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The current standard of care for pediatric patients with unrepairable congenital valvular disease is a heart valve implant. However, current heart valve implants are unable to accommodate the somatic growth of the recipient, preve...
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The current standard of care for pediatric patients with unrepairable congenital valvular disease is a heart valve implant. However, current heart valve implants are unable to accommodate the somatic growth of the recipient, preventing long-term clinical success in these patients. Therefore, there is an urgent need for a growing heart valve implant for children. This article reviews recent studies investigating tissue-engineered heart valves and partial heart transplantation as potential growing heart valve implants in large animal and clinical translational research. In vitro and in situ designs of tissue engineered heart valves are discussed, as well as the barriers to clinical translation.
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Abstract Background Prior studies have demonstrated deleterious outcomes for physician–patient racial discordance. We explored recipient–surgeon racial concordance and short‐term postoperative survival in adults undergoing orth...
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Abstract Background Prior studies have demonstrated deleterious outcomes for physician–patient racial discordance. We explored recipient–surgeon racial concordance and short‐term postoperative survival in adults undergoing orthotopic heart transplantation (OHT). Methods The United Network for Organ Sharing (UNOS) database was queried to identify White and Black adult (≥18 years) patients undergoing isolated OHT between 2000 and 2020. Surgeon race was obtained from publicly available images. All non‐White and?non‐Black recipients and surgeons were excluded. Linear probability models were utilized to explore the relationship between recipient–surgeon racial concordance and 30‐, 60‐, and 90‐day post‐transplant mortality using a fixed effects approach. Results A total of 26,133 recipients were identified (mean age 52.79 years, 74.4% male) with 77.65% (n?=?20,292) being White and 22.35% (n?=?5841) being Black. A total of 662 White surgeons performed 25,946 (97.56%) OHTs during the study period while 17 Black surgeons performed 437 (1.67%) OHTs. Although some evidence of differences across groups was observed in cross‐tabular specifications, these differences became insignificant after the inclusion of controls (i.e., comorbidities and fixed effects). This suggests that recipient race and physician race are?not correlated with post‐OHT survival at 30, 60, or 90 days. Conclusions Recipient–surgeon racial concordance and discordance among adults undergoing OHT do?not appear to impact post‐transplant survival. Nor do we observe significant penalties accruing for Black patients overall once controls are accounted for. Given that worse outcomes have historically been demonstrated for Black patients undergoing OHT, further work will be necessary to improve understanding of racial disparities for patients with end‐stage heart failure.
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Abstract Background Postoperative pericardial adhesions have been associated with increased morbidity, mortality, and surgical difficulty. Barriers exist to limit adhesion formation, yet little is known about their use in cardiac ...
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Abstract Background Postoperative pericardial adhesions have been associated with increased morbidity, mortality, and surgical difficulty. Barriers exist to limit adhesion formation, yet little is known about their use in cardiac surgery. The study presented here provides the first major systematic review of adhesion barriers in cardiac surgery. Methods Scopus and PubMed were assessed on November 20, 2020. Inclusion criteria were clinical studies on human subjects, and exclusion criteria were studies not published in English and case reports. Risk of bias was evaluated with the Cochrane Risk of Bias Tool. Barrier efficacy data was assessed with Excel and GraphPad Prism 5. Results Twenty‐five studies were identified with a total of 13 barriers and 2928 patients. Polytetrafluoroethylene (PTFE) was the most frequently evaluated barrier (13 studies, 67% of patients) with adhesion formation rate of 37.31% and standardized tenacity score of 26.50. Several barriers had improved efficacy. In particular, Cova CARD had a standardized tenacity score of 15.00. Conclusions Overall, the data varied considerably in terms of study design and reporting bias. The amount of data was also limited for the non‐PTFE studies. PTFE has historically been effective in preventing adhesions. More recent barriers may be superior, yet the current data is nonconfirmatory. No ideal adhesion barrier currently exists, and future barriers must focus on the requirements unique to operating in and around the heart.
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Background: Bronchial artery revascularization (BAR) during lung transplantation has been hypothesized to improve early tracheal healing and delay the onset of bronchiolitis obliterans syndrome (BOS). We aimed to assess the outcom...
