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Bui HT, Khair N, Yeats B, Gooden S, James SP, Dasi LP. Transcatheter Heart Valves: A Biomaterials Perspective. Adv Healthc Mater 2021; 10:e2100115. [PMID: 34038627 DOI: 10.1002/adhm.202100115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/23/2021] [Indexed: 11/11/2022]
Abstract
Heart valve disease is prevalent throughout the world, and the number of heart valve replacements is expected to increase rapidly in the coming years. Transcatheter heart valve replacement (THVR) provides a safe and minimally invasive means for heart valve replacement in high-risk patients. The latest clinical data demonstrates that THVR is a practical solution for low-risk patients. Despite these promising results, there is no long-term (>20 years) durability data on transcatheter heart valves (THVs), raising concerns about material degeneration and long-term performance. This review presents a detailed account of the materials development for THVRs. It provides a brief overview of THVR, the native valve properties, the criteria for an ideal THV, and how these devices are tested. A comprehensive review of materials and their applications in THVR, including how these materials are fabricated, prepared, and assembled into THVs is presented, followed by a discussion of current and future THVR biomaterial trends. The field of THVR is proliferating, and this review serves as a guide for understanding the development of THVs from a materials science and engineering perspective.
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Affiliation(s)
- Hieu T. Bui
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
| | - Nipa Khair
- School of Advanced Materials Discovery Colorado State University 700 Meridian Ave Fort Collins CO 80523 USA
| | - Breandan Yeats
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
| | - Shelley Gooden
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
| | - Susan P. James
- School of Advanced Materials Discovery Colorado State University 700 Meridian Ave Fort Collins CO 80523 USA
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
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Bozso SJ, El-Andari R, Al-Adra D, Moon MC, Freed DH, Nagendran J, Nagendran J. A review of the immune response stimulated by xenogenic tissue heart valves. Scand J Immunol 2021; 93:e13018. [PMID: 33372305 DOI: 10.1111/sji.13018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/30/2020] [Accepted: 12/26/2020] [Indexed: 12/23/2022]
Abstract
Valvular heart disease continues to afflict millions of people around the world. In many cases, the only corrective treatment for valvular heart disease is valve replacement. Valve replacement options are currently limited, and the most common construct utilized are xenogenic tissue heart valves. The main limitation with the use of this valve type is the development of valvular deterioration. Valve deterioration results in intrinsic permanent changes in the valve structure, often leading to hemodynamic compromise and clinical symptoms of valve re-stenosis. A significant amount of research has been performed regarding the incidence of valve deterioration and determination of significant risk factors for its development. As a result, many believe that the underlying driver of valve deterioration is a chronic immune-mediated rejection process of the foreign xenogenic-derived tissue. The underlying mechanisms of how this occurs are an area of ongoing research and active debate. In this review, we provide an overview of the important components of the immune system and how they respond to xenografts. A review of the proposed mechanisms of xenogenic heart valve deterioration is provided including the immune response to xenografts. Finally, we discuss the role of strategies to combat valve degeneration such as preservation protocols, epitope modification and decellularization.
