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Constable M, Northeast R, Lawless BM, Burton HE, Gramigna V, Goh KL, Buchan KG, Espino DM. Mechanical testing of glutaraldehyde cross-linked mitral valves. Part two: Elastic and viscoelastic properties of chordae tendineae. Proc Inst Mech Eng H 2020; 235:291-299. [PMID: 33243079 DOI: 10.1177/0954411920975938] [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] [Indexed: 11/15/2022]
Abstract
The aim of this study was to assess whether the mechanical properties of mitral valve chordae tendineae are sensitive to being cross-linked under load. A total 64 chordae were extracted from eight porcine hearts. Two chordae (posterior basal) from each heart were subjected to uniaxial ramp testing and six chordae (two strut, two anterior basal and two posterior basal) were subjected to dynamic mechanical analysis over frequencies between 0.5 and 10 Hz. Chordae were either cross-linked in tension or cross-linked in the absence of loading. Chordae cross-linked under load transitioned from high to low extension at a lower strain than cross-linked unloaded chordae (0.07 cf. 0.22), with greater pre-transitional (30.8 MPa cf. 5.78 MPa) and post-transitional (139 MPa cf. 74.1 MPa) moduli. The mean storage modulus of anterior strut chordae ranged from 48 to 54 MPa for cross-linked unloaded chordae, as compared to 53-61 MPa cross-linked loaded chordae. The mean loss modulus of anterior strut chordae ranged from 2.3 to 2.9 MPa for cross-linked unloaded chordae, as compared to 3.8-4.8 MPa cross-linked loaded chordae. The elastic and viscoelastic properties of chordae following glutaraldehyde cross-linking are dependent on the inclusion/exclusion of loading during the cross-linking process; with loading increasing the magnitude of the material properties measured.
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Affiliation(s)
- Matthew Constable
- Department of Mechanical Engineering, University of Birmingham, Birmingham, UK
| | - Rhiannon Northeast
- Department of Mechanical Engineering, University of Birmingham, Birmingham, UK
| | - Bernard M Lawless
- Department of Mechanical Engineering, University of Birmingham, Birmingham, UK.,Filament PD, Level 4 - Skypark 3, Skypark, Glasgow, UK
| | - Hanna E Burton
- Department of Mechanical Engineering, University of Birmingham, Birmingham, UK
| | - Vera Gramigna
- University of Magna Graecia, Catanzaro, Italy.,IBFM, National Research Council, Germaneto, Catanzaro, Italy
| | - Kheng Lim Goh
- Department of Mechanical Engineering, University of Newcastle, Singapore
| | - Keith G Buchan
- Department of Cardio-thoracic Surgery, Aberdeen Royal Infirmary, Forresterhill, Aberdeen, UK
| | - Daniel M Espino
- Department of Mechanical Engineering, University of Birmingham, Birmingham, UK
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2
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Wollmann LC, Suss PH, Kraft L, Ribeiro VS, Noronha L, da Costa FDA, Tuon FF. Histological and Biomechanical Characteristics of Human Decellularized Allograft Heart Valves After Eighteen Months of Storage in Saline Solution. Biopreserv Biobank 2020; 18:90-101. [PMID: 31990593 DOI: 10.1089/bio.2019.0106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: The best storage preservation method for maintaining the quality and safety of human decellularized allograft heart valves is yet to be established. Objective: The aim of the present study was to evaluate the stability in terms of extracellular matrix (ECM) integrity of human heart valve allografts decellularized using sodium dodecyl sulfate-ethylenediaminetetraacetic acid (SDS-EDTA) and stored for 6, 12, and 18 months. Methods: A total of 70 decellularized aortic and pulmonary valves were analyzed across different storage times (0, 6, 12, and 18 months) for solution pH measurements, histological findings, cytotoxicity assay results, biomechanical test results, and microbiological suitability test results. Continuous data were analyzed using one-way analysis of variance comparing the follow-up times. Results: The pH of the stock solution did not change during the different time points, and no microbial growth occurred up to 18 months. Histological analysis showed that the decellularized allografts did not present deleterious outcomes or signs of structural degeneration in the ECM up to 12 months. The biomechanical properties showed changes over time in different aspects. Allografts stored for 18 months presented lower tensile strength and elasticity than those stored for 12 months (p < 0.05). The microbiological suitability test suggested no residual antimicrobial effects. Conclusion: Changes in the structure and functionality of SDS-EDTA decellularized heart valve allografts occur after 12 months of storage.
