 44%. With a mean follow-up period of 39 months, the survival rates at 3 and 8 years were 85% and 77%, respectively. Limb salvage rates were 92% and 87%. Primary patencies were 98% and 84%. Freedom from target lesion revascularization was 95% at 3 years and 91% at 8 years. Our findings support the durability of FEA, with comparable long-term procedural results in CLTI patients as well as IC patients. Since the FEA is a gate maneuver for hybrid revascularization in CLTI patients, our findings support a strategy combining open and endovascular approaches. Femoral endarterectomy remains a durable solution for common femoral occlusive disease in IC and CLTI in the era of endovascular therapy.
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Shim IK, Kang MS, Lee ES, Choi JH, Lee YN, Koh KH. Decellularized Bovine Pericardial Patch Loaded With Mesenchymal Stromal Cells Enhance the Mechanical Strength and Biological Healing of Large-to-Massive Rotator Cuff Tear in a Rat Model. Arthroscopy 2022; 38:2987-3000. [PMID: 35716989 DOI: 10.1016/j.arthro.2022.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/13/2022] [Accepted: 06/03/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to determine whether the addition of decellularized bovine pericardial patch loaded with mesenchymal stromal cells enhanced bone-to-tendon healing and improved the biomechanical strength of large-to-massive rotator cuff tears in a small animal model. METHODS Adipose-derived mesenchymal stromal cells (MSCs) from rat inguinal fat were isolated, cultured, and loaded onto decellularized bovine pericardium patches. To simulate large-to-massive tears, rats were managed with free cage activity for 6 weeks after tear creation. A total of 18 rats were randomly allocated to repair-only (control), repair with pericardial patch augmentation (patch), or repair with MSC loaded pericardial patch augmentation (patch-MSC). Each group had 6 rats (one shoulder of each rat was used for histological evaluation and another for biomechanical evaluation). MSCs seeded on the pericardial patches were traced on four shoulders from 2 other rats at 4 weeks after surgery. Histological evaluation for bone-to-tendon healing and biomechanical testing was carried out at 8 weeks after repair. RESULTS MSCs tagged with a green fluorescent protein were observed in the repair site 4 weeks after the repair. One shoulder each in the control and patch groups showed complete discontinuity between the bone and tendon. One shoulder in the control group showed attenuation with only a tenuous connection. Fibrocartilage and tidemark formation at the bone-to-tendon interface (P = .002) and collagen fiber density (P = .040) and orientation (P = .003) were better in the patch-MSC group than in the control or patch group. Load-to-failure in the patch-MSC and patch groups was higher than that in the control group (P = .001 and .009, respectively). CONCLUSION Decellularized bovine pericardial patches loaded with adipose-derived and cultured mesenchymal stromal cells enhanced healing in terms of both histology and mechanical strength at 8 weeks following rotator cuff repair in a rat model. CLINICAL RELEVANCE Large-to-massive rotator tears need a strategy to prevent retear and enhance healing. The addition of decellularized bovine pericardial patch loaded with MSCs can enhance bone-to-tendon healing and improve biomechanical healing of large-to-massive rotator cuff tears following repair.
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Affiliation(s)
- In Kyong Shim
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Michael Seungcheol Kang
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eui-Sup Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Hee Choi
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yu Na Lee
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoung Hwan Koh
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Chaschin IS, Sinolits MA, Badun GA, Chernysheva MG, Anuchina NM, Krasheninnikov SV, Khugaev GA, Petlenko AA, Britikov DV, Zubko AV, Kurilov AD, Dreger EI, Bakuleva NP. Chitosan/hyaluronic acid polyanion bilayer applied from carbon acid as an advanced coating with intelligent antimicrobial properties for improved biological prosthetic heart valves. Int J Biol Macromol 2022; 222:2761-2774. [DOI: 10.1016/j.ijbiomac.2022.10.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/30/2022] [Accepted: 10/07/2022] [Indexed: 11/05/2022]
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Suroto NS, Rantam FA, Al Fauzi A, Widiyanti P, Turchan A, Pangaribuan V. Selection criteria for patch angioplasty material in carotid endarterectomy. Surg Neurol Int 2022; 13:362. [PMID: 36128094 PMCID: PMC9479565 DOI: 10.25259/sni_470_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/30/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Carotid endarterectomy (CEA) with patch angioplasty has been favored due to its lower reoccurrence of restenosis compared to primary CEA. There are multiple types of patch angioplasty material available. However, selection of patch material is based on uncertain criteria. The aim of this study is to determine the ideal criteria for selecting the best patch material for CEA.
Methods:
We conducted a comprehensive literature search for studies that describe the ideal criteria for selecting patch material for CEA. We compiled all of the criteria mentioned into one table and selecting the criteria which were most frequently mentioned with a simple scoring system.
Results:
A total of 65 studies out of 784 studies were assessed for its full-text eligibility. Thus, we found 23 studies that were eligible for analysis. There are 22 ideal criteria that were mentioned in the analyzed studies. We grouped these criteria into physical characteristics, safety, contribution to hemodynamic, contribution in tissue healing, economic aspect, and ability to prevent postsurgical complication. We proposed 10 ideal criteria for guiding vascular surgeon in selecting the best patch angioplasty material.
Conclusion:
To this day, no material has been discovered which meets all ten criteria. This study’s proposed ideal criteria serve as the foundation for the creation of the best patch angioplasty material.
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Affiliation(s)
- Nur Setiawan Suroto
- Doctoral Program of Medical Science, Faculty of Medicine, Universitas Airlangga,
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, / Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia,
| | - Fedik Abdul Rantam
- Stem Cell Research and Development Center, Universitas Airlangga,
- Department of Microbiology, Virology and Immunology Laboratory, Faculty of Veterinary Medicine, Universitas Airlangga,
| | - Asra Al Fauzi
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, / Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia,
| | - Prihartini Widiyanti
- Biomedical Engineering Study Program, Department of Physics, Faculty of Science and Technology, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Agus Turchan
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, / Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia,
| | - Vega Pangaribuan
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, / Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia,
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Inflammation-triggered dual release of nitroxide radical and growth factor from heparin mimicking hydrogel-tissue composite as cardiovascular implants for anti-coagulation, endothelialization, anti-inflammation, and anti-calcification. Biomaterials 2022; 289:121761. [DOI: 10.1016/j.biomaterials.2022.121761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/15/2022] [Accepted: 08/21/2022] [Indexed: 11/20/2022]
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21
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Zhang Y, Zhang W, Snow T, Ju Y, Liu Y, Smith AJ, Prabakar S. Minimising Chemical Crosslinking for Stabilising Collagen in Acellular Bovine Pericardium: Mechanistic Insights via Structural Characterisations. Acta Biomater 2022; 152:113-123. [DOI: 10.1016/j.actbio.2022.08.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/10/2022] [Accepted: 08/24/2022] [Indexed: 11/01/2022]
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22
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Nguyen MTN, Tran HLB. In-Vitro Endothelialization Assessment of Heparinized Bovine Pericardial Scaffold for Cardiovascular Application. Polymers (Basel) 2022; 14:polym14112156. [PMID: 35683829 PMCID: PMC9182580 DOI: 10.3390/polym14112156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Hemocompatibility is a critical challenge for tissue-derived biomaterial when directly contacting the bloodstream. In addition to surface modification with heparin, endothelialization of the grafted material is suggested to improve long-term clinical efficacy. This study aimed to evaluate the ability to endothelialize in vitro of heparinized bovine pericardial scaffolds. (2) Methods: bovine pericardial scaffolds were fabricated and heparinized using a layer-by-layer assembly technique. The heparinized scaffolds were characterized for heparin content, surface morphology, and blood compatibility. Liquid extraction of the samples was prepared for cytotoxicity testing on human endothelial cells. The in-vitro endothelialization was determined via human endothelial cell attachment and proliferation on the scaffold. (3) Results: The heparinized bovine pericardial scaffold exhibited a heparin coating within its microfiber network. The scaffold surface immobilized with heparin performed good anti-thrombosis and prevented platelet adherence. The proper cytotoxicity impact was observed for a freshly used heparinized sample. After 24 h washing in PBS 1X, the cell compatibility of the heparinized scaffolds was improved. In-vitro examination results exhibited human endothelial cell attachment and proliferation for 7 days of culture. (4) Conclusions: Our in-vitro analysis provided evidence for the scaffold's ability to support endothelialization, which benefits long-term thromboresistance.
