Small intestinal submucosa extracellular matrix (CorMatrix®) in cardiovascular surgery: a systematic review

Abstract

Extracellular matrix (ECM) derived from small intestinal submucosa (SIS) is widely used in clinical applications as a scaffold for tissue repair. Recently, CorMatrix® porcine SIS-ECM (CorMatrix Cardiovascular, Inc., Roswell, GA, USA) has gained popularity for 'next-generation' cardiovascular tissue engineering due to its ease of use, remodelling properties, lack of immunogenicity, absorbability and potential to promote native tissue growth. Here, we provide an overview of the biology of porcine SIS-ECM and systematically review the preclinical and clinical literature on its use in cardiovascular surgery. CorMatrix® has been used in a variety of cardiovascular surgical applications, and since it is the most widely used SIS-ECM, this material is the focus of this review. Since CorMatrix® is a relatively new product for cardiovascular surgery, some clinical and preclinical studies published lack systematic reporting of functional and pathological findings in sufficient numbers of subjects. There are also emerging reports to suggest that, contrary to expectations, an undesirable inflammatory response may occur in CorMatrix® implants in humans and longer-term outcomes at particular sites, such as the heart valves, may be suboptimal. Large-scale clinical studies are needed driven by robust protocols that aim to quantify the pathological process of tissue repair.

Strategies to develop endogenous stem cell-recruiting bioactive materials for tissue repair and regeneration

“…Similarly, a promising material for myocardial regeneration is the ECM derived from porcine small intestinal submucosa (SIS-ECM) which is commercially available as a patch (CorMatrix®) to enhance the repair of the pericardium after surgery and for other cardiovascular surgical applications [138]. SIS-ECM is biodegradable and is capable of inducing the recruitment of marrow-derived stem cells and proliferation of cardiomyocytes at the site of implantation.…”

The Effect of Extracellular Matrix Patch on Femoral Artery after Endarterectomy

“…Spectral studies of CorMatrix in cardiovascular surgery have few reports of complications when it is used in the low-pressure vessels, usually extracardiac environment, but when it is used at the higher pressure, the intracardiac sites such as the aortic valve complications are more likely to occur [21]. CorMatrix is used as a patch in cardiovascular operations [21,25,26]. In the study of Weber and al., implanted patches in the carotid position resulted in 10% incidence of pseudoaneurysm formation [27].…”

“…Handling is easy and it does not create calcification, thickening or retraction with minor inflammation. It has been used in cardiovascular applications, including paediatric patients [21]. Several large animal studies testing this material in vascular locations have reported positive results [22][23][24].…”

Decellularized muscle‐derived hydrogels support in vitro cardiac microtissue fabrication

“…In this study, for the first time, we have shown the potential for D‐SIS to allow hESC‐derived CPC differentiation into cardiomyocytes. ECM scaffolds based on decellularized SIS, especially CorMatrix® porcine SIS‐ECM, have been previously applied for cardiac tissue engineering; however, cardiac lineage commitment of cells on these matrices was not reported (Mosala Nezhad et al, 2016). Furthermore, our findings showed that decellularized Ao as well as a highly vascular tissue (hUC) well supported differentiation of CPCs into the vessel lining cells, including endothelial and smooth muscle cells.…”