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Affiliation(s)
- Sabin J Bozso
- Department of Surgery, Division of Cardiac Surgery, University of Alberta, Edmonton, AB, Canada
| | - Ryaan El-Andari
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - David Al-Adra
- Department of Surgery, Division of Transplantation, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Michael C Moon
- Department of Surgery, Division of Cardiac Surgery, University of Alberta, Edmonton, AB, Canada
| | - Darren H Freed
- Department of Surgery, Division of Cardiac Surgery, University of Alberta, Edmonton, AB, Canada
| | - Jayan Nagendran
- Department of Surgery, Division of Cardiac Surgery, University of Alberta, Edmonton, AB, Canada
| | - Jeevan Nagendran
- Department of Surgery, Division of Cardiac Surgery, University of Alberta, Edmonton, AB, Canada
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3
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Rusu LC, Ardelean LC, Jitariu AA, Miu CA, Streian CG. An Insight into the Structural Diversity and Clinical Applicability of Polyurethanes in Biomedicine. Polymers (Basel) 2020; 12:polym12051197. [PMID: 32456335 PMCID: PMC7285236 DOI: 10.3390/polym12051197] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/13/2020] [Accepted: 05/22/2020] [Indexed: 01/16/2023] Open
Abstract
Due to their mechanical properties, ranging from flexible to hard materials, polyurethanes (PUs) have been widely used in many industrial and biomedical applications. PUs’ characteristics, along with their biocompatibility, make them successful biomaterials for short and medium-duration applications. The morphology of PUs includes two structural phases: hard and soft segments. Their high mechanical resistance featuresare determined by the hard segment, while the elastomeric behaviour is established by the soft segment. The most important biomedical applications of PUs include antibacterial surfaces and catheters, blood oxygenators, dialysis devices, stents, cardiac valves, vascular prostheses, bioadhesives/surgical dressings/pressure-sensitive adhesives, drug delivery systems, tissue engineering scaffolds and electrospinning, nerve generation, pacemaker lead insulation and coatings for breast implants. The diversity of polyurethane properties, due to the ease of bulk and surface modification, plays a vital role in their applications.
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Affiliation(s)
- Laura-Cristina Rusu
- Department of Oral Pathology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu sq, 300041 Timisoara, Romania;
| | - Lavinia Cosmina Ardelean
- Department of Technology of Materials and Devices in Dental Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu sq, 300041 Timisoara, Romania
- Correspondence:
| | - Adriana-Andreea Jitariu
- Department of Microscopic Morphology/Histology and Angiogenesis Research Center Timisoara, “Victor Babes” University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu sq, 300041 Timisoara, Romania;
| | - Catalin Adrian Miu
- 3rd Department of Orthopaedics-Traumatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu sq, 300041 Timisoara, Romania;
| | - Caius Glad Streian
- Department of Cardiac Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu sq, 300041 Timisoara, Romania;
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Filgueira CS, Igo SR, Wang DK, Hirsch M, Schulz DG, Bruckner BA, Grattoni A. Technologies for intrapericardial delivery of therapeutics and cells. Adv Drug Deliv Rev 2019; 151-152:222-232. [PMID: 30797957 DOI: 10.1016/j.addr.2019.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/13/2019] [Accepted: 02/15/2019] [Indexed: 12/12/2022]
Abstract
The pericardium, which surrounds the heart, provides a unique enclosed volume and a site for the delivery of agents to the heart and coronary arteries. While strategies for targeting the delivery of therapeutics to the heart are lacking, various technologies and nanodelivery approaches are emerging as promising methods for site specific delivery to increase therapeutic myocardial retention, efficacy, and bioactivity, while decreasing undesired systemic effects. Here, we provide a literature review of various approaches for intrapericardial delivery of agents. Emphasis is given to sustained delivery approaches (pumps and catheters) and localized release (patches, drug eluting stents, and support devices and meshes). Further, minimally invasive access techniques, pericardial access devices, pericardial washout and fluid analysis, as well as therapeutic and cell delivery vehicles are presented. Finally, several promising new therapeutic targets to treat heart diseases are highlighted.