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Background: Bronchial artery revascularization (BAR) during lung transplantation has been hypothesized to improve early tracheal healing and delay the onset of bronchiolitis obliterans syndrome (BOS). We aimed to assess the outcomes of BAR after lung transplantation. Methods: Electronic search in Ovid Medline, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Scopus, and Cochrane Controlled Trials Register (CCTR) databases was performed to identify all relevant studies published about lung transplantation with BAR. Studies discussing lung transplantation utilizing BAR were included while those without outcome data such as BOS and survival were excluded. Cohort-level data were extracted and pooled for analysis. A binary outcome meta-analysis of proportions with logit transformation was conducted. Newcastle-Ottawa scale was used for risk of bias assessment. Results: Seven studies were selected for the analysis comprising 143 patients. Mean patient age was 47 (95% CI: 40–55) years. Sixty-one percent (48–72%) were male. Seventy-three percent (65–79%) of patients underwent double lung transplant while 27% (21–25%) underwent single lung transplant. In patients with postoperative angiography, successful BAR was demonstrated in 93% (82–97%) of all assessed conduits. The 30-day/in-hospital mortality was 6% (3–11%). Seventy-nine percent (63–89%) of patients were free from rejection at three months. Eighty-three percent (29–98%) of patients were free from signs of airway ischemia at three and six months. Pooled survival at one year and five years was 87% (78–92%) and 71% (46–87%), respectively, with a mean follow-up time of 21 (3–38) months. Pooled freedom from bronchiolitis obliterans was 86% (77–91%) at two years. Conclusions: While this systematic review and meta-analysis is limited by the available surgeons, institutions, and papers discussing a highly specialized technique, it does show that BAR is a viable technique to minimize BOS and early anastomotic intervention following lung transplantation.
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Separation of traumatized tissue represents the only promising strategy in postoperative adhesion prevention, a relevant clinical problem after surgical intervention. In the present study scanning electron microscopy (SEM) and sub...
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Separation of traumatized tissue represents the only promising strategy in postoperative adhesion prevention, a relevant clinical problem after surgical intervention. In the present study scanning electron microscopy (SEM) and subsequent morphometry were used to analyse the tissue response to five commercial adhesion barriers. Standardised peritoneal lesions in Wistar rats were covered with solid and viscous barrier materials and semiquantita-tively analysed 14 days postoperatively. Striking morphological differences in lesion surface organisation between the barrier groups became apparent with colonisation of the barrier by mesothelial cells to different degrees. Furthermore, the mesothelial cells showed either a normal or activated phenotype depending on the underlying bioma-terial. These experiments demonstrate that the examination by SEM gives useful insights into the performance of barrier materials and the cellular processes of adhesion prevention, since mesothelial cells play an active role in the pathogenesis of adhesion formation.
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Animal models for adhesion induction are heterogeneous and often poorly described. We compare and discuss different models to induce peritoneal adhesions in a randomized, experimental in vivo animal study with 72 female Wistar rat...
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Animal models for adhesion induction are heterogeneous and often poorly described. We compare and discuss different models to induce peritoneal adhesions in a randomized, experimental in vivo animal study with 72 female Wistar rats. Six different standardized techniques for peritoneal trauma were used: brushing of peritoneal sidewall and uterine horns (group 1), brushing of parietal peritoneum only (group 2), sharp excision of parietal peritoneum closed with interrupted sutures (group 3), ischemic buttons by grasping the parietal peritoneum and ligating the base with Vicryl suture (group 4), bipolar electrocoagulation of the peritoneum (group 5), and traumatisation by electrocoagulation followed by closure of the resulting peritoneal defect using Vicryl sutures (group 6). Upon second look, there were significant differences in the adhesion incidence between the groups (P < 0.01). Analysis of the fraction of adhesions showed that groups 2 (0%) and 5 (4%) were significantly less than the other groups (P < 0.01). Furthermore, group 6 (69%) was significantly higher than group 1 (48%) (P < 0.05) and group 4 (47%) (P < 0.05). There was no difference between group 3 (60%) and group 6 (P = 0.2). From a clinical viewpoint, comparison of different electrocoagulation modes and pharmaceutical adhesion barriers is possible with standardised models.
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The first successful mitral valve repair was performed by Elliot Cutler at Brigham and Women’s Hospital in 1923. Subsequent evolution in the surgical techniques as well as multi-disciplinary cooperation between cardiac surgeons, ...