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Affiliation(s)
- My Thi Ngoc Nguyen
- Laboratory of Tissue Engineering and Biomedical Materials, University of Science, Ho Chi Minh City 700000, Vietnam;
- Department of Physiology and Animal Biotechnology, Faculty of Biology—Biotechnology, University of Science, Ho Chi Minh City 700000, Vietnam
- Vietnam National University, Ho Chi Minh City 700000, Vietnam
| | - Ha Le Bao Tran
- Laboratory of Tissue Engineering and Biomedical Materials, University of Science, Ho Chi Minh City 700000, Vietnam;
- Department of Physiology and Animal Biotechnology, Faculty of Biology—Biotechnology, University of Science, Ho Chi Minh City 700000, Vietnam
- Vietnam National University, Ho Chi Minh City 700000, Vietnam
- Correspondence:
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Mudigonda J, Xu D, Amedi A, Lane BA, Corporan D, Wang V, Padala M. A Biohybrid Material With Extracellular Matrix Core and Polymeric Coating as a Cell Honing Cardiovascular Tissue Substitute. Front Cardiovasc Med 2022; 9:807255. [PMID: 35402573 PMCID: PMC8987446 DOI: 10.3389/fcvm.2022.807255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/20/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo investigate the feasibility of a hybrid material in which decellularized pericardial extracellular matrix is functionalized with polymeric nanofibers, for use as a cardiovascular tissue substitute.BackgroundA cardiovascular tissue substitute, which is gradually resorbed and is replaced by host's native tissue, has several advantages. Especially in children and young adults, a resorbable material can be useful in accommodating growth, but also enable rapid endothelialization that is necessary to avoid thrombotic complications. In this study, we report a hybrid material, wherein decellularized pericardial matrix is functionalized with a layer of polymeric nanofibers, to achieve the mechanical strength for implantation in the cardiovascular system, but also have enhanced cell honing capacity.MethodsPericardial sacs were decellularized with sodium deoxycholate, and polycaprolactone-chitosan fibers were electrospun onto the matrix. Tissue-polymer interaction was evaluated using spectroscopic methods, and the mechanical properties of the individual components and the hybrid material were quantified. In-vitro blood flow loop studies were conducted to assess hemocompatibility and cell culture methods were used to assess biocompatibility.ResultsEncapsulation of the decellularized matrix with 70 μm thick matrix of polycaprolactone-chitosan nanofibers, was feasible and reproducible. Spectroscopy of the cross-section depicted new amide bond formation and C–O–C stretch at the interface. An average peel strength of 56.13 ± 11.87 mN/mm2 was measured, that is sufficient to withstand a high shear of 15 dynes/cm2 without delamination. Mechanical strength and extensibility ratio of the decellularized matrix alone were 18,000 ± 4,200 KPa and 0.18 ± 0.03% whereas that of the hybrid was higher at 20,000 ± 6,600 KPa and 0.35 ± 0.20%. Anisotropy index and stiffness of the biohybrid were increased as well. Neither thrombus formation, nor platelet adhesion or hemolysis was measured in the in-vitro blood flow loop studies. Cellular adhesion and survival were adequate in the material.ConclusionEncapsulating a decellularized matrix with a polymeric nanofiber coating, has favorable attributes for use as a cardiovascular tissue substitute.
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Affiliation(s)
- Jahnavi Mudigonda
- Structural Heart Research & Innovation Laboratory, Carlyle Fraser Heart Center, Emory University Hospital Midtown, Atlanta, GA, United States
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Dongyang Xu
- Structural Heart Research & Innovation Laboratory, Carlyle Fraser Heart Center, Emory University Hospital Midtown, Atlanta, GA, United States
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Alan Amedi
- Structural Heart Research & Innovation Laboratory, Carlyle Fraser Heart Center, Emory University Hospital Midtown, Atlanta, GA, United States
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Brooks A. Lane
- Structural Heart Research & Innovation Laboratory, Carlyle Fraser Heart Center, Emory University Hospital Midtown, Atlanta, GA, United States
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Daniella Corporan
- Structural Heart Research & Innovation Laboratory, Carlyle Fraser Heart Center, Emory University Hospital Midtown, Atlanta, GA, United States
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Vivian Wang
- Structural Heart Research & Innovation Laboratory, Carlyle Fraser Heart Center, Emory University Hospital Midtown, Atlanta, GA, United States
| | - Muralidhar Padala
- Structural Heart Research & Innovation Laboratory, Carlyle Fraser Heart Center, Emory University Hospital Midtown, Atlanta, GA, United States
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States
- *Correspondence: Muralidhar Padala
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Vascular Remodeling of Clinically Used Patches and Decellularized Pericardial Matrices Recellularized with Autologous or Allogeneic Cells in a Porcine Carotid Artery Model. Int J Mol Sci 2022; 23:ijms23063310. [PMID: 35328732 PMCID: PMC8954945 DOI: 10.3390/ijms23063310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/04/2022] [Accepted: 03/12/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Cardiovascular surgery is confronted by a lack of suitable materials for patch repair. Acellular animal tissues serve as an abundant source of promising biomaterials. The aim of our study was to explore the bio-integration of decellularized or recellularized pericardial matrices in vivo. Methods: Porcine (allograft) and ovine (heterograft, xenograft) pericardia were decellularized using 1% sodium dodecyl sulfate ((1) Allo-decel and (2) Xeno-decel). We used two cell types for pressure-stimulated recellularization in a bioreactor: autologous adipose tissue-derived stromal cells (ASCs) isolated from subcutaneous fat of pigs ((3) Allo-ASC and (4) Xeno-ASC) and allogeneic Wharton’s jelly mesenchymal stem cells (WJCs) ((5) Allo-WJC and (6) Xeno-WJC). These six experimental patches were implanted in porcine carotid arteries for one month. For comparison, we also implanted six types of control patches, namely, arterial or venous autografts, expanded polytetrafluoroethylene (ePTFE Propaten® Gore®), polyethylene terephthalate (PET Vascutek®), chemically stabilized bovine pericardium (XenoSure®), and detoxified porcine pericardium (BioIntegral® NoReact®). The grafts were evaluated through the use of flowmetry, angiography, and histological examination. Results: All grafts were well-integrated and patent with no signs of thrombosis, stenosis, or aneurysm. A histological analysis revealed that the arterial autograft resembled a native artery. All other control and experimental patches developed neo-adventitial inflammation (NAI) and neo-intimal hyperplasia (NIH), and the endothelial lining was present. NAI and NIH were most prominent on XenoSure® and Xeno-decel and least prominent on NoReact®. In xenografts, the degree of NIH developed in the following order: Xeno-decel > Xeno-ASC > Xeno-WJC. NAI and patch resorption increased in Allo-ASC and Xeno-ASC and decreased in Allo-WJC and Xeno-WJC. Conclusions: In our setting, pre-implant seeding with ASC or WJC had a modest impact on vascular patch remodeling. However, ASC increased the neo-adventitial inflammatory reaction and patch resorption, suggesting accelerated remodeling. WJC mitigated this response, as well as neo-intimal hyperplasia on xenografts, suggesting immunomodulatory properties.
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EDITORIAL COMMENT. Urology 2021; 158:242. [PMID: 34895630 DOI: 10.1016/j.urology.2021.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/14/2021] [Indexed: 11/23/2022]
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Fodor M, Fodor L, Bota O. The role of nanomaterials and nanostructured surfaces for improvement of biomaterial peculiarities in vascular surgery: a review. PARTICULATE SCIENCE AND TECHNOLOGY 2021. [DOI: 10.1080/02726351.2021.1871692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Marius Fodor
- Department of Vascular Surgery, First Surgical Clinic, Emergency District Hospital, Cluj-Napoca, Romania, Cluj-Napoca, Romania
| | - Lucian Fodor
- Department of Plastic Surgery, First Surgical Clinic, Emergency District Hospital, Cluj-Napoca, Romania, Cluj-Napoca, Romania
| | - Olimpiu Bota
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
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Bai H, Wei S, Sun P, Zhang L, Liu Y, Qiao Z, Wang W, Xie B, Zhang C, Li Z. Biomimetic Elastin Fiber Patch in Rat Aorta Angioplasty. ACS OMEGA 2021; 6:26715-26721. [PMID: 34661025 PMCID: PMC8515827 DOI: 10.1021/acsomega.1c04170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/14/2021] [Indexed: 05/07/2023]
Abstract
Introduction: Vascular grafts significantly contribute to advances in vascular surgery, but none of the currently available prosthetic grafts have elastin fibers similar to native arteries. We hypothesized that a novel elastin patch could be produced after a rat decellularized thoracic aorta elastin fiber scaffold is implanted subcutaneously in rats; we tested this novel elastin patch in a rat aortic arterioplasty model. Methods: Sprague-Dawley rats (200 g) were used. Rat thoracic aortae were decellularized and sectioned at a thickness of 30 μm. A single elastin fiber scaffold was fabricated as a net (5 × 5 mm2), and then a three-layer scaffold was constructed to make a new patch. The hyaluronic acid-sodium alginate (HA/SA) hydrogel was fabricated by reacting sodium SA, HA, and CaCO3, and then the hydrogel was added to the patch to secure the elastin fibers. The patches were implanted subcutaneously in rats and harvested at day 14. The elastin patches were then implanted into the same rat's aorta and harvested at day 14; a decellularized rat thoracic aorta (TA) patch was used as a control. Sections of the retrieved patches were stained by immunohistochemistry and immunofluorescence. Results: The elastin fibers could be secured by the hydrogel. After 14 days, the subcutaneously implanted elastin patch was incorporated into the rat tissue, and H&E staining showed that new tissue had formed around the elastin patch with almost no hydrogel left. After implantation into the rat aorta and then retrieval on day 14, H&E staining showed that there was neointima and adventitia formation in both the TA and elastin patch groups. Both patches showed a similar histological structure after implantation, and immunofluorescence showed that there were CD34- and nestin-positive cells in the neointima. In both groups, the endothelial cells expressed the arterial identity markers Ephrin-B2 and dll-4; almost one-third of the cells in the neointima were PCNA-positive with rare cleaved caspase-3-positive cells. Conclusion: We demonstrated a novel approach to making elastin fiber scaffold hydrogel patches (elastin patches) and tested them in a rat aorta arterioplasty model. This patch showed a similar healing process as the decellularized TA patch; it also showed potential applications in large animals and may be a substitute for prosthetic grafts in vascular surgery.