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Fahrenholtz MM, Wen S, Grande-Allen KJ. Development of a heart valve model surface for optimization of surface modifications. Acta Biomater 2015; 26:64-71. [PMID: 26296937 DOI: 10.1016/j.actbio.2015.08.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 08/11/2015] [Accepted: 08/18/2015] [Indexed: 12/16/2022]
Abstract
Current bioprosthetic valve replacements (BPVs) are susceptible to myriad complications, including calcification and thrombosis; however, recent research has explored surface modifications to encourage re-endothelialization of the tissue, preventing unwanted blood-tissue interactions. A bioprosthetic valve surface model (BVSM) was developed to facilitate rapid in vitro optimization of surface modification techniques for BPVs. The BVSM was manufactured by photopolymerization of PEGDA and collagen type I and subsequent addition of amine-rich peptide to provide reactive sites for surface modification. This BVSM mimics surface mechanical properties of bioprosthetic valve tissue, as measured by micropipette aspiration. The BVSM successfully mimics the latent toxic effects of glutaraldehyde fixation, as shown through MTT assay results. Amine content, assessed by XPS, was shown to be significantly lower in the BVSM than unfixed tissue. However, incubation of the surface with amine-reactive NHS-PEG-Cy5 revealed even coverage of the BVSM surface, suggesting that there exists sufficient surface reactive groups to anchor surface modifications, and that translation of the modification process to tissue will yield more complete modification of the BPV surface. These results indicate successful construction of a BVSM that mimics essential properties of bioprosthetic valve tissue and its usefulness for rapid in vitro optimization of surface modification methods for endothelialization. STATEMENT OF SIGNIFICANCE Current bioprosthetic valve replacements are susceptible to many complications, including calcification and thrombosis; however, recent research has explored surface modifications to encourage the integration of the replacement with the native tissue, which would prevent unwanted blood-tissue interactions. However, methods to analyze and optimize such modifications are limited by the complex surface topography, individual variability, and opacity of native tissue. Thus, we have developed a novel bioprosthetic valve tissue model (BVM) which mimics the important features of the bioprosthetic valve tissue and serves as a platform for rapid optimization and testing of surface modification strategies for tissue valves. Thus, the BVM will provide a needed platform to support rapid improvement of clinically available cardiovascular implants.
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Santoro R, Consolo F, Spiccia M, Piola M, Kassem S, Prandi F, Vinci MC, Forti E, Polvani G, Fiore GB, Soncini M, Pesce M. Feasibility of pig and human-derived aortic valve interstitial cells seeding on fixative-free decellularized animal pericardium. J Biomed Mater Res B Appl Biomater 2015; 104:345-56. [PMID: 25809726 DOI: 10.1002/jbm.b.33404] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 02/09/2015] [Accepted: 02/16/2015] [Indexed: 11/08/2022]
Abstract
Glutaraldehyde-fixed pericardium of animal origin is the elective material for the fabrication of bio-prosthetic valves for surgical replacement of insufficient/stenotic cardiac valves. However, the pericardial tissue employed to this aim undergoes severe calcification due to chronic inflammation resulting from a non-complete immunological compatibility of the animal-derived pericardial tissue resulting from failure to remove animal-derived xeno-antigens. In the mid/long-term, this leads to structural deterioration, mechanical failure, and prosthesis leaflets rupture, with consequent need for re-intervention. In the search for novel procedures to maximize biological compatibility of the pericardial tissue into immunocompetent background, we have recently devised a procedure to decellularize the human pericardium as an alternative to fixation with aldehydes. In the present contribution, we used this procedure to derive sheets of decellularized pig pericardium. The decellularized tissue was first tested for the presence of 1,3 α-galactose (αGal), one of the main xenoantigens involved in prosthetic valve rejection, as well as for mechanical tensile behavior and distensibility, and finally seeded with pig- and human-derived aortic valve interstitial cells. We demonstrate that the decellularization procedure removed the αGAL antigen, maintained the mechanical characteristics of the native pig pericardium, and ensured an efficient surface colonization of the tissue by animal- and human-derived aortic valve interstitial cells. This establishes, for the first time, the feasibility of fixative-free pericardial tissue seeding with valve competent cells for derivation of tissue engineered heart valve leaflets.
