Abbas Haider Zaidi1, Meena Nathan2, Sitaram Emani2, Christopher Baird2, Pedro J del Nido2, Kimberlee Gauvreau1, Marian Harris3, Stephen P Sanders4, Robert F Padera5. 1. Department of Cardiology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass. 2. Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass; Department of Surgery, Harvard Medical School, Boston, Mass. 3. Department of Pathology, Boston Children's Hospital, Boston, Mass; Department of Pathology, Harvard Medical School, Boston, Mass. 4. Department of Cardiology, Boston Children's Hospital, Boston, Mass; Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass; Department of Pathology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass. Electronic address: stephen.sanders@childrens.harvard.edu. 5. Department of Pathology, Boston Children's Hospital, Boston, Mass; Department of Pathology, Brigham and Women's Hospital, Boston, Mass; Department of Pathology, Harvard Medical School, Boston, Mass.
Abstract
OBJECTIVE: We compared the histologic findings in explanted CorMatrix (9 patients) and autologous pericardium (9 patients) used for valvuloplasty of the aortic (7 patients) and/or mitral (11 patients) valve in patients with congenital heart defects. METHODS: We used standard tissue stains and immunohistochemistry to identify the inflammatory cell type. RESULTS: CorMatrix was associated with an intense inflammatory response in the surrounding native tissue, extending into CorMatrix in 8 of 9 cases, continuing to the longest follow-up point (9 months). The typical response included macrophages and giant cells in contact with the material, surrounded by lymphocytes, macrophages, plasma cells, and eosinophils. The thickness of the residual CorMatrix material was 280 to 300 μm, similar to the nominal thickness at implantation and unrelated to the implantation duration. Only at the longest follow-up interval was any significant resorption of CorMatrix material evident. A neointima had formed on the surface of CorMatrix, increasing in thickness with the period in situ. Mild cellular infiltration of CorMatrix was noted in all cases; however, in no case, did it appear that CorMatrix was being remodeled into tissue resembling a 3-layered native valve. In contrast, a near absence of any inflammatory reaction was seen and no eosinophilia associated with autologous pericardium was present, irrespective of the duration in situ. Furthermore, we observed more tissue infiltration, remodeling, vascularization, and neointima formation with autologous pericardium. CONCLUSIONS: Although CorMatrix used for valve repair induced an intense inflammatory response, little or no remodeling to form tissue resembling a 3-layered native valve was seen at ≤9 months after implantation.
OBJECTIVE: We compared the histologic findings in explanted CorMatrix (9 patients) and autologous pericardium (9 patients) used for valvuloplasty of the aortic (7 patients) and/or mitral (11 patients) valve in patients with congenital heart defects. METHODS: We used standard tissue stains and immunohistochemistry to identify the inflammatory cell type. RESULTS: CorMatrix was associated with an intense inflammatory response in the surrounding native tissue, extending into CorMatrix in 8 of 9 cases, continuing to the longest follow-up point (9 months). The typical response included macrophages and giant cells in contact with the material, surrounded by lymphocytes, macrophages, plasma cells, and eosinophils. The thickness of the residual CorMatrix material was 280 to 300 μm, similar to the nominal thickness at implantation and unrelated to the implantation duration. Only at the longest follow-up interval was any significant resorption of CorMatrix material evident. A neointima had formed on the surface of CorMatrix, increasing in thickness with the period in situ. Mild cellular infiltration of CorMatrix was noted in all cases; however, in no case, did it appear that CorMatrix was being remodeled into tissue resembling a 3-layered native valve. In contrast, a near absence of any inflammatory reaction was seen and no eosinophilia associated with autologous pericardium was present, irrespective of the duration in situ. Furthermore, we observed more tissue infiltration, remodeling, vascularization, and neointima formation with autologous pericardium. CONCLUSIONS: Although CorMatrix used for valve repair induced an intense inflammatory response, little or no remodeling to form tissue resembling a 3-layered native valve was seen at ≤9 months after implantation.
Authors: Adeel Ashfaq; Amit Iyengar; Oh Jin Kwon; Mohammad S Soroya; Son Nguyen; Ryan Ou; Brian Reemtsen Journal: Pediatr Cardiol Date: 2017-07-15 Impact factor: 1.655
Authors: Emanuela S Fioretta; Sarah E Motta; Valentina Lintas; Sandra Loerakker; Kevin K Parker; Frank P T Baaijens; Volkmar Falk; Simon P Hoerstrup; Maximilian Y Emmert Journal: Nat Rev Cardiol Date: 2020-09-09 Impact factor: 32.419