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Affiliation(s)
- Luciana Cristina Wollmann
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.,Tissue Bank, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Paula Hansen Suss
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Leticia Kraft
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | | | - Lúcia Noronha
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.,Experimental Pathology Laboratory, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Francisco Diniz Affonso da Costa
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.,Tissue Bank, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Felipe Francisco Tuon
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.,Tissue Bank, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
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3
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Rassoli A, Li Y, Bao X, Kawecki F, Zhao X, Chappard D, Le-Bel G, Feng J, Weber B, Fatouraee N, Zhang Z, Jing Z, Germain L, Wang L, Guidoin R. Donkey pericardium as a select sourcing to manufacture percutaneous heart valves: Decellularization has not yet demonstrated any clear cut advantage to glutaraldehyde treatment. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2019. [DOI: 10.1016/j.medntd.2020.100029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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4
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Biofunctionalization of gelatin microcarrier with oxidized hyaluronic acid for corneal keratocyte cultivation. Colloids Surf B Biointerfaces 2014; 122:277-286. [DOI: 10.1016/j.colsurfb.2014.07.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 07/07/2014] [Accepted: 07/08/2014] [Indexed: 12/22/2022]
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5
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Gauvin R, Marinov G, Mehri Y, Klein J, Li B, Larouche D, Guzman R, Zhang Z, Germain L, Guidoin R. A comparative study of bovine and porcine pericardium to highlight their potential advantages to manufacture percutaneous cardiovascular implants. J Biomater Appl 2012; 28:552-65. [DOI: 10.1177/0885328212465482] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rationale: Prosthetic heart valves designed to be implanted percutaneously must be loaded within delivery catheters whose diameter can be as low as 18 F (6 mm). This mandatory crimping of the devices may result in deleterious damages to the tissues used for valve manufacturing. As bovine and porcine pericardial tissue are currently given preference because of their excellent availability and traceability, a preliminary comparative study was undertaken to highlight their potential advantages. Materials and methods: Bovine and pericardium patches were compared morphologically (light microscopy, scanning electron microscopy and transmission electron microscopy). The acute thrombogenicity of both materials was measured in term of platelet uptake and observed by scanning electron microscopy, porcine intact and injured arteries being used as controls. The pericardium specimens were also subjected to uniaxial tensile tests to compare their respective mechanical characteristics. Results: Both pericardiums showed a layered architecture of collagen bundles presenting some interstitial cells. They displayed wavy crimps typical of an unloaded collagenous tissue. The collagen bundles were not bound together and the fibrils were parallel with characteristic periodicity patterns of cross striations. The mesothelial cells found in vivo on the serous surface were no longer present due to tissue processing, but the adjacent structure was far more compacted when compared to the fibrous side. The fibrinocollagenous surfaces were found to be more thrombogenic for both bovine and porcine tissues and the serous side of the porcine pericardium retained more platelets when compared to the bovine samples, making the acute thrombogenicity more important in the porcine pericardium. Conclusion: Both bovine and porcine pericardium used in cardiovascular implantology can be selected to manufacture percutaneous heart valves. The selection of one pericardium preferably to the other should deserve additional testing regarding the innocuousness of crimping when loaded in delivery catheters and the long-term durability after percutaneous deployment.