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Affiliation(s)
- Rosaria Santoro
- Unità di Ingegneria Tissutale, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Filippo Consolo
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
| | - Marco Spiccia
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
| | - Marco Piola
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
| | - Samer Kassem
- Divisione di Cardiochirurgia, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Francesca Prandi
- Unità di Ingegneria Tissutale, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | - Elisa Forti
- Unità di Ingegneria Tissutale, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Gianluca Polvani
- Dipartimento di Scienze Cliniche e di Comunità, Sezione cardiovascolare, Università di Milano, Milan, Italy
| | | | - Monica Soncini
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
| | - Maurizio Pesce
- Unità di Ingegneria Tissutale, Centro Cardiologico Monzino, IRCCS, Milan, Italy
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In vitro Endothelialization and Platelet Adhesion on Titaniferous Upgraded Polyether and Polycarbonate Polyurethanes. MATERIALS 2014; 7:623-636. [PMID: 28788479 PMCID: PMC5453079 DOI: 10.3390/ma7020623] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 01/16/2014] [Accepted: 01/19/2014] [Indexed: 01/26/2023]
Abstract
Polycarbonateurethanes (PCU) and polyetherurethanes (PEU) are used for medical devices, however their bio- and haemocompatibility is limited. In this study, the effect of titaniferous upgrading of different polyurethanes on the bio- and haemocompatibility was investigated by endothelial cell (EC) adhesion/proliferation and platelet adhesion (scanning electron microscopy), respectively. There was no EC adhesion/proliferation and only minor platelet adhesion on upgraded and pure PCU (Desmopan). PEUs (Texin 985, Tecothane 1085, Elastollan 1180A) differed in their cyto- and haemocompatibility. While EC adhesion depended on the type of PEU, any proliferative activity was inhibited. Additional titaniferous upgrading of PEU induced EC proliferation and increased metabolic activity. However, adherent ECs were significantly activated. While Texin was highly thrombotic, only small amounts of platelets adhered onto Tecothane and Elastollan. Additional titaniferous upgrading reduced thrombogenicity of Texin, preserved haemocompatibility of Elastollan, and increased platelet activation/aggregation on Tecothane. In conclusion, none of the PUs was cytocompatible; only titaniferous upgrading allowed EC proliferation and metabolism on PEUs. Haemocompatibility depended on the type of PU.
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Abstract
Zebrafish (Danio rerio) are an excellent vertebrate model for studying heart development, regeneration and cardiotoxicity. Zebrafish embryos exposed during the temporal window of epicardium development to the aryl hydrocarbon receptor (AHR) agonist 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) exhibit severe heart malformations. TCDD exposure prevents both proepicardial organ (PE) and epicardium development. Exposure later in development, after the epicardium has formed, does not produce cardiac toxicity. It is not until the adult zebrafish heart is stimulated to regenerate does TCDD again cause detrimental effects. TCDD exposure prior to ventricular resection prevents cardiac regeneration. It is likely that TCDD-induced inhibition of epicardium development and cardiac regeneration occur via a common mechanism. Here, we describe experiments that focus on the epicardium as a target and sensor of zebrafish heart toxicity.
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Affiliation(s)
| | | | | | - Warren Heideman
- Author to whom correspondence should be addressed; ; Fax: +1-608-262-5345
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Riescher S, Wehner D, Schmid T, Zimmermann H, Hartmann B, Schmid C, Lehle K. Titaniumcarboxonitride layer increased biocompatibility of medical polyetherurethanes. J Biomed Mater Res B Appl Biomater 2013; 102:141-8. [DOI: 10.1002/jbm.b.32990] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 03/20/2013] [Accepted: 05/28/2013] [Indexed: 12/12/2022]
Affiliation(s)
- Sebastian Riescher
- Department of Cardiothoracic Surgery; University Medical Centre Regensburg; Franz-Josef-Strauss-Allee 11 93042 Regensburg Germany
| | - Daniel Wehner
- Dualis Medtech GmbH; Am Technologiepark 8+10 82229 Seefeld Germany
| | - Thomas Schmid
- Dualis Medtech GmbH; Am Technologiepark 8+10 82229 Seefeld Germany
| | | | - Björn Hartmann
- pfm medical titanium gmbh; Hoefener Str. 45 90431 Nürnberg Germany
| | - Christof Schmid
- Department of Cardiothoracic Surgery; University Medical Centre Regensburg; Franz-Josef-Strauss-Allee 11 93042 Regensburg Germany
| | - Karla Lehle
- Department of Cardiothoracic Surgery; University Medical Centre Regensburg; Franz-Josef-Strauss-Allee 11 93042 Regensburg Germany