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Affiliation(s)
- Hualong Bai
- Department
of Vascular and Endovascular Surgery, First
Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China
- Key
Vascular Physiology and Applied Research Laboratory of Zhengzhou City, Zhengzhou, Henan 450001, China
- or . Tel: +86 18838151596
| | - Shunbo Wei
- Department
of Vascular and Endovascular Surgery, First
Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Peng Sun
- Department
of Vascular and Endovascular Surgery, First
Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Liwei Zhang
- Department
of Vascular and Endovascular Surgery, First
Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Yuanfeng Liu
- Department
of Vascular and Endovascular Surgery, First
Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Zhentao Qiao
- Department
of Vascular and Endovascular Surgery, First
Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Wang Wang
- Key
Vascular Physiology and Applied Research Laboratory of Zhengzhou City, Zhengzhou, Henan 450001, China
- Department
of Physiology, Medical School of Zhengzhou
University, Zhengzhou, Henan 450001, China
| | - Boao Xie
- Department
of Vascular and Endovascular Surgery, First
Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Cong Zhang
- Department
of Vascular and Endovascular Surgery, First
Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Zhuo Li
- Key
Vascular Physiology and Applied Research Laboratory of Zhengzhou City, Zhengzhou, Henan 450001, China
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Over 400 Uses of An Intestinal Submucosal Extracellular Matrix Patch in a Congenital Heart Program. Ann Thorac Surg 2021; 114:1475-1483. [PMID: 34375649 DOI: 10.1016/j.athoracsur.2021.06.087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/04/2021] [Accepted: 06/28/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Repair of complex congenital heart disease frequently requires usage of a patch as an anatomical substitute. The study's aim is to evaluate the use, effectiveness and safety of utilizing small intestine submucosa extracellular matrix (SIS-ECM) patches in a congenital cardiac surgery program. METHODS This is a single-center, retrospective, cohort study of surgeries utilizing SIS-ECM between 2012-2019. The SIS-ECM data was categorized by usage and type (4-ply and 2-ply). All re-interventions/complications were reviewed by an independent surgeon, a practicing congenital heart surgeon and a pediatric cardiologist. RESULTS 408 SIS-ECM patches were used in 309 patients (M/F=188/121; median age 8.5months). The usage consisted of 314 (77%) arterioplasties, 22 (5.4%) venoplasties, 63 (15.4%) intracardiac repairs, and 9 (2.2%) valve repairs. The most common usage was pulmonary artery repair (n=181; 44.4%). Median follow-up time was 3.9 years (range: 3days-7.4years). Ten (2.5%) patches required surgical (2 in first 30-days and 5 in 1st year) and 27 (6.6%) required percutaneous re-interventions (2 in first 30-days and 22 in 1st year). Between 4-ply (n=376) and 2-ply (n=32) SIS-ECM, rate of surgical (2.1% (n=8) vs 6.3% (n=2); p=0.18) or percutaneous re-interventions (6.4% (n=24) vs 9.4% (n=3); p=0.46) was not different. There were no deaths related to the SIS-ECM patch or reports of calcification. CONCLUSIONS SIS-ECM is a viable patch option that can be used in various cardiac and vascular reconstructive surgeries with low risk of failure and calcification. Long-term, positive outcomes may be maximized by consistent techniques and understanding appropriate applications of the patch.
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Stöwe I, Pissarek J, Moosmann P, Pröhl A, Pantermehl S, Bielenstein J, Radenkovic M, Jung O, Najman S, Alkildani S, Barbeck M. Ex Vivo and In Vivo Analysis of a Novel Porcine Aortic Patch for Vascular Reconstruction. Int J Mol Sci 2021; 22:7623. [PMID: 34299243 PMCID: PMC8303394 DOI: 10.3390/ijms22147623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/25/2021] [Accepted: 07/13/2021] [Indexed: 01/12/2023] Open
Abstract
(1) Background: The aim of the present study was the biocompatibility analysis of a novel xenogeneic vascular graft material (PAP) based on native collagen won from porcine aorta using the subcutaneous implantation model up to 120 days post implantationem. As a control, an already commercially available collagen-based vessel graft (XenoSure®) based on bovine pericardium was used. Another focus was to analyze the (ultra-) structure and the purification effort. (2) Methods: Established methodologies such as the histological material analysis and the conduct of the subcutaneous implantation model in Wistar rats were applied. Moreover, established methods combining histological, immunohistochemical, and histomorphometrical procedures were applied to analyze the tissue reactions to the vessel graft materials, including the induction of pro- and anti-inflammatory macrophages to test the immune response. (3) Results: The results showed that the PAP implants induced a special cellular infiltration and host tissue integration based on its three different parts based on the different layers of the donor tissue. Thereby, these material parts induced a vascularization pattern that branches to all parts of the graft and altogether a balanced immune tissue reaction in contrast to the control material. (4) Conclusions: PAP implants seemed to be advantageous in many aspects: (i) cellular infiltration and host tissue integration, (ii) vascularization pattern that branches to all parts of the graft, and (iii) balanced immune tissue reaction that can result in less scar tissue and enhanced integrative healing patterns. Moreover, the unique trans-implant vascularization can provide unprecedented anti-infection properties that can avoid material-related bacterial infections.
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Affiliation(s)
- Ignacio Stöwe
- Helios Clinic Emil-von-Behring, Department of Vascular and Endovascular Surgery, 14165 Berlin, Germany;
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, 18057 Rostock, Germany; (S.P.); (J.B.); (O.J.)
| | - Jens Pissarek
- biotrics bioimplants AG, 12109 Berlin, Germany; (J.P.); (P.M.)
| | - Pia Moosmann
- biotrics bioimplants AG, 12109 Berlin, Germany; (J.P.); (P.M.)
| | - Annica Pröhl
- BerlinAnalytix GmbH, 12109 Berlin, Germany; (A.P.); (S.A.)
| | - Sven Pantermehl
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, 18057 Rostock, Germany; (S.P.); (J.B.); (O.J.)
| | - James Bielenstein
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, 18057 Rostock, Germany; (S.P.); (J.B.); (O.J.)
| | - Milena Radenkovic
- Scientific Research Center for Biomedicine, Department for Cell and Tissue Engineering, Faculty of Medicine, University of Niš, 18000 Niš, Serbia; (M.R.); (S.N.)
| | - Ole Jung
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, 18057 Rostock, Germany; (S.P.); (J.B.); (O.J.)
| | - Stevo Najman
- Scientific Research Center for Biomedicine, Department for Cell and Tissue Engineering, Faculty of Medicine, University of Niš, 18000 Niš, Serbia; (M.R.); (S.N.)
- Department of Biology and Human Genetics, Faculty of Medicine, University of Niš, 18000 Niš, Serbia
| | - Said Alkildani
- BerlinAnalytix GmbH, 12109 Berlin, Germany; (A.P.); (S.A.)
| | - Mike Barbeck
- Department of Ceramic Materials, Chair of Advanced Ceramic Materials, Institute for Materials Science and Technologies, Technical University Berlin, 10623 Berlin, Germany
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Xing Q, Parvizi M, Lopera Higuita M, Griffiths LG. Basement membrane proteins modulate cell migration on bovine pericardium extracellular matrix scaffold. Sci Rep 2021; 11:4607. [PMID: 33633241 PMCID: PMC7907089 DOI: 10.1038/s41598-021-84161-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 02/12/2021] [Indexed: 01/22/2023] Open
Abstract
Native bovine pericardium (BP) exhibits anisotropy of its surface ECM niches, with the serous surface (i.e., parietal pericardium) containing basement membrane components (e.g., Laminin, Col IV) and the fibrous surface (i.e., mediastinal side) being composed primarily of type I collagen (Col I). Native BP surface ECM niche anisotropy is preserved in antigen removed BP (AR-BP) extracellular matrix (ECM) scaffolds. By exploiting sideness (serous or fibrous surface) of AR-BP scaffolds, this study aims to determine the mechanism by which ECM niche influences human mesenchymal stem cells (hMSCs) migration. Human mesenchymal stem cells (hMSC) seeding on serous surface promoted more rapid cell migration than fibrous surface seeding. Gene analysis revealed that expression of integrin α3 and α11 were increased in cells cultured on serous surface compared to those on the fibrous side. Monoclonal antibody blockade of α3β1 (i.e., laminin binding) inhibited early (i.e. ≤ 6 h) hMSC migration following serous seeding, while having no effect on migration of cells on the fibrous side. Blockade of α3β1 resulted in decreased expression of integrin α3 by cells on serous surface. Monoclonal antibody blockade of α11β1 (i.e., Col IV binding) inhibited serous side migration at later time points (i.e., 6-24 h). These results confirmed the role of integrin α3β1 binding to laminin in mediating early rapid hMSCs migration and α11β1 binding to Col IV in mediating later hMSCs migration on the serous side of AR-BP, which has critical implications for rate of cellular monolayer formation and use of AR-BP as blood contacting material for clinical applications.
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Affiliation(s)
- Qi Xing
- Department of Cardiovascular Diseases, Mayo Clinic, Stabile 4-58, 200 First Street, Rochester, MN, 55905, USA
| | - Mojtaba Parvizi
- Department of Cardiovascular Diseases, Mayo Clinic, Stabile 4-58, 200 First Street, Rochester, MN, 55905, USA
| | - Manuela Lopera Higuita
- Department of Cardiovascular Diseases, Mayo Clinic, Stabile 4-58, 200 First Street, Rochester, MN, 55905, USA
| | - Leigh G Griffiths
- Department of Cardiovascular Diseases, Mayo Clinic, Stabile 4-58, 200 First Street, Rochester, MN, 55905, USA.
