Histological examination of explanted tissue-engineered bovine pericardium following heart valve repair

Deutsch, Oliver; Bruehl, Frido K.; Cleuziou, Julie; Prinzing, Anatol; Schlitter, Anna Melissa; Krane, Markus; Lange, Rüdiger

doi:10.1093/icvts/ivz234

Cited by 17 publications

(21 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We then started to use the CardioCel, which is a decellularized bovine pericardium, as the next extracellular matrix patch. Although better long-term performance was expected [ 20 ], others had experienced early failures, including calcification proven by the histopathological analysis [ 21 ]. It is well known that glutaraldehyde-fixed autologous or xenograft pericardium may be associated with late calcification and stenosis [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Early and late results of mitral valve repair with anterior leaflet patch augmentation

Kehara

Minakata

McCarthy

et al. 2022

Interactive CardioVascular and Thoracic Surgery

View full text Add to dashboard Cite

Objectives To determine the long-term results of mitral valve (MV) repair with anterior leaflet patch augmentation. Patients and Methods Between 2012 and 2015, 45 patients underwent MV repair using the anterior leaflet patch augmentation technique at our institution. The mean age of the patients was 65.9 ± 13.0 years (16 males). We reviewed the MV pathology and the surgical techniques used, and assessed the early and late results. Results In terms of MV pathology, 43 patients (95.6%) had pure mitral regurgitation (MR), and 2 patients (4.4%) had mixed mitral stenosis (MS) and MR. Rheumatic changes were seen in 18 patients (40.0%). Postoperative echocardiography showed that 95.6% of patients had none to mild MR. During a median follow-up period of 5.5 years (range 0.1 ∼ 8.3 years), there were 8 late deaths. Nine patients (20%) required reoperation. The mean interval between the initial operation and redo operation was 3.7 ± 3.1 years (range: 0.4 ∼ 7.8 years). The causes of reoperation included patch dehiscence (n = 4), progression of MS (n = 2), band dehiscence (n = 1), patch enlargement (n = 1), and unknown (n = 1). Eight patients underwent MV replacement and 1 underwent repeat MV repair. The freedom from reoperation at 3 and 5 years was 85.7 ± 6.7% and 81.2 ± 7.7%, respectively. Conclusions Anterior leaflet patch augmentation can provide excellent early results in the majority of the patients even in the presence of rheumatic pathology, however, we observed late reoperation in 20% of patients. Thus, this technique should be used with caution and careful follow-up with serial echocardiography is essential.

show abstract

Section: Discussionmentioning

confidence: 99%

Early and late results of mitral valve repair with anterior leaflet patch augmentation

Kehara

Minakata

McCarthy

et al. 2022

Interactive CardioVascular and Thoracic Surgery

View full text Add to dashboard Cite

show abstract

“…Others discovered fragmentations of collagen matrix, nodular disruption and sclerosis and confirmed calcification of CardioCel®. While they could identify neointima formation, endothelialization of the graft could not be confirmed ( 2 ).…”

Section: Discussionmentioning

confidence: 99%

“…Clinically, these observations are even more apparent: in a retrospective analysis of the CardioCel® patch, longevity of the implanted material was limited, as freedom from reoperation was only 57% after 3 years ( 13 ). In another study, 9 of 60 adult men who received a CardioCel® patches in a valvular position needed reoperation, 6 of them due to focal calcification and consecutive valve dysfunction ( 2 ). Pavy et al experienced graft failure of CardioCel® when implanted in aortic position ( 14 ).…”