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Vinci MC, Tessitore G, Castiglioni L, Prandi F, Soncini M, Santoro R, Consolo F, Colazzo F, Micheli B, Sironi L, Polvani G, Pesce M. Mechanical compliance and immunological compatibility of fixative-free decellularized/cryopreserved human pericardium. PLoS One 2013; 8:e64769. [PMID: 23705010 PMCID: PMC3660606 DOI: 10.1371/journal.pone.0064769] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 04/18/2013] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The pericardial tissue is commonly used to produce bio-prosthetic cardiac valves and patches in cardiac surgery. The procedures adopted to prepare this tissue consist in treatment with aldehydes, which do not prevent post-graft tissue calcification due to incomplete xeno-antigens removal. The adoption of fixative-free decellularization protocols has been therefore suggested to overcome this limitation. Although promising, the decellularized pericardium has not yet used in clinics, due to the absence of proofs indicating that the decellularization and cryopreservation procedures can effectively preserve the mechanical properties and the immunologic compatibility of the tissue. PRINCIPAL FINDINGS The aim of the present work was to validate a procedure to prepare decellularized/cryopreserved human pericardium which may be implemented into cardiovascular homograft tissue Banks. The method employed to decellularize the tissue completely removed the cells without affecting ECM structure; furthermore, uniaxial tensile loading tests revealed an equivalent resistance of the decellularized tissue to strain, before and after the cryopreservation, in comparison with the fresh tissue. Finally, immunological compatibility, showed a minimized host immune cells invasion and low levels of systemic inflammation, as assessed by tissue transplantation into immune-competent mice. CONCLUSIONS Our results indicate, for the first time, that fixative-free decellularized pericardium from cadaveric tissue donors can be banked according to Tissue Repository-approved procedures without compromising its mechanical properties and immunological tolerance. This tissue can be therefore treated as a safe homograft for cardiac surgery.
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Affiliation(s)
- Maria Cristina Vinci
- Laboratorio di Ingegneria Tissutale Cardiovascolare, Centro Cardiologico Monzino-IRCCS, Milan, Italy
| | - Giulio Tessitore
- Dipartimento di Scienze Cardiovascolari, Università degli Studi di Milano, Milan, Italy
| | | | - Francesca Prandi
- Laboratorio di Ingegneria Tissutale Cardiovascolare, Centro Cardiologico Monzino-IRCCS, Milan, Italy
| | - Monica Soncini
- Dipartimento di Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Rosaria Santoro
- Laboratorio di Ingegneria Tissutale Cardiovascolare, Centro Cardiologico Monzino-IRCCS, Milan, Italy
| | - Filippo Consolo
- Dipartimento di Bioingegneria, Politecnico di Milano, Milan, Italy
| | | | - Barbara Micheli
- Banca dei Tessuti Cardiovascolari della Regione Lombardia, Milan, Italy
| | - Luigi Sironi
- Dipartimento di Farmacologia, Università di Milano, Milan, Italy
| | - Gianluca Polvani
- Dipartimento di Scienze Cardiovascolari, Università degli Studi di Milano, Milan, Italy
| | - Maurizio Pesce
- Laboratorio di Ingegneria Tissutale Cardiovascolare, Centro Cardiologico Monzino-IRCCS, Milan, Italy
- * E-mail:
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Lam MT, Wu JC. Biomaterial applications in cardiovascular tissue repair and regeneration. Expert Rev Cardiovasc Ther 2013; 10:1039-49. [PMID: 23030293 DOI: 10.1586/erc.12.99] [Citation(s) in RCA: 123] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cardiovascular disease physically damages the heart, resulting in loss of cardiac function. Medications can help alleviate symptoms, but it is more beneficial to treat the root cause by repairing injured tissues, which gives patients better outcomes. Besides heart transplants, cardiac surgeons use a variety of methods for repairing different areas of the heart such as the ventricular septal wall and valves. A multitude of biomaterials are used in the repair and replacement of impaired heart tissues. These biomaterials fall into two main categories: synthetic and natural. Synthetic materials used in cardiovascular applications include polymers and metals. Natural materials are derived from biological sources such as human donor or harvested animal tissues. A new class of composite materials has emerged to take advantage of the benefits of the strengths and minimize the weaknesses of both synthetic and natural materials. This article reviews the current and prospective applications of biomaterials in cardiovascular therapies.
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Affiliation(s)
- Mai T Lam
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Hagey Pediatric Regenerative Research Laboratory, Stanford University School of Medicine, Stanford, CA, USA
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