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Shaik TA, Lagarto JL, Baria E, Goktas M, Onoja PI, Blank KG, Pavone FS, Popp J, Krafft C, Cicchi R. Monitoring Changes in Biochemical and Biomechanical Properties of Collagenous Tissues Using Label-Free and Nondestructive Optical Imaging Techniques. Anal Chem 2021; 93:3813-3821. [PMID: 33596051 DOI: 10.1021/acs.analchem.0c04306] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We demonstrate the ability of nondestructive optical imaging techniques such as second-harmonic generation (SHG), two-photon fluorescence (TPF), fluorescence lifetime imaging (FLIM), and Raman spectroscopy (RS) to monitor biochemical and mechanical alterations in tissues upon collagen degradation. Decellularized equine pericardium (EP) was treated with 50 μg/mL bacterial collagenase at 37 °C for 8, 16, 24, and 32 h. The SHG ratio (defined as the normalized ratio between SHG and TPF signals) remained unchanged for untreated EP (stored in phosphate-buffered solution (PBS)), whereas treated EP showed a trend of a decreasing SHG ratio with increasing collagen degradation. In the fluorescence domain, treated EP experienced a red-shifted emission and the fluorescence lifetime had a trend of decreasing lifetime with increasing collagen digestion. RS monitors collagen degradation, the spectra had less intense Raman bands at 814, 852, 938, 1242, and 1270 cm-1. Non-negative least-squares (NNLS) modeling quantifies collagen loss and relative increase of elastin. The Young's modulus, derived from atomic force microscope-based nanoindentation experiments, showed a rapid decrease within the first 8 h of collagen degradation, whereas more gradual changes were observed for optical modalities. We conclude that optical imaging techniques like SHG, RS, and FLIM can monitor collagen degradation in a label-free manner and coarsely access mechanical properties in a nondestructive manner.
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Affiliation(s)
- Tanveer Ahmed Shaik
- Leibniz Institute of Photonic Technology, Albert-Einstein-Strasse 9, 07745 Jena, Germany
| | - João L Lagarto
- National Institute of Optics (INO), National Research Council (CNR), Largo E. Fermi 6, 50125 Florence, Italy.,European Laboratory for Non-Linear Spectroscopy (LENS), University of Florence, Via Nello Carrara 1, 50019 Sesto Fiorentino, Italy
| | - Enrico Baria
- National Institute of Optics (INO), National Research Council (CNR), Largo E. Fermi 6, 50125 Florence, Italy.,European Laboratory for Non-Linear Spectroscopy (LENS), University of Florence, Via Nello Carrara 1, 50019 Sesto Fiorentino, Italy
| | - Melis Goktas
- Mechano(bio)chemistry, Max Planck Institute of Colloids and Interfaces, Am Mühlenberg 1, 14476 Potsdam, Germany
| | - Patrick Igoche Onoja
- Leibniz Institute of Photonic Technology, Albert-Einstein-Strasse 9, 07745 Jena, Germany
| | - Kerstin G Blank
- Mechano(bio)chemistry, Max Planck Institute of Colloids and Interfaces, Am Mühlenberg 1, 14476 Potsdam, Germany
| | - Francesco S Pavone
- National Institute of Optics (INO), National Research Council (CNR), Largo E. Fermi 6, 50125 Florence, Italy.,European Laboratory for Non-Linear Spectroscopy (LENS), University of Florence, Via Nello Carrara 1, 50019 Sesto Fiorentino, Italy
| | - Jürgen Popp
- Leibniz Institute of Photonic Technology, Albert-Einstein-Strasse 9, 07745 Jena, Germany.,Institute of Physical Chemistry, Friedrich Schiller University, Helmholtzweg 4, 07743 Jena, Germany.,Abbe Center of Photonics, Friedrich Schiller University, Albert-Einstein-Strasse 6, 07745 Jena, Germany
| | - Christoph Krafft
- Leibniz Institute of Photonic Technology, Albert-Einstein-Strasse 9, 07745 Jena, Germany
| | - Riccardo Cicchi
- National Institute of Optics (INO), National Research Council (CNR), Largo E. Fermi 6, 50125 Florence, Italy.,European Laboratory for Non-Linear Spectroscopy (LENS), University of Florence, Via Nello Carrara 1, 50019 Sesto Fiorentino, Italy
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Chakraborty B, Wang H. Pathological Changes of Adult Mitral Valves after Failed CorMatrix ECM Repair. JOURNAL OF CLINICAL AND TRANSLATIONAL PATHOLOGY 2021; 1:9-15. [PMID: 34957472 PMCID: PMC8697744 DOI: 10.14218/jctp.2021.00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES CorMatrix acts as a tissue scaffold and is intended to promote the proliferation of small vessels and tissue remodeling to replicate normal tissue function. METHODS At Temple University Hospital, Philadelphia, PA, USA from 2013 to 2016, CorMatrix material was utilized during mitral valve anterior leaflet augmentation repair in 25 adult patients, and four patients required repeat interventions at 4-12 months (8.25 ± 4.35 months) after the initial repair. This study evaluated the pathological changes in four patients. RESULTS Histological examination of the CorMatrix showed matrix degradation in all cases. At 4 months after repair, mixed acute and chronic inflammatory cells that included eosinophils were visible within the matrix, which was more severe around the suture material. Later, the extent of inflammation abated and became more chronic with macrophage dominance. Some macrophages and multinucleated cells were visible deep in the matrix. The neovascularization was limited to the tissue-matrix boundary at early time points; the more mature vessels with dilated lumens extended deeper into the matrix as time increased, combined with some elongated fibroblast-like cells. In addition, marked acute and chronic inflammation with neutrophil and eosinophil infiltrate was identified in the surrounding native tissue at 4 months, especially around the suture material. Marked granulomatous inflammation was identified in all cases, with prominent multinucleated giant cells present at later time points (50%). Immunohistochemical staining for CD68 and CD163 showed prominent M2 macrophages in the CorMatrix and surrounding tissue. CONCLUSIONS Our results demonstrated time-dependent changes in failed CorMatrix repaired valves after mitral valve repair, with macrophages and neovascularization in the matrix 12 months after the initial repair.
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Affiliation(s)
- Baidarbhi Chakraborty
- Department of Pathology and Laboratory Medicine, Temple University Hospital, Philadelphia, PA, USA
| | - He Wang
- Department of Pathology, Yale University School of Medicine, 310 Cedar Street, New Haven, CT, USA
- Correspondence to: He Wang, Department of Pathology, Yale University School of Medicine, 310 Cedar Street, New Haven, CT 06520, USA. Tel: +1-203-789-3707, Fax: +1-203-789-3710,
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Xie H, Pather S, Yeo D, Mylvaganam G, Venclovas R, Anderson L. Precaval recurrent endometrial cancer treated with en-bloc resection of the inferior vena cava and reconstruction using bovine pericardium. A case report and review of the literature. Gynecol Oncol Rep 2020; 34:100679. [PMID: 33304980 PMCID: PMC7718161 DOI: 10.1016/j.gore.2020.100679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/16/2020] [Accepted: 11/21/2020] [Indexed: 12/03/2022] Open
Abstract
Bovine pericardium for IVC reconstruction has significant advantages comparing to vascular ligation, autogenous or PTFE grafts. En-bloc resection of metastatic precaval lymph nodes and reconstruction of the IVC is feasible. Recurrence of endometrial cancer at para-aortic lymph nodes is good candidate for secondary cytoreduction with MDT approach.
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Affiliation(s)
- Huan Xie
- Sydney Gynaecologic Oncology Group, Chris O Brien Lifehouse Comprehensive Cancer Centre and Royal Prince Alfred Hospital, Camperdown, Sydney, Australia
| | - Selvan Pather
- Sydney Gynaecologic Oncology Group, Chris O Brien Lifehouse Comprehensive Cancer Centre and Royal Prince Alfred Hospital, Camperdown, Sydney, Australia.,The University of Sydney School of Medicine, Sydney, Australia
| | - David Yeo
- Department of Upper Gastrointestinal Surgery, Chris O Brien Lifehouse Comprehensive Cancer Centre and Royal Prince Alfred Hospital, Camperdown, Sydney, Australia
| | - Gaithri Mylvaganam
- Sydney Gynaecologic Oncology Group, Chris O Brien Lifehouse Comprehensive Cancer Centre and Royal Prince Alfred Hospital, Camperdown, Sydney, Australia
| | - Rasa Venclovas
- Department of Anaesthesiology, Chris O Brien Lifehouse Comprehensive Cancer Centre and Royal Prince Alfred Hospital, Camperdown, Sydney, Australia
| | - Lyndal Anderson
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia.,The University of Sydney School of Medicine, Sydney, Australia
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Sowa P, Soult M, Blecha M. Community Hospital Experience With Bovine Tissue in Infected Vascular Fields. Am Surg 2020; 87:732-736. [PMID: 33169620 DOI: 10.1177/0003134820952819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Vascular prosthetic graft infections are rare but associated with high morbidity and mortality. Treatment involves removal of the infected graft requiring arteriotomy closure. Previously this was performed with autologous graft, but bovine tissue has increasingly been used. The objective of this paper is to review the community hospital experience with bovine tissue repair in an infected vascular field. MATERIALS AND METHODS A retrospective review of all cases performed by a single surgeon in a community hospital for infected prosthetic grafts was completed. Sixteen cases were included where bovine tissue was used for repair. Presentation, location of graft, and causative organism were reviewed, and outcomes including reoperation and mortality were recorded. RESULTS Of the 16 patients, 15 (94%) had positive cultures of the graft. Methicillin-Resistant Staph Aureus was the most commonly isolated organism (50%). There were 3 unplanned reoperations including a revision from below to above knee amputation, drainage of a hematoma, and a wound debridement within the first year. Over the 1 year follow up period, 3 patients died for a mortality of 19%. There were no reinfections during follow-up. DISCUSSION Prosthetic graft infection is a rare but serious vascular surgery complication. The causative organism has shifted in the last few years to become increasingly drug resistant. Treatment requires excision, and bovine tissue has been demonstrated to provide a safe and durable method of repair.