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Affiliation(s)
- Robert Gauvin
- Center of LOEX, Laval University, Quebec (QC), Canada
| | | | - Yayhe Mehri
- Montreal Heart Institute, Montreal (QC), Canada
| | | | - Bin Li
- Research Center of Saint-François d'Assise Hospital (CHU), Laval University, Quebec (QC), Canada
| | | | | | - Ze Zhang
- Research Center of Saint-François d'Assise Hospital (CHU), Laval University, Quebec (QC), Canada
| | - Lucie Germain
- Center of LOEX, Laval University, Quebec (QC), Canada
| | - Robert Guidoin
- Research Center of Saint-François d'Assise Hospital (CHU), Laval University, Quebec (QC), Canada
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6
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Leong J, Munnelly A, Liberio B, Cochrane L, Vyavahare N. Neomycin and carbodiimide crosslinking as an alternative to glutaraldehyde for enhanced durability of bioprosthetic heart valves. J Biomater Appl 2011; 27:948-60. [DOI: 10.1177/0885328211430542] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Glutaraldehyde cross-linked porcine aortic valves, referred to as bioprosthetic heart valves (BHVs), are often used in heart valve replacements. Glutaraldehyde does not stabilize glycosaminoglycans (GAGs) and they are lost during preparation, in vivo implantation, cyclic fatigue, and storage. We report that binding of neomycin, a hyaluronidase inhibitor, to the tissues with carbodiimide cross-linking improves GAG retention without reducing collagen and elastin stability. It also led to improved biomechanical properties. Neomycin carbodiimide cross-linking did not significantly reduce calcification in a rat subdermal implantation model when they were stored in formaldehyde after cross-linking. Removal of formaldehyde storage significantly reduced calcification.
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Affiliation(s)
- Joshua Leong
- Department of Bioengineering, Clemson University, Clemson, SC 29634, USA
| | - Amy Munnelly
- Department of Bioengineering, Clemson University, Clemson, SC 29634, USA
| | - Brianna Liberio
- Department of Bioengineering, Clemson University, Clemson, SC 29634, USA
| | - Leonard Cochrane
- Department of Bioengineering, Clemson University, Clemson, SC 29634, USA
| | - Naren Vyavahare
- Department of Bioengineering, Clemson University, Clemson, SC 29634, USA
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7
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Friebe VM, Mikulis B, Kole S, Ruffing CS, Sacks MS, Vyavahare NR. Neomycin enhances extracellular matrix stability of glutaraldehyde crosslinked bioprosthetic heart valves. J Biomed Mater Res B Appl Biomater 2011; 99:217-29. [DOI: 10.1002/jbm.b.31889] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 01/13/2011] [Accepted: 02/10/2011] [Indexed: 11/08/2022]
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8
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Malafaya PB, Silva GA, Reis RL. Natural-origin polymers as carriers and scaffolds for biomolecules and cell delivery in tissue engineering applications. Adv Drug Deliv Rev 2007; 59:207-33. [PMID: 17482309 DOI: 10.1016/j.addr.2007.03.012] [Citation(s) in RCA: 794] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Accepted: 03/28/2007] [Indexed: 12/11/2022]
Abstract
The present paper intends to overview a wide range of natural-origin polymers with special focus on proteins and polysaccharides (the systems more inspired on the extracellular matrix) that are being used in research, or might be potentially useful as carriers systems for active biomolecules or as cell carriers with application in the tissue engineering field targeting several biological tissues. The combination of both applications into a single material has proven to be very challenging though. The paper presents also some examples of commercially available natural-origin polymers with applications in research or in clinical use in several applications. As it is recognized, this class of polymers is being widely used due to their similarities with the extracellular matrix, high chemical versatility, typically good biological performance and inherent cellular interaction and, also very significant, the cell or enzyme-controlled degradability. These biocharacteristics classify the natural-origin polymers as one of the most attractive options to be used in the tissue engineering field and drug delivery applications.
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Affiliation(s)
- Patrícia B Malafaya
- 3B's Research Group, Biomaterials, Biodegradables and Biomimetics, Department of Polymer Engineering, University of Minho, Campus de Gualtar, Braga, Portugal.