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The first successful mitral valve repair was performed by Elliot Cutler at Brigham and Women’s Hospital in 1923. Subsequent evolution in the surgical techniques as well as multi-disciplinary cooperation between cardiac surgeons, cardiologists and cardiac anesthesiologists has resulted in excellent outcomes. In spite of this, the etiology of mitral valve pathology ultimately determines the outcome of mitral valve repair.
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Abstract Introduction Partial heart transplants are a new type of pediatric transplant that replace defective heart valves with the parts of matched donor hearts containing the necessary valves. Short‐term outcomes of partial hea...
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Abstract Introduction Partial heart transplants are a new type of pediatric transplant that replace defective heart valves with the parts of matched donor hearts containing the necessary valves. Short‐term outcomes of partial heart transplants are excellent, but long‐term outcomes are unknown. In order to predict the long‐term outcomes of partial heart transplants, we evaluated long‐term growth and function of semilunar heart valves transplanted in infancy as part of a heart transplant. Methods All children who underwent infant heart transplantation at a single center from 1997 to 2014 were included in this study. Children in whom echocardiograms after heart transplantation and after 10?years were not available for review were excluded. The echocardiograms were reviewed by two authors to analyze semilunar valve annulus diameters, Z‐scores, peak valve gradients, and valve regurgitation. Statistical difference was determined using two‐tailed, paired sample t‐tests with Bonferroni correction for multiple comparisons. Results Data from 15 patients were analyzed. The aortic valve annulus averaged 1.3?cm (range 0.7–1.8?cm) immediately after transplantation and grew to an average of 1.7?cm (range 1.4–2.3?cm) after 10?years (p?收起
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Abstract Background Partial heart transplantation delivers growing heart valve implants by transplanting the part of the heart containing the necessary heart valve only. In contrast to heart transplantation, partial heart transpla...
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Abstract Background Partial heart transplantation delivers growing heart valve implants by transplanting the part of the heart containing the necessary heart valve only. In contrast to heart transplantation, partial heart transplantation spares the native ventricles. This has important implications for partial heart transplant biology, including the allowable ischemia time, optimal graft preservation, primary graft dysfunction, immune rejection, and optimal immunosuppression. Aims Exploration of partial heart transplant biology will depend on suitable animal models. Here we review our experience with partial heart transplantation in rodents, piglets, and non‐human primates. Materials & Methods This review is based on our experience with partial heart transplantation using over 100 rodents, over 50 piglets and one baboon. Results Suitable animal models for partial heart transplantation include rodent heterotopic partial heart transplantation, piglet orthotopic partial heart transplantation, and non‐human primate partial heart xenotransplantation. Discussion Rodent models are relatively cheap and offer extensive availability of research tools. However, rodent open‐heart surgery is technically not feasible. This limits rodents to heterotopic partial heart transplant models. Piglets are comparable in size to children. This allows for open‐heart surgery using clinical grade equipment for orthoptic partial heart transplantation. Piglets also grow rapidly, which is useful for studying partial heart transplant growth. Finally, nonhuman primates are immunologically most closely related to humans. Therefore, nonhuman primates are most suitable for studying partial heart transplant immunobiology and xenotransplantation. Conclusions Animal research is a privilege that is contingent on utilitarian ethics and the 3R principles of replacement, reduction and refinement. This privilege allows the research community to seek fundamental knowledge about partial heart transplantation, and to apply this knowledge to enhance the health of children who require partial heart transplants.
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Abstract Background The treatment of babies with unrepairable heart valve dysfunction remains an unsolved problem because there are no growing heart valve implants. However, orthotopic heart transplants are known to grow with reci...
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Abstract Background The treatment of babies with unrepairable heart valve dysfunction remains an unsolved problem because there are no growing heart valve implants. However, orthotopic heart transplants are known to grow with recipients. Aim Partial heart transplantation is a new approach to delivering growing heart valve implants, which involves transplantation of the part of the heart containing the valves only. In this review, we discuss the benefits of this procedure in children with unrepairable valve dysfunction. Conclusion Partial heart transplantation can be performed using donor hearts with poor ventricular function and slow progression to donation after cardiac death. This should ameliorate donor heart utilization and avoid both primary orthotopic heart transplantation in children with unrepairable heart valve dysfunction and progression of these children to end‐stage heart failure.
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