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Affiliation(s)
- Patrick Sowa
- Department of Surgery, St. Joseph Hospital, Chicago, IL, USA
| | - Michael Soult
- Division of Vascular Surgery and Endovascular Therapy, Loyola University Chicago, IL, USA
| | - Matthew Blecha
- Division of Vascular Surgery and Endovascular Therapy, Loyola University Chicago, IL, USA
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35
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Gavardinas ID, Spyrou LA, Zervaki A, Spanos K, Giannoukas AD, Giannakopoulos AE. Fatigue of textiles used in vascular surgery: Application to carotid endarterectomy. J Mech Behav Biomed Mater 2020; 113:104121. [PMID: 33186812 DOI: 10.1016/j.jmbbm.2020.104121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 09/05/2020] [Accepted: 09/28/2020] [Indexed: 11/24/2022]
Abstract
Fatigue is a material-based phenomenon playing a significant role in the mechanical behavior of components and structures. Although fatigue has been well studied for traditional materials, such as metals, its underlying mechanisms are not thoroughly understood in novel applications such as the case of textiles used as patches to close the arteriotomy in carotid endarterectomy. The latter is a type of vascular surgery for the treatment of carotid artery disease in which after an arteriotomy and removal of atherosclerotic plaque closure is made with a patch sutured on the artery. Completion of the operation signals the initiation of complex mechanical and hemodynamic phenomena. Fatigue performance of the patch eventually determines the successful outcome of carotid endarterectomy. In this study, we evaluate with a two-fold approach the mechanics of patch angioplasty in carotid endarterectomy. First, an analytical model for the fatigue behavior of textiles is developed, considering the microstructure and geometry of the fabric. Then, the surgical procedure is simulated and a finite element analysis of the endarterectomized and patched carotid artery is employed. Stress fields are calculated, while deformation at the site of patch angioplasty indicates a potential cause for the formation of aneurismal degeneration after the surgery. Such analysis can provide a better understanding in the establishment of follow-up protocols.
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Affiliation(s)
- I D Gavardinas
- Laboratory for Strength of Materials and Micromechanics, Department of Civil Engineering, University of Thessaly, Volos, Greece.
| | - L A Spyrou
- Biomechanics Group, Institute for Bio-Economy and Agri-Technology, Centre for Research & Technology Hellas (CERTH), Volos, Greece.
| | - A Zervaki
- Laboratory of Materials, Department of Mechanical Engineering, University of Thessaly, Volos, Greece.
| | - K Spanos
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
| | - A D Giannoukas
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
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Laker L, Dohmen PM, Smit FE. The sequential effects of a multifactorial detergent based decellularization process on bovine pericardium. Biomed Phys Eng Express 2020; 6. [PMID: 35066494 DOI: 10.1088/2057-1976/abb5e9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/07/2020] [Indexed: 11/12/2022]
Abstract
Decellularization is a promising method for obtaining extracellular matrix scaffolds (ECM) to be used as replacement material in reconstructive procedures. The effectiveness of decellularization and the alterations to the ECM vary, depending on several factors, including the tissue source, composition and density. With an optimized decellularization process, decellularized scaffolds can preserve the spatial and temporal ECM microenvironment, which play an integral role in modulating cell migration, proliferation and differentiation. The exploration of a variety of decellularization protocols has led to mixed outcomes and comparisons between decellularization protocols could not attribute these differences to any single step in a multiple-step process. This study aimed to characterize the effects of each step of a multifactorial decellularization method on the scaffold structure and mechanical integrity of bovine pericardium. Each step of the decellularization process and the effect on the tissue was assessed using hematoxylin and eosin staining, electron microscopy, total protein, ECM protein and triglyceride quantification. The biomechanical properties were assessed using uniaxial tensile strength testing. Cell lysis occurred mainly during the detergent and alcohol steps. Collagen structural damage occurred during the detergent and alcohol steps, with no significant decreased in collagen concentration. No significant damage to elastin could be shown throughout the process, however glycosaminoglycans were significantly removed by detergent treatment. Triglycerides were removed mostly by the alcohol treatment. The strength of the pericardium decreased somewhat after each step of the protocol. It is important to characterize each decellularization protocol with regards to the decellularization efficiency and the effect on the ECM proteins structure and function to accurately evaluatein vivooutcomes.
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Affiliation(s)
- L Laker
- Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State (UFS), Bloemfontein, South Africa
| | - P M Dohmen
- Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State (UFS), Bloemfontein, South Africa.,Department of Cardiac Surgery, Heart Centre Rostock, University of Rostock, Rostock, Germany
| | - F E Smit
- Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State (UFS), Bloemfontein, South Africa
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Hedergott A, Pink-Theofylaktopoulos U, Neugebauer A, Fricke J. Tendon elongation with bovine pericardium in strabismus surgery-indications beyond Graves' orbitopathy. Graefes Arch Clin Exp Ophthalmol 2020; 259:145-155. [PMID: 32949299 PMCID: PMC7790785 DOI: 10.1007/s00417-020-04939-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/18/2020] [Accepted: 09/10/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND For some patients with complex ocular motility disorders, conventional strabismus surgery is insufficient. Surgery with tendon elongation allows correction of larger angles and maintains a sufficient arc of contact for rectus muscles. This study reports results for tendon elongation with bovine pericardium (Tutopatch®) in indications other than Graves' orbitopathy in which it is already widely used. METHODS We reviewed the records of all patients who underwent surgery with Tutopatch® in our institution. Angles of squint and head postures were analyzed preoperatively, on the first postoperative day, and in the long term (median 9 weeks after the operation). Patients with Graves' orbitopathy were excluded. RESULTS From 2011 to 2018, the procedures on 58 eyes of 54 patients (35 females, median age 35 years (3-75)) met the inclusion criteria. Horizontal rectus muscle surgery (53 eyes) was conducted on patients with residual strabismus (13), Duane's retraction syndrome with eso- (type I: 16)/exodeviation (type II: 2, type III: 1), 6th (7)/3rd nerve palsy (7), Möbius syndrome (2), congenital fibrosis of the extraocular muscles type 3A (CFEOM3A, TUBB3 mutation) (4), and orbital apex syndrome (1). Vertical rectus muscle surgery (5 eyes) was conducted on patients with myasthenia (1), vertical tropia after orbital floor fracture (1), CFEOM1 (2), and Parry-Romberg syndrome (1). 42 eyes had prior eye muscle surgery (1-5 procedures, median 1). Out of 45 patients with postoperative long-term data, 43 showed an angle reduction. Fifty-one percent had an angle of 10Δ (prism diopter) or less, one had a significant over-effect, and 10 had revision surgery. For the heterogeneous group of residual eso- and exotropias, the median absolute horizontal angle was reduced from 35Δ (16 to 45Δ) to 9Δ (0 to 40Δ), for Duane's retraction syndrome from 27.5Δ (9 to 40Δ) to 7Δ (0 to 40Δ), and for sixth and third nerve palsies from 43Δ (20 to 75Δ) to 18Δ (4 to 40Δ). For 3 patients with vertical rectus muscle surgery, the median absolute vertical angle was reduced from 30Δ (20 to 45Δ) to 4Δ (1 to 22Δ). The motility range was shifted in the direction contrary to the elongated muscle in all subgroups. A considerable reduction of the excursion into the field of action of the elongated muscle had to be registered. CONCLUSIONS Strabismus surgery with bovine pericardium introduces new surgical options for complicated revisions and for rare and complex oculomotor dysfunctions. Yet, it has to be recognized that this type of surgery aiming at maximum effects, despite preservation or restitution of the arc of contact, leads to reduction of the excursion into the field of action of the elongated muscle. Furthermore, dose finding can be difficult depending on the underlying pathology and more than one intervention might be necessary for optimal results.