Section: Discussionmentioning

confidence: 99%

“…Matrix patch™ (Auto Tissue GmbH Berlin, Berlin, Germany) is a decellularized equine pericardial patch, with a low RNA and DNA content, fixed in glutaraldehyde ( 1 ). CardioCel ® (LeMaitre Vascular, Inc., Burlington, MA, USA), a bovine pericardial patch, is treated with the so-called APAPT ® anti-calcification process including removal of cell particles and nucleic acids as well as minimization of glutaraldehyde cytotoxicity levels ( 2 ). Manufacturers of Supple Peri-Guard ® and Vascu-Guard ® Patches (LaMed, Oberhaching, Germany), other patches of bovine origin, put an emphasis on the “acellular” aspect of the patch and its permanent tear strength ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Industrial Processing Induces Pericardial Patch Degeneration

et al. 2022

View full text Add to dashboard Cite

BackgroundAutologous pericardium is considered gold standard for various reconstructive surgical procedures in children. However, processed bovine, equine, and porcine pericardial tissue are also widely used. We investigated structural differences and analyzed alterations caused by industrial processing. Additionally human and equine pericardium explants, used during aortic valve reconstruction were analyzed.MethodsPericardial tissues (native, processed and explanted) were gathered and stained with HE and EvG to visualize collagen as well as elastic fibers. Fiber structures were visualized by light and polarization microscopy. Antibody staining against CD 3, CD 20, and CD 68 was performed to identify inflammation.ResultsNative pericardium of different species showed small differences in thickness, with bovine pericardium being the thickest [bovine: 390 μm (± 40.6 μm); porcine: 223 μm (± 30.1 μm); equine: 260 μm (± 28.4 μm)]. Juvenile pericardium was 277 μm (± 26.7 μm). Single collagen bundle diameter displayed variations (~3–20 μm). Parallel collagen fibers were densely packed with small inter-fibrillary space. After industrial tissue processing, loosening of collagen network with inter-fibrillary gapping was observed. Pericardium appeared thicker (mean values ranging from 257–670 μm). Processed tissue showed less birefringence under polarized light. All analyzed tissues showed a small number of elastic fibers. Fibrosis, calcification and inflammatory processes of autologous and equine pericardium were observed in patient explants.ConclusionNone of the analyzed tissues resembled the exact structure of the autologous pericardial explant. Degeneration of pericardium starts during industrial processing, suggesting a potential harm on graft longevity in children. A careful surgical approach prior to the implantation of xenografts is therefore needed.

show abstract

“… 80 , 87 , 88 In a study where 15% (9/60) CardioCel heart valve grafts from both adults and children failed, all explanted grafts showed matrix degeneration and a lack of recellularization. 89 …”

Section: Allogeneic and Xenogeneic Materialsmentioning

confidence: 99%

Bioengineering Human Tissues and the Future of Vascular Replacement

Naegeli

Kural

et al. 2022

Circulation Research

View full text Add to dashboard Cite

Cardiovascular defects, injuries, and degenerative diseases often require surgical intervention and the use of implantable replacement material and conduits. Traditional vascular grafts made of synthetic polymers, animal and cadaveric tissues, or autologous vasculature have been utilized for almost a century with well-characterized outcomes, leaving areas of unmet need for the patients in terms of durability and long-term patency, susceptibility to infection, immunogenicity associated with the risk of rejection, and inflammation and mechanical failure. Research to address these limitations is exploring avenues as diverse as gene therapy, cell therapy, cell reprogramming, and bioengineering of human tissue and replacement organs. Tissue-engineered vascular conduits, either with viable autologous cells or decellularized, are the forefront of technology in cardiovascular reconstruction and offer many benefits over traditional graft materials, particularly in the potential for the implanted material to be adopted and remodeled into host tissue and thus offer safer, more durable performance. This review discusses the key advances and future directions in the field of surgical vascular repair, replacement, and reconstruction, with a focus on the challenges and expected benefits of bioengineering human tissues and blood vessels.

show abstract

Histological examination of explanted tissue-engineered bovine pericardium following heart valve repair

Cited by 17 publications

References 18 publications

Early and late results of mitral valve repair with anterior leaflet patch augmentation

Early and late results of mitral valve repair with anterior leaflet patch augmentation

Industrial Processing Induces Pericardial Patch Degeneration

Bioengineering Human Tissues and the Future of Vascular Replacement

Contact Info

Product

Resources

About