Al Hussein Hussam, Al Hussein Hamida, Suciu Horatiu, Anitei David Emanuel, Sircuta Carmen, Cotfas Ionela, Cordos Bogdan, Lefter Cynthia, Brinzaniuc Klara, Simionescu Dan, Harpa Marius Mihai
Department of Anatomy and Embryology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540142, Targu Mures, Romania.
Regenerative Medicine Laboratory, CCAMF, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540142, Targu Mures, Romania.
Tissue Eng Regen Med. 2025 Jul 7. doi: 10.1007/s13770-025-00735-8.
Tissue-engineered pulmonary valves (TEPVs) hold considerable potential for improving outcomes in valve replacement surgeries. We investigated the surgical outcomes of TEPVs replacement in sheep, specifically examining the effects of valve type (decellularized versus adipose-derived stem cell-seeded valve [ADSC]) and the animal's age at the surgery. The primary goals were to assess survival rates, postoperative complications, and the effects of cardiopulmonary bypass (CPB) on homeostasis.
Nineteen juvenile and adult sheep were randomly assigned to orthotopic pulmonary valve replacement using either decellularized (DECELL, n = 10) or ADSC-seeded valves (CELL, n = 9). Blood gas analysis was conducted intraoperatively and postoperatively to assess CPB-related metabolic changes. The follow-up period after surgery was 6 months. Key demographic and operative parameters were recorded, and early and late postoperative complications were monitored.
No significant differences were observed in operative parameters or postoperative complications between the DECELL and CELL groups. Adult sheep exhibited longer anesthesia, CPB, and operative times due to tissue fragility but demonstrated better long-term survival than juveniles, who experienced more late-stage complications, including endocarditis. CPB exposure increased lactate and reduced hemoglobin levels, particularly in adult sheep, affecting homeostasis. The overall mortality rate was 42.1%, with deaths primarily attributed to congestive heart failure and endocarditis.
Valve type did not significantly affect short-term outcomes and ADSC-seeding had no significant impact on operative parameters, postoperative complications, or survival rate. However, age remained a crucial factor influencing both surgical complexity and survival, highlighting the need for age-specific strategies in tissue-engineered valve applications.
组织工程肺瓣膜（TEPVs）在改善瓣膜置换手术的疗效方面具有巨大潜力。我们研究了绵羊TEPVs置换的手术结果，特别考察了瓣膜类型（去细胞瓣膜与脂肪来源干细胞种植瓣膜[ADSC]）以及手术时动物年龄的影响。主要目标是评估生存率、术后并发症以及体外循环（CPB）对体内稳态的影响。
将19只幼年和成年绵羊随机分配，分别使用去细胞瓣膜（DECELL，n = 10）或ADSC种植瓣膜（CELL，n = 9）进行原位肺瓣膜置换。在术中及术后进行血气分析，以评估与CPB相关的代谢变化。术后随访期为6个月。记录关键的人口统计学和手术参数，并监测术后早期和晚期并发症。
DECELL组和CELL组在手术参数或术后并发症方面未观察到显著差异。成年绵羊由于组织脆弱，麻醉、CPB和手术时间较长，但与幼年绵羊相比，长期生存率更高，幼年绵羊经历了更多晚期并发症，包括心内膜炎。CPB暴露会增加乳酸水平并降低血红蛋白水平，尤其是在成年绵羊中，影响体内稳态。总体死亡率为42.1%，死亡主要归因于充血性心力衰竭和心内膜炎。
瓣膜类型对短期结果没有显著影响，ADSC种植对手术参数、术后并发症或生存率没有显著影响。然而，年龄仍然是影响手术复杂性和生存率的关键因素，这凸显了在组织工程瓣膜应用中制定针对不同年龄的策略的必要性。