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9
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Freytes DO, Tullius RS, Badylak SF. Effect of storage upon material properties of lyophilized porcine extracellular matrix derived from the urinary bladder. J Biomed Mater Res B Appl Biomater 2006; 78:327-33. [PMID: 16365866 DOI: 10.1002/jbm.b.30491] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Xenogeneic extracellular matrices (ECMs) have been developed as off-the-shelf biologic scaffolds that have been effectively used in preclinical and clinical applications for tissue reconstruction. Such materials must be suitable for terminal sterilization and capable of storage for extended periods of time without significant changes in material properties and bioactivity. Material properties of interest for ECM scaffolds include hydrostatic permeability index (PI), uniaxial maximum load and elongation, maximum tangential stiffness (MTS), suture retention strength (SRS), and ball-burst strength (BBS). The present study evaluated these material properties for lyophilized forms of an ECM scaffold derived from the porcine urinary bladder, termed urinary bladder matrix (UBM), that was terminally sterilized by e-beam irradiation at 22 kGy and stored at room temperature (RT; 20-24 degrees C) or refrigerated temperature (REFT; 4-8 degrees C) for up to 12 months. UBM devices showed no change in SRS, BBS, and hydrostatic PI after the evaluation period. Lyophilized devices stored at RT showed an increase in maximum load and MTS while devices stored at REFT showed an increase in maximum elongation after 1 year of storage (p < 0.05). These results indicate that structural changes in the UBM device may slowly occur as a function of prolonged storage and storage temperature.
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Affiliation(s)
- Donald O Freytes
- McGowan Institute for Regenerative Medicine, Pittsburgh, Pennsylvania 15219, USA
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10
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Abstract
Tissue-engineered heart valves have been proposed by physicians and scientists alike to be the ultimate solution for treating valvular heart disease. Rather than replacing a diseased or defective native valve with a mechanical or animal tissue-derived artificial valve, a tissue-engineered valve would be a living organ, able to respond to growth and physiological forces in the same way that the native aortic valve does. Two main approaches have been attempted over the past 10 to 15 years: regeneration and repopulation. Regeneration involves the implantation of a resorbable matrix that is expected to remodel in vivo and yield a functional valve composed of the cells and connective tissue proteins of the patient. Repopulation involves implanting a whole porcine aortic valve that has been previously cleaned of all pig cells, leaving an intact, mechanically sound connective tissue matrix. The cells of the patients are expected to repopulate and revitalize the acellular matrix, creating living tissue that already has the complex microstructure necessary for proper function and durability. Regrettably, neither of the 2 approaches has fared well in animal experiments, and the only clinical experience with tissue-engineered valves resulted in a number of early failures and patient death. This article reviews the technological details of the 2 main approaches, their rationale, their strengths and weaknesses, and the likely mechanisms for their failure. Alternative approaches to valvular tissue engineering, as well as the role of industry in shaping this field in the future, are also reviewed.
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Affiliation(s)
- Ivan Vesely
- The Saban Research Institute of Children's Hospital Los Angeles, Keck School of Medicine, University of Southern CaliforniaLos Angeles, CA 90027, USA.
