Adam E. Saltman1, Jacques P. Guyette2, Damon Kelly3, Daniel V. Filipe2, Megan K. Murphy2, Deep Singh2, Nicholas S. McBride2, George D. Pins2, B. N. Oray4, Glenn R. Gaudette2.
1Maimonides Medical Center, Brooklyn, NY, USA, 2Worcester Polytechnic Institute, Worcester, MA, USA, 3Stony Brook University, Stony Brook, NY, USA, 4Synovis Life Technologies, St. Paul, MN, USA.
OBJECTIVE: Myocardial infarctions damage heart muscle, depress ventricular function and often result in aneurysm formation. Recent advances in ventricular remodeling have benefited patients with post-infarction aneurysms, yet only synthetic patches have been used in these procedures. We hypothesized that replacement of infarcted tissue with a scaffold that supports cardiac muscle regeneration while maintaining mechanical integrity would further enhance the benefit of the ventricular remodeling procedure.
METHODS:: A 1x2 cm full thickness right ventricular defect was created in the normal canine heart and replaced with a pericardial-based bio-scaffold (n = 4) or woven polyester (n = 4) as control. Eight weeks after implantation, regional function was determined within the implant region using a novel high resolution technique in order to test for regenerative capacity and functional performance. The implant region was also immunostained for myocyte content and vascularization. Tensile strength and suture retention were used to determine the mechanical properties of the bio-scaffold.
RESULTS:The tensile strength of the bio-scaffold was sufficient to withstand an intracavitary pressure of >300 mmHg. In addition, the suture retention capabilities exceeded the specifications. After 8 weeks of recovery, systolic area contraction, a measurement of regional mechanical function, in the bio-scaffold implant region exceeded that of Dacron (+1.5 +/- 0.5% vs. -1.8 +/- 1.1%, p<0.05). Immunostaining showed striated myocytes that were positive for alpha-actinin within the implant boundary, many of which demonstrated connexin 43 staining, suggesting the formation of gap junctions between myocytes.
CONCLUSIONS: A pericardial-based bioscaffold can support cardiac myocyte regeneration after implantation in the working heart and demonstrate mechanical function while providing mechanical integrity. Its performance in these regards exceeds those of commonly used inert implants such as woven polyester.
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