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Affiliation(s)
- Andrea Hedergott
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
| | - Ursula Pink-Theofylaktopoulos
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Antje Neugebauer
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Julia Fricke
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
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Sevostianova VV, Antonova LV, Mironov AV, Yuzhalin AE, Silnikov VN, Glushkova TV, Godovikova TS, Krivkina EO, Bolbasov E, Akentyeva TN, Khanova MY, Matveeva VG, Velikanova EA, Tarasov RS, Barbarash LS. Biodegradable Patches for Arterial Reconstruction Modified with RGD Peptides: Results of an Experimental Study. ACS OMEGA 2020; 5:21700-21711. [PMID: 32905385 PMCID: PMC7469394 DOI: 10.1021/acsomega.0c02593] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/10/2020] [Indexed: 05/09/2023]
Abstract
Modification by Arg-Gly-Asp (RGD) peptides is a promising approach to improve the biocompatibility of biodegradable vascular patches for arteriotomy. In this study, we evaluated the performance of vascular patches electrospun using a blend of polycaprolactone (PCL) and polyhydroxybutyrate/valerate (PHBV) and additionally modified with RGDK, AhRGD, and c[RGDFK] peptides using 1,6-hexamethylenediamine or 4,7,10-trioxa-1,13-tridecanediamine (TTDDA) linkers. We examined mechanical properties and hemocompatibility of resulting patches before implanting them in rat abdominal aortas to assess their performance in vivo. Patches were explanted 1, 3, 6, and 12 months postoperation followed by histological and immunofluorescence analyses. Patches manufactured from the human internal mammary artery or commercially available KemPeriplas-Neo xenopericardial patches were used as a control. The tensile strength and F max of KemPeriplas-Neo patches were 4- and 16.7-times higher than those made of human internal mammary artery, respectively. Both RGD-modified and unmodified PHBV/PCL patches demonstrated properties similar to a human internal mammary artery patch. Regardless of RGD modification, experimental PHBV/PCL patches displayed fewer lysed red blood cells and resulted in milder platelet aggregation than KemPeriplas-Neo patches. Xenopericardial patches failed to form an endothelial layer in vivo and were prone to calcification. By contrast, TTDDA/RGDK-modified biodegradable patches demonstrated a resistance to calcification. Modification by TTDDA/RGDK and TTDDA/c[RGDFK] facilitated the formation of neovasculature upon the implantation in vivo.
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Affiliation(s)
- Viktoriia V. Sevostianova
- Research
Institute for Complex Issues of Cardiovascular Diseases, Kemerovo 650002, Russia
- . Phone: +7-3842-643802
| | - Larisa V. Antonova
- Research
Institute for Complex Issues of Cardiovascular Diseases, Kemerovo 650002, Russia
| | - Andrey V. Mironov
- Research
Institute for Complex Issues of Cardiovascular Diseases, Kemerovo 650002, Russia
| | - Arseniy E. Yuzhalin
- Research
Institute for Complex Issues of Cardiovascular Diseases, Kemerovo 650002, Russia
| | - Vladimir N. Silnikov
- Institute
of Chemical Biology and Fundamental Medicine of the Siberian Branch
of the Russian Academy of Sciences, Novosibirsk 630090, Russia
| | - Tatiana V. Glushkova
- Research
Institute for Complex Issues of Cardiovascular Diseases, Kemerovo 650002, Russia
| | - Tatyana S. Godovikova
- Institute
of Chemical Biology and Fundamental Medicine of the Siberian Branch
of the Russian Academy of Sciences, Novosibirsk 630090, Russia
| | - Evgeniya O. Krivkina
- Research
Institute for Complex Issues of Cardiovascular Diseases, Kemerovo 650002, Russia
| | - Evgeniy Bolbasov
- National
Research Tomsk Polytechnic University, Tomsk 634050, Russia
| | - Tatiana N. Akentyeva
- Research
Institute for Complex Issues of Cardiovascular Diseases, Kemerovo 650002, Russia
| | - Mariam Yu. Khanova
- Research
Institute for Complex Issues of Cardiovascular Diseases, Kemerovo 650002, Russia
| | - Vera G. Matveeva
- Research
Institute for Complex Issues of Cardiovascular Diseases, Kemerovo 650002, Russia
| | - Elena A. Velikanova
- Research
Institute for Complex Issues of Cardiovascular Diseases, Kemerovo 650002, Russia
| | - Roman S. Tarasov
- Research
Institute for Complex Issues of Cardiovascular Diseases, Kemerovo 650002, Russia
| | - Leonid S. Barbarash
- Research
Institute for Complex Issues of Cardiovascular Diseases, Kemerovo 650002, Russia
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Kotoulas C, Georgiou C, Chouliaras E, Theodosiadis N, Kotoulas S, Kotoulas A, Panagiotou I. Diagnostic dilemma in spontaneous innominate artery pathology: a case report. Gen Thorac Cardiovasc Surg 2020; 69:367-370. [PMID: 32862367 DOI: 10.1007/s11748-020-01472-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 08/20/2020] [Indexed: 11/30/2022]
Abstract
We report the case of a 71-year-old female who presented with sudden onset of right cervical pain and ipsilateral arm hypoaesthesia. The diagnostic evaluation revealed a pathology of the origin of the innominate artery (IA). The differential diagnosis was among a spontaneous acute dissection and a ruptured pseudoaneurysm. The dilemma of the proper treatment emerged. Surgical or medical treatment? Open or endovascular approach? The patient was offered an open treatment under cardiopulmonary bypass and sort circulatory arrest. As less than ten cases of isolated IA dissection have been previously reported in the literature, we discuss the differential diagnosis difficulties and the treatment options.
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Affiliation(s)
- Christophoros Kotoulas
- Cardiac Surgery Department, 401 Army General Hospital of Athens, Kifissias Ave 38, 11526, Athens, Greece.
| | - Charalampos Georgiou
- Cardiac Surgery Department, 401 Army General Hospital of Athens, Kifissias Ave 38, 11526, Athens, Greece
| | | | - Nikolaos Theodosiadis
- Cardiac Surgery Department, 401 Army General Hospital of Athens, Kifissias Ave 38, 11526, Athens, Greece
| | | | | | - Ioannis Panagiotou
- Cardiac Surgery Department, 401 Army General Hospital of Athens, Kifissias Ave 38, 11526, Athens, Greece
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40
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Martin GH, Saqib NU, Safi HJ. Treatment of an Infected, Bovine Pericardial Carotid Patch: Excision and Reconstruction with a Superficial Femoral Arterial Interposition Graft. Ann Vasc Surg 2020; 70:565.e1-565.e5. [PMID: 32768534 DOI: 10.1016/j.avsg.2020.07.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 10/23/2022]
Abstract
Carotid patch infection is a rare complication but one often associated with severe morbidity, including hemorrhage, stroke, cranial nerve injury, and mortality. We present a case of a gram-negative bacterial infection of a bovine pericardial carotid patch. Treatment ultimately required patch explantation and reconstruction with a femoral arterial interposition graft.
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Affiliation(s)
- Gordon H Martin
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX.
| | - Naveed U Saqib
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX
| | - Hazim J Safi
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX
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Shaik TA, Alfonso-García A, Zhou X, Arnold KM, Haudenschild AK, Krafft C, Griffiths LG, Popp J, Marcu L. FLIm-Guided Raman Imaging to Study Cross-Linking and Calcification of Bovine Pericardium. Anal Chem 2020; 92:10659-10667. [PMID: 32598134 PMCID: PMC7539574 DOI: 10.1021/acs.analchem.0c01772] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Bovine pericardium (BP) is a vascular biomaterial used in cardiovascular surgery that is typically cross-linked for masking antigenicity and enhance stability. There is a need for biochemical evaluation of the tissue properties prior to implantation to ensure that quality and reliability standards are met. Here, engineered antigen removed BP (ARBP) that was cross-linked with 0.2% and 0.6% glutaraldehyde (GA), and further calcified in vitro to simulate graft calcifications upon implantation was characterized nondestructively using fluorescence lifetime imaging (FLIm) to identify regions of interest which were then assessed by Raman spectroscopy. We observed that the tissue fluorescence lifetime shortened, and that Raman bands at 856, 935, 1282, and 1682 cm-1 decreased, and at 1032 and 1627 cm-1 increased with increasing GA cross-linking. Independent classification analysis based on fluorescence lifetime and on Raman spectra discriminated between GA-ARBP and untreated ARBP with an accuracy of 91% and 66%, respectively. Pearson's correlation analysis showed a strong correlation between pyridinium cross-links measured with high-performance liquid chromatography and fluorescence lifetime measured at 380-400 nm (R = -0.76, p = 0.00094), as well as Raman bands at 856 cm-1 for hydroxy-proline (R = -0.68, p = 0.0056) and at 1032 cm-1 for hydroxy-pyridinium (R = 0.74, p = 0.0016). Calcified areas of GA cross-linked tissue showed characteristic hydroxyapatite (959 and 1038 cm-1) bands in the Raman spectrum and fluorescence lifetime shortened by 0.4 ns compared to uncalcified regions. FLIm-guided Raman imaging could rapidly identify degrees of cross-linking and detected calcified regions with high chemical specificity, an ability that can be used to monitor tissue engineering processes for applications in regenerative medicine.