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11
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Grande-Allen KJ, Mako WJ, Calabro A, Shi Y, Ratliff NB, Vesely I. Loss of chondroitin 6-sulfate and hyaluronan from failed porcine bioprosthetic valves. J Biomed Mater Res A 2003; 65:251-9. [PMID: 12734820 DOI: 10.1002/jbm.a.10475] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Explanted porcine bioprosthetic valves have a thinned spongiosa, partially because of an overall loss of glycosaminoglycans (GAGs). We measured the concentrations of specific GAG classes in explanted bioprosthetic valves (n = 14, implanted 12.0 +/- 4.7 years) compared with glutaraldehyde-fixed porcine controls. After extraction with NaOH, GAGs were analyzed using either a hexuronic acid assay or fluorophore-assisted carbohydrate electrophoresis to quantify the individual GAG classes. The total GAG concentration in explants was 198 +/- 95 pmol/mg wet weight-93% less than freshly fixed controls. Explants also contained altered proportions of the different GAG classes relative to controls. The proportions of hyaluronan and chondroitin/dermatan-6-sulfate were reduced from 39 to 7% and 34 to 18% of total GAGs, respectively. The predominant explant GAG class was chondroitin/dermatan-4-sulfate (proportion elevated from 14 to 70%). This GAG is commonly found in the collagen-associated proteoglycan decorin, which is likely well crosslinked by glutaraldehyde. Chondroitin-6-sulfate is commonly found in the water- and hyaluronan-binding proteoglycan versican, which is likely poorly crosslinked. The loss of versican and its associated water-binding capacity is consistent with the thinned spongiosa. The resultant compromise of hydration, compressive resistance, and viscoelasticity may be responsible for the deterioration of the bioprosthesis in vivo.
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Affiliation(s)
- K Jane Grande-Allen
- Department of Biomedical Engineering, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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12
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García Páez JM, Carrera A, Herrero EJ, Millán I, Rocha A, Cordón A, Sainz N, Mendez J, Castillo-Olivares JL. Influence of the selection of the suture material on the mechanical behavior of a biomaterial to be employed in the construction of implants. Part 1: Calf pericardium. J Biomater Appl 2001; 16:47-67. [PMID: 11475359 DOI: 10.1106/gnct-31pt-jhkj-fpx5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
A hydraulic stress simulator was employed to study the mechanical behavior of the calf pericardium used in the construction of cardiac valve leaflets. One hundred eighty pairs of tissue samples were subjected to tensile testing to rupture. One of the two samples from each of 144 pairs (four series of 36 pairs each) was sutured with commercially available threads made of nylon, silk, Prolene or Gore-Tex, while the other sample in each of these pairs was left unsewn. The remaining 36 pairs were employed as controls in which neither of the two samples was subjected to suturing. The sutured tissue samples showed a significant decrease in tensile strength at rupture (range: 11.81 to 26.04 MPa) when compared with unsutured samples (range: 39.38 to 87.96 MPa; p < 0.01). The application of morphological and mechanical selection criteria to maximize the homogeneity of the samples provided excellent fit with respect to the stress/strain curves. This method made it possible to carry out a predictive study of the mechanical behavior of a sutured sample, based on that observed in the corresponding unsutured fragment. The interaction of the different suture materials with the pericardial tissue was also assessed by comparing the mechanical behavior of the sutured samples with that of the control samples. At stresses of less than 0.8 MPa, samples sewn with Gore-Tex were found to show the least difference with respect to the controls, indicating that this material presented the lowest degree of interaction with the pericardium. In conclusion, the degree of the loss of resistance to tearing of the sutured samples is of no value in the selection of the optimal suture material. The selection process applied makes it possible to predict the mechanical behavior in response to suturing of a given unsewn tissue specimen by determining that of its sutured mate. The similarity between the findings in samples sewn with Gore-Tex and in the unsutured controls indicates a lesser degree of interaction between the suture material and the pericardium employed in the construction of cardiac valve leaflets.
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Affiliation(s)
- J M García Páez
- Clínica Puerta de Hierro de Madrid, Servicio de Cirugía Experimental and Medicina Preventiva, Spain.
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13
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Abstract
Cardiac valve bioprostheses are assessed in terms of their present and future clinical utility. The problems concerning durability basically involve early failure due to tears in the valve leaflets and late failure mainly associated with calcification of the biological tissue. New strategies for selection and chemical treatment of the biomaterials employed are analyzed, and the available knowledge regarding their mechanical behavior is reviewed. It is concluded that the durability of these devices, and thus their successful use in the future, depends on the knowledge of the interactions among the different biomaterials of which they are composed, the development of new materials, and the engineering design applied in their construction.
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Affiliation(s)
- J M García Páez
- Servicio de Cirugía Experimental Clínica Puerta de Hierro, Madrid, Spain
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