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European Surgical Research
Research Article
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Schilling T.a· Meyer T.a· Brandes G.b· Hartung D.c· Tudorache I.a· Nolte I.d· Wacker F.c· Hilfiker A.a· Höffler K.a· Haverich A.a· Cebotari S.aaDepartment of Cardiothoracic, Transplantation, and Vascular Surgery, Medical School Hannover, Hannover, Germany
bInstitute of Neuroanatomy and Cell Biology, Medical School Hannover, Hannover, Germany
cInstitute for Radiology, Hannover Medical School, Hannover, Germany
dClinic for Small Animals, University of Veterinary Medicine Hannover Foundation, Hannover, Germany
Tobias Schilling, schilling.tobias@mh-hannover.de
AbstractIntroduction: Surgical replacement of dysfunctional cardiac muscle with regenerative tissue is an important option to combat heart failure. But, current available myocardial prostheses like a Dacron or a pericardium patch neither have a regenerative capacity nor do they actively contribute to the heart’s pump function. This study aimed to show the feasibility of utilizing a vascularized stomach patch for transmural left ventricular wall reconstruction. Methods: A left ventricular transmural myocardial defect was reconstructed by performing transdiaphragmatic autologous transplantation of a vascularized stomach segment in six Lewe minipigs. Three further animals received a conventional Dacron patch as a control treatment. The first 3 animals were followed up for 3 months until planned euthanasia, whereas the observation period for the remaining 3 animals was scheduled 6 months following surgery. Functional assessment of the grafts was carried out via cardiac magnetic resonance tomography and angiography. Physiological remodeling was evaluated histologically and immunohistochemically after heart explantation. Results: Five out of six test animals and all control animals survived the complex surgery and completed the follow-up without clinical complications. One animal died intraoperatively due to excessive bleeding. No animal experienced rupture of the stomach graft. Functional integration of the heterotopically transplanted stomach into the surrounding myocardium was observed. Angiography showed development of connections between the gastric graft vasculature and the coronary system of the host cardiac tissue. Conclusions: The clinical results and the observed physiological integration of gastric grafts into the cardiac structure demonstrate the feasibility of vascularized stomach tissue as myocardial prosthesis. The physiological remodeling indicates a regenerative potential of the graft. Above all, the connection of the gastric vessels with the coronary system constitutes a rationale for the use of vascularized and, therefore, viable stomach tissue for versatile tissue engineering applications.
© 2022 The Author(s). Published by S. Karger AG, Basel
References Statista GmbH. Häufigste Todesursachen in Deutschland. Hamburg: 2021 [cited 2021 Jul 1]. Available from: https://de.statista.com/themen/69/todesursachen/. Dor V, Saab M, Coste P, Kornaszewska M, Montiglio F. Left ventricular aneurysm: a new surgical approach. Thorac Cardiovasc Surg. 1989 Feb;37(1):11–9. Calafiore AM, Iaco AL, Abukoudair W, Penco M, Di MM. Left ventricular surgical remodeling after the STICH trial. Thorac Cardiovasc Surg. 2011 Jun;59(4):195–200. Schilling T, Cebotari S, Tudorache I, Haverich A. Tissue engineering of vascularized myocardial prosthetic tissue. Biological and solid matrices. Chirurg. 2011 Apr;82(4):319–24. Acker MA, Hammond RL, Mannion JD, Salmons S, Stephenson LW. Skeletal muscle as the potential power source for a cardiovascular pump: assessment in vivo. Science. 1987 Apr;236(4799):324–7. Beck CS. The development of a new blood supply to the heart by operation. Ann Surg. 1935 Nov;102(5):801–13. Lovett M, Lee K, Edwards A, Kaplan DL. Vascularization strategies for tissue engineering. Tissue Eng Part B Rev. 2009 Sep;15(3):353–70. Percie du Sert N, Hurst V, Ahluwalia A, Alam S, Avey MT, Baker M, et al. The ARRIVE guidelines 2.0: updated guidelines for reporting animal research. J Physiol. 2020;598:3793. McMurray JJ, Stewart S. Epidemiology, aetiology, and prognosis of heart failure. Heart. 2000 May;83(5):596–602. Badylak SF, Kochupura PV, Cohen IS, Doronin SV, Saltman AE, Gilbert TW, et al. The use of extracellular matrix as an inductive scaffold for the partial replacement of functional myocardium. Cell Transplant. 2006;15:S29–40. Burugapalli K, Pandit A. Characterization of tissue response and in vivo degradation of cholecyst-derived extracellular matrix. Biomacromolecules. 2007 Nov;8(11):3439–51. Kanamori T, Watanabe G, Yasuda T, Nagamine H, Kamiya H, Koshida Y. Hybrid surgical angiogenesis: omentopexy can enhance myocardial angiogenesis induced by cell therapy. Ann Thorac Surg. 2006 Jan;81(1):160–7. Taheri SA, Yeh J, Batt RE, Fang Y, Ashraf H, Heffner R, et al. Uterine myometrium as a cell patch as an alternative graft for transplantation to infarcted cardiac myocardium: a Preliminary Study. Int J Artif Organs. 2008 Jan;31(1):62–7. Wang B, Borazjani A, Tahai M, Curry AL, Simionescu DT, Guan J, et al. Fabrication of cardiac patch with decellularized porcine myocardial scaffold and bone marrow mononuclear cells. J Biomed Mater Res A. 2010 Sep;94(4):1100–10. Wei HJ, Chen SC, Chang Y, Hwang SM, Lin WW, Lai PH, et al. Porous acellular bovine pericardia seeded with mesenchymal stem cells as a patch to repair a myocardial defect in a syngeneic rat model. Biomaterials. 2006 Nov;27(31):5409–19. Ota T, Gilbert TW, Badylak SF, Schwartzman D, Zenati MA. Electromechanical characterization of a tissue-engineered myocardial patch derived from extracellular matrix. J Thorac Cardiovasc Surg. 2007 Apr;133(4):979–85. Wainwright JM, Hashizume R, Fujimoto KL, Remlinger NT, Pesyna C, Wagner WR, et al. Right ventricular outflow tract repair with a cardiac biologic scaffold. Cells Tissues Organs. 2012;195(1–2):159–70. Ruel MA, Sellke FW, Bianchi C, Khan TA, Faro R, Zhang JP, et al. Endogenous myocardial angiogenesis and revascularization using a gastric submucosal patch. Ann Thorac Surg. 2003 May;75(5):1443–9. Article / Publication DetailsFirst-Page Preview
Received: September 15, 2021
Accepted: January 13, 2022
Published online: February 08, 2022
Number of Print Pages: 8
Number of Figures: 4
Number of Tables: 0
ISSN: 0014-312X (Print)
eISSN: 1421-9921 (Online)
For additional information: https://www.karger.com/ESR
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