Author + information
- Zahra Mosala Nezhad1,
- Alain Poncelet1,
- Caroline Fervaille2,
- Jean-Paul Dehoux3,
- Gebrine Elkhoury1 and
- Pierre Gianello4
- 1Universite Catholique de Louvain UCL-Institute of Experimental and Clinical Research (IREC), Division of Cardiovascular research (CARD), Saint-Luc University hospital, Department of cardiovascular and thoracic surgery, Brussels, Belgium
- 2Universite Catholique de Louvain UCL-Godinne University Hospital-CHU, Laboratory of Anatomy Pathology, Brussels, Belgium
- 3Universite Catholique de Louvain UCL-Health Sciences sector, Faculty of Medicine and Dentistry, Animals housing facility, Brussels, Belgium
- 4Universite Catholique de Louvain UCL-Institute of Experimental and Clinical Research (IREC), Division of Experimental surgery and transplantation (CHEX), Brussels, Belgium
To compare biodegradation and local tissue reactions to porcine small intestinal submucosa (CorMatrix; Roswell, GA) and three other commercial cardiac tissue substitutes (porcine pericardium (Vascutek; Scotland, UK); bovine pericardium (SJM; St Paul, MN); and GoreTex (expanded polytetrafluoroethylene.(L. Gore & Associates, Inc., Flagstaff, AZ)) in allograft (pig) and xenograft (sheep) models over one year.
Three miniature pigs and adult sheep were studied, each representing a time point (1, 3, and 12 months). Materials were implanted subcutaneously and tissue explants processed for histology and immunohistochemistry, and parameters were graded semi-quantitatively (1+ = mild; 2+ = moderate; 3+ = severe).
Pig model: At 1 and 3 months, CorMatrix showed gradual degradation (mild to moderate), and was surrounded by dense fibrosis (2+) and severe inflammation (3+). By one year, it was fully degraded and replaced with fibrosis (1+) and subcutaneous tissues. At 1 month, Vascutek was intact, surrounded by moderate fibrosis (2+) and severe inflammatory reaction (3+). By three months, inflammation was mainly perivascular (2+) and increased encapsulating fibrosis (3+). It remained intact at 12 months but with reduced fibrosis (1+) and mild chronic inflammation (1+). SJM explants were similar to Vascutek but with significantly less encapsulating fibrosis (1+) and inflammation at three months, which remained stable thereafter. GoreTex was visible as exogenous material in a fibrotic capsule (2+), which reduced after one month, and moderate inflammation (2+).
Sheep model: CorMatrix was partially fragmented and disintegrated at 1 month, with severe fibrosis and inflammation (3+). Afterwards, the patch was invisible, with moderate inflammation and more severe fibrosis (3+), which reduced by 1 year. Vascutek (intact and encapsulated) and SJM (partially fragmented) explants showed mild chronic inflammation at 1 month which increased at 3 months and 1 year (1+). Fibrosis was moderate (2+) and intensified thereafter (3+). The GoreTex was intact with a fibrotic capsule.
The biological patches were biocompatible in both models. CorMatrix was resorbed and showed signs of early degradation. All materials except CorMatrix, were encapsulated. Biological materials support healing and remodelling, while GorTex elicits a typical foreign body-type reaction. The processes were accelerated in sheep. We cautiously suggest that CorMatrix, when used as a xenomaterial, exhibits a more intense tissue reaction.