Nelson Jennifer S, Heider Amer, Si Ming-Sing, Ohye Richard G
Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan.
Ann Thorac Surg. 2016 Oct;102(4):1329-35. doi: 10.1016/j.athoracsur.2016.03.086. Epub 2016 May 27.
Animal data demonstrate that intracardiac patches of decellularized porcine small intestine submucosa (CorMatrix; CorMatrix Cardiovascular, Inc, Atlanta, GA) become repopulated with native cells, suggesting the possibility of a substrate for regenerative tissue in humans. We report the only prospective series to date of explanted CorMatrix patches placed in infants with congenital heart disease.
CorMatrix patches were implanted as the hemi-Fontan baffle in patients during their second stage of palliation. The patch material was explanted as part of the standard Fontan operation. Specimens were analyzed with the use of hematoxylin and eosin, Movat pentachrome, and trichrome stains.
Of the 12 implantations, 10 specimens were explanted. Two patients did not undergo Fontan because of unfavorable hemodynamics. Acellular material, chronic inflammation, fibrosis, and foreign body giant cell reaction was seen in all explanted patches. Also noted in explanted specimens was calcification (n = 2), elastic fibers (n = 2), and eosinophils (n = 2). No explanted CorMatrix material showed evidence of ingrowth of native cells or transformation into cardiac tissue at a median of 21 months after implantation.
Although the CorMatrix remained pliable and most did not exhibit calcification, these intracardiac patches did not show evidence of native heart tissue ingrowth at a median of 21 months in vivo.
动物数据表明,脱细胞猪小肠黏膜下层的心内补片(CorMatrix;CorMatrix心血管公司,佐治亚州亚特兰大)会被天然细胞重新填充,这提示其有可能成为人类再生组织的基质。我们报告了迄今为止唯一一组关于先天性心脏病婴儿植入CorMatrix补片的前瞻性系列研究。
在患者进行二期姑息治疗时,将CorMatrix补片作为半Fontan挡板植入。作为标准Fontan手术的一部分,将补片材料取出。标本采用苏木精-伊红染色、Movat五色染色和三色染色进行分析。
在12例植入手术中,取出了10份标本。2例患者因血流动力学不佳未进行Fontan手术。在所有取出的补片中均可见无细胞材料、慢性炎症、纤维化和异物巨细胞反应。在取出的标本中还发现了钙化(n = 2)、弹性纤维(n = 2)和嗜酸性粒细胞(n = 2)。在植入后中位时间21个月时,没有取出的CorMatrix材料显示有天然细胞长入或转化为心脏组织的证据。
尽管CorMatrix补片仍保持柔韧性且大多数未出现钙化,但在体内中位时间21个月时,这些心内补片没有显示出天然心脏组织长入的证据。