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Affiliation(s)
- Tanveer Ahmed Shaik
- Leibniz Institute of Photonic Technology Jena e.V., Albert-Einstein-Strasse 9, 07745 Jena, Germany
| | - Alba Alfonso-García
- Department of Biomedical Engineering, University of California Davis, One Shields Avenue, Davis, California 95616, United States
| | - Xiangnan Zhou
- Department of Biomedical Engineering, University of California Davis, One Shields Avenue, Davis, California 95616, United States
| | - Katherine M Arnold
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, United States
| | - Anne K Haudenschild
- Department of Biomedical Engineering, University of California Davis, One Shields Avenue, Davis, California 95616, United States
| | - Christoph Krafft
- Leibniz Institute of Photonic Technology Jena e.V., Albert-Einstein-Strasse 9, 07745 Jena, Germany
| | - Leigh G Griffiths
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, United States
| | - Jürgen Popp
- Leibniz Institute of Photonic Technology Jena e.V., Albert-Einstein-Strasse 9, 07745 Jena, Germany
- Institute of Physical Chemistry and Abbe Center of Photonics, Friedrich Schiller University Jena, Helmholtzweg 4, 07743 Jena, Germany
| | - Laura Marcu
- Department of Biomedical Engineering, University of California Davis, One Shields Avenue, Davis, California 95616, United States
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Kimicata M, Allbritton-King JD, Navarro J, Santoro M, Inoue T, Hibino N, Fisher JP. Assessment of decellularized pericardial extracellular matrix and poly(propylene fumarate) biohybrid for small-diameter vascular graft applications. Acta Biomater 2020; 110:68-81. [PMID: 32305447 PMCID: PMC7294167 DOI: 10.1016/j.actbio.2020.04.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 01/05/2023]
Abstract
Autologous grafts are the current gold standard of care for coronary artery bypass graft surgeries, but are limited by availability and plagued by high failure rates. Similarly, tissue engineering approaches to small diameter vascular grafts using naturally derived and synthetic materials fall short, largely due to inappropriate mechanical properties. Alternatively, decellularized extracellular matrix from tissue is biocompatible and has comparable strength to vessels, while poly(propylene fumarate) (PPF) has shown promising results for vascular grafts. This study investigates the integration of decellularized pericardial extracellular matrix (dECM) and PPF to create a biohybrid scaffold (dECM+PPF) suitable for use as a small diameter vascular graft. Our method to decellularize the ECM was efficient at removing DNA content and donor variability, while preserving protein composition. PPF was characterized and added to dECM, where it acted to preserve dECM against degradative effects of collagenase without disturbing the material's overall mechanics. A transport study showed that diffusion occurs across dECM+PPF without any effect from collagenase. The modulus of dECM+PPF matched that of human coronary arteries and saphenous veins. dECM+PPF demonstrated ample circumferential stress, burst pressure, and suture retention strength to survive in vivo. An in vivo study showed re-endothelialization and tissue growth. Overall, the dECM+PPF biohybrid presents a robust solution to overcome the limitations of the current methods of treatment for small diameter vascular grafts. STATEMENT OF SIGNIFICANCE: In creating a dECM+PPF biohybrid graft, we have observed phenomena that will have a lasting impact within the scientific community. First, we found that we can reduce donor variability through decellularization, a unique use of the decellularization process. Additionally, we coupled a natural material with a synthetic polymer to capitalize on the benefits of each: the cues provided to cells and the ability to easily tune material properties, respectively. This principle can be applied to other materials in a variety of applications. Finally, we created an off-the-shelf alternative to autologous grafts with a newly developed material that has yet to be utilized in any scaffolds. Furthermore, bovine pericardium has not been investigated as a small diameter vascular graft.
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Affiliation(s)
- Megan Kimicata
- Department of Materials Science and Engineering, University of Maryland, 3121 A. James Clark Hall, College Park, MD 20742, United States; Center for Engineering Complex Tissues, University of Maryland, 3121 A. James Clark Hall, College Park, MD 20742, United States
| | - Jules D Allbritton-King
- Center for Engineering Complex Tissues, University of Maryland, 3121 A. James Clark Hall, College Park, MD 20742, United States; Fischell Department of Bioengineering, University of Maryland, 3121 A. James Clark Hall, College Park, MD 20742, United States
| | - Javier Navarro
- Center for Engineering Complex Tissues, University of Maryland, 3121 A. James Clark Hall, College Park, MD 20742, United States; Fischell Department of Bioengineering, University of Maryland, 3121 A. James Clark Hall, College Park, MD 20742, United States
| | - Marco Santoro
- Center for Engineering Complex Tissues, University of Maryland, 3121 A. James Clark Hall, College Park, MD 20742, United States; Fischell Department of Bioengineering, University of Maryland, 3121 A. James Clark Hall, College Park, MD 20742, United States
| | - Takahiro Inoue
- Department of Surgery, Division of Cardiac Surgery, Johns Hopkins University, 1800 Orleans St, Baltimore, MD, 21287; Department of Surgery, Section of Cardiac Surgery, The University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, United States
| | - Narutoshi Hibino
- Department of Surgery, Division of Cardiac Surgery, Johns Hopkins University, 1800 Orleans St, Baltimore, MD, 21287; Department of Surgery, Section of Cardiac Surgery, The University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, United States
| | - John P Fisher
- Center for Engineering Complex Tissues, University of Maryland, 3121 A. James Clark Hall, College Park, MD 20742, United States; Fischell Department of Bioengineering, University of Maryland, 3121 A. James Clark Hall, College Park, MD 20742, United States.
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43
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Kumar R, Halder V, Gourav KP, Patel R, Munirathimnam GK, Mandal B, Thingnam SKS. Pulmonary valve neocuspidisation with glutaraldehyde-treated autologous pericardium-A novel technique in pulmonary valve endocarditis. J Card Surg 2020; 35:1725-1728. [PMID: 32579761 DOI: 10.1111/jocs.14659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/24/2020] [Accepted: 05/12/2020] [Indexed: 11/27/2022]
Abstract
Infective endocarditis (IE) is a serious condition leading to heart failure, persistent sepsis. The management of IE involving valve is mainly excision of the infected valve and replacement with a heart valve; which are also at the risk of prosthetic valve endocarditis. Hence repair of the valve with autologous pericardium is much more physiological. We had a 20-year-old male presented with features of heart failure and high-grade fever not responding to optimum medical management. Two-dimensional echocardiogram revealed vegetation on pulmonary valve cusps with the erosion of the left and right cusps. Neo cusps with autologous pericardium offered good hemodynamics with trivial regurgitation. The patient is doing well with normal pulmonary valve function 3 months after surgery. This technique is reliable, economic, and easily reproducible.
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Affiliation(s)
- Rupesh Kumar
- Department of Cardiothoracic and Vascular Surgery, Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikram Halder
- Department of Cardiothoracic and Vascular Surgery, Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Krishna P Gourav
- Department of Cardiothoracic and Vascular Anesthesiology, Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ruchit Patel
- Department of Cardiothoracic and Vascular Surgery, Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ganesh K Munirathimnam
- Department of Cardiothoracic and Vascular Anesthesiology, Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Banashree Mandal
- Department of Cardiothoracic and Vascular Anesthesiology, Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shyam K S Thingnam
- Department of Cardiothoracic and Vascular Surgery, Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Whole Organ Engineering: Approaches, Challenges, and Future Directions. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10124277] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
End-stage organ failure remains a leading cause of morbidity and mortality across the globe. The only curative treatment option currently available for patients diagnosed with end-stage organ failure is organ transplantation. However, due to a critical shortage of organs, only a fraction of these patients are able to receive a viable organ transplantation. Those patients fortunate enough to receive a transplant must then be subjected to a lifelong regimen of immunosuppressant drugs. The concept of whole organ engineering offers a promising alternative to organ transplantation that overcomes these limitations. Organ engineering is a discipline that merges developmental biology, anatomy, physiology, and cellular interactions with enabling technologies such as advanced biomaterials and biofabrication to create bioartificial organs that recapitulate native organs in vivo. There have been numerous developments in bioengineering of whole organs over the past two decades. Key technological advancements include (1) methods of whole organ decellularization and recellularization, (2) three-dimensional bioprinting, (3) advanced stem cell technologies, and (4) the ability to genetically modify tissues and cells. These advancements give hope that organ engineering will become a commercial reality in the next decade. In this review article, we describe the foundational principles of whole organ engineering, discuss key technological advances, and provide an overview of current limitations and future directions.
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45
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Guariento A, Pradegan N, Castaldi B, Cattapan C, Weixler V, Blitzer D, Vida VL. Modified extracardiac Fontan with a fenestrated pericardial patch. J Card Surg 2020; 35:1618-1620. [PMID: 32445209 DOI: 10.1111/jocs.14595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/15/2020] [Accepted: 04/18/2020] [Indexed: 11/28/2022]
Abstract
Extracardiac Fontan is a preferred treatment strategy in many centers treating patients with single ventricle physiology, and many of these centers regularly include a fenestration between the extracardiac conduit and the common atrium. Spontaneous closure of the fenestration is a common complication of this technique and is independently associated with increased morbidity and mortality. Recently, we introduced a novel technique for fenestration of the extracardiac conduit wherein a pericardial patch is utilized at the fenestration point with excellent outcomes in the midterm fenestration patency rates, thus reducing the risk of acute post-Fontan complications.
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Affiliation(s)
- Alvise Guariento
- Pediatric Cardiac Surgery Unit, Department of Cardiac, Padua University Hospital, Padua, Italy.,Department of Cardiovascular Surgery, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nicola Pradegan
- Pediatric Cardiac Surgery Unit, Department of Cardiac, Padua University Hospital, Padua, Italy
| | - Biagio Castaldi
- Paediatric Cardiology Unit, Department of Child and Woman's Health, University of Padua, Padua, Italy
| | - Claudia Cattapan
- Pediatric Cardiac Surgery Unit, Department of Cardiac, Padua University Hospital, Padua, Italy
| | - Viktoria Weixler
- Department of Congenital Heart Surgery, German Heart Institute, Berlin, Germany
| | - David Blitzer
- Department of Surgery, Columbia University Medical Center, New York, New York
| | - Vladimiro L Vida
- Pediatric Cardiac Surgery Unit, Department of Cardiac, Padua University Hospital, Padua, Italy
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Toong DWY, Toh HW, Ng JCK, Wong PEH, Leo HL, Venkatraman S, Tan LP, Ang HY, Huang Y. Bioresorbable Polymeric Scaffold in Cardiovascular Applications. Int J Mol Sci 2020; 21:E3444. [PMID: 32414114 PMCID: PMC7279389 DOI: 10.3390/ijms21103444] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 12/12/2022] Open
Abstract
Advances in material science and innovative medical technologies have allowed the development of less invasive interventional procedures for deploying implant devices, including scaffolds for cardiac tissue engineering. Biodegradable materials (e.g., resorbable polymers) are employed in devices that are only needed for a transient period. In the case of coronary stents, the device is only required for 6-8 months before positive remodelling takes place. Hence, biodegradable polymeric stents have been considered to promote this positive remodelling and eliminate the issue of permanent caging of the vessel. In tissue engineering, the role of the scaffold is to support favourable cell-scaffold interaction to stimulate formation of functional tissue. The ideal outcome is for the cells to produce their own extracellular matrix over time and eventually replace the implanted scaffold or tissue engineered construct. Synthetic biodegradable polymers are the favoured candidates as scaffolds, because their degradation rates can be manipulated over a broad time scale, and they may be functionalised easily. This review presents an overview of coronary heart disease, the limitations of current interventions and how biomaterials can be used to potentially circumvent these shortcomings in bioresorbable stents, vascular grafts and cardiac patches. The material specifications, type of polymers used, current progress and future challenges for each application will be discussed in this manuscript.
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Affiliation(s)
- Daniel Wee Yee Toong
- School of Materials Science and Engineering, Nanyang Technological University, Nanyang Avenue, Singapore 639798, Singapore; (D.W.Y.T.); (L.P.T.)
| | - Han Wei Toh
- National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore; (H.W.T.); (J.C.K.N.); (P.E.H.W.)
- Department of Biomedical Engineering, National University of Singapore, 4 Engineering Drive 3, Singapore 117583, Singapore;
| | - Jaryl Chen Koon Ng
- National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore; (H.W.T.); (J.C.K.N.); (P.E.H.W.)
- Department of Biomedical Engineering, National University of Singapore, 4 Engineering Drive 3, Singapore 117583, Singapore;
| | - Philip En Hou Wong
- National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore; (H.W.T.); (J.C.K.N.); (P.E.H.W.)
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore 169857, Singapore
| | - Hwa Liang Leo
- Department of Biomedical Engineering, National University of Singapore, 4 Engineering Drive 3, Singapore 117583, Singapore;
| | - Subramanian Venkatraman
- Materials Science and Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore 117575, Singapore;
| | - Lay Poh Tan
- School of Materials Science and Engineering, Nanyang Technological University, Nanyang Avenue, Singapore 639798, Singapore; (D.W.Y.T.); (L.P.T.)
| | - Hui Ying Ang
- National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore; (H.W.T.); (J.C.K.N.); (P.E.H.W.)
- Department of Biomedical Engineering, National University of Singapore, 4 Engineering Drive 3, Singapore 117583, Singapore;
| | - Yingying Huang
- School of Materials Science and Engineering, Nanyang Technological University, Nanyang Avenue, Singapore 639798, Singapore; (D.W.Y.T.); (L.P.T.)
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47
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Compransion Of The Clinical Outcomes Of Primary Closure And Patch Plasty Thecniques In Carotid Endarterectomy. JOURNAL OF CONTEMPORARY MEDICINE 2020. [DOI: 10.16899/jcm.675512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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48
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Short- and Long-Term Outcomes Following Biological Pericardium Patches Versus Prosthetic Patches for Carotid Endarterectomy: A Retrospective Bicentric Study. Ann Vasc Surg 2020; 72:66-71. [PMID: 32339685 DOI: 10.1016/j.avsg.2020.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Currently, there are various types of patches available on the market for carotid endarterectomy (CEA) with enlargement angioplasty, prosthetic, and biological patches including bovine pericardial patches. Despite the increasing use of these biological patches, there are little data in the literature comparing the results of these 2 types of patch. The purpose of this study is to compare the short- and long-term results of bovine pericardium patches (BPPs) with prosthetic patches (PPs) in carotid thromboendarterectomy. METHODS This study presents a retrospective analysis of all CEAs performed at Montpellier and Nîmes University Hospitals (France) in 2014 and 2015. Patients who underwent eversion were excluded. Preoperative, peroperative, and postoperative clinical and Doppler ultrasound results were collected and analyzed. The primary end point was the comparison of the restenosis rate between the BPP and the PP group. Secondary end points were the analysis of restenosis risk factors (type of patch, gender, renal failure, smoking, diabetes, arterial hypertension, dyslipidemia, and redo surgery were analyzed); the comparison of morbidity-mortality and infection between the BPP and the PP group and the comparison of morbidity-mortality between symptomatic and asymptomatic stenosis. RESULTS In total, 342 CEAs were performed: 168 (49%) with BPP and 174 (51%) with PP. Median follow-up was 30 months (interquartile range = 24). The stroke rate at day 30 was 3.22% and mortality at day 30 was 1.86%. There was no significant difference between groups concerning anyone of the variables of interest. At the end of follow-up, the restenosis rate >50% was 7.31% (6.45% for the BPP group vs. 8.22% for the PP group, P = 0.55). The severe restenosis rate (>70%) was 4.65% (5.16% for the BPP group vs. 4.11% for the PP group, P = 0.79). The univariate analysis identified renal failure (odds ratio = 2.69) as the main risk factor. The postoperative infection rate was 1.17% (0.59% for the BPP group vs. 1.75% for the PP group, P = 0.62). CONCLUSIONS The rates of stroke and postoperative death, bleeding, infection, and restenosis are comparable between BPPs and PPs in our study. The use of prosthetic or biological patches seems to deliver comparable outcomes. Further studies on larger samples are required.
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Joyce K, Rahmani S, Rochev Y. Quasi-isothermal modulated DSC as a valuable characterisation method for soft tissue biomaterial crosslinking reactions. Bioact Mater 2020; 5:428-434. [PMID: 32258832 PMCID: PMC7125324 DOI: 10.1016/j.bioactmat.2020.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/04/2020] [Accepted: 03/05/2020] [Indexed: 11/03/2022] Open
Abstract
Glutaraldehyde (Glut) is an extensively used sterilant and fixative for the crosslinking of natural soft tissue biomaterials like bovine pericardium (BP) to provide stability and is required for its application in vivo. There is plenty of debate around the reaction mechanism of Glut with natural biomaterials. Differential scanning calorimetry (DSC) is a commonly used technique that is typically used to measure the thermal profile of polymers. However, a variation known as quasi-isothermal modulated differential scanning calorimetry (QiMDSC) has been utilised for the analysis of polymorphic transformations in both the pharmaceutical and food industries. This communication will address QiMDSC as a method for analysing soft tissue biomaterials and their crosslinking mechanisms and how it can be applied to other biomaterial applications.
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Affiliation(s)
- K Joyce
- Centre for Research in Medical Devices (CÚRAM), Biomedical Sciences, National University of Ireland Galway (NUIG), Newcastle Road, Galway, Ireland.,Boston Scientific Limited, Ballybrit Business Park, Galway, Ireland
| | - S Rahmani
- Boston Scientific Limited, Ballybrit Business Park, Galway, Ireland
| | - Y Rochev
- National University of Ireland, Galway, University Road, Galway, Ireland.,Institute for Regenerative Medicine, Sechenov University, 8-2 Trubetskaya St., Moscow, 119991, Russia
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Grebenik EA, Gafarova ER, Istranov LP, Istranova EV, Ma X, Xu J, Guo W, Atala A, Timashev PS. Mammalian Pericardium-Based Bioprosthetic Materials in Xenotransplantation and Tissue Engineering. Biotechnol J 2020; 15:e1900334. [PMID: 32077589 DOI: 10.1002/biot.201900334] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 01/29/2020] [Indexed: 12/13/2022]
Abstract
Bioprosthetic materials based on mammalian pericardium tissue are the gold standard in reconstructive surgery. Their application range covers repair of rectovaginal septum defects, abdominoplastics, urethroplasty, duraplastics, maxillofacial, ophthalmic, thoracic and cardiovascular reconstruction, etc. However, a number of factors contribute to the success of their integration into the host tissue including structural organization, mechanical strength, biocompatibility, immunogenicity, surface chemistry, and biodegradability. In order to improve the material's properties, various strategies are developed, such as decellularization, crosslinking, and detoxification. In this review, the existing issues and long-term achievements in the development of bioprosthetic materials based on the mammalian pericardium tissue, aimed at a wide-spectrum application in reconstructive surgery are analyzed. The basic technical approaches to preparation of biocompatible forms providing continuous functioning, optimization of biomechanical and functional properties, and clinical applicability are described.
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Affiliation(s)
- Ekaterina A Grebenik
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, 119991, Russia
| | - Elvira R Gafarova
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, 119991, Russia
| | - Leonid P Istranov
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, 119991, Russia
| | - Elena V Istranova
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, 119991, Russia
| | - Xiaowei Ma
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing, 100190, P. R. China
| | - Jing Xu
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing, 100190, P. R. China
| | - Weisheng Guo
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing, 100190, P. R. China
| | - Anthony Atala
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, 27101, USA
| | - Peter S Timashev
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, 119991, Russia.,Institute of Photonic Technologies, Research center "Crystallography and Photonics" RAS, Moscow, 142190, Russia.,N. N. Semenov Institute of Chemical Physics, Russian Academy of Sciences, Moscow, 119991, Russia
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