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PubMed2006

Polyethyleneterephthalate provides superior retention of endothelial cells during shear stress compared to polytetrafluoroethylene and pericardium.

BACKGROUND: Polyethyleneterephthalate (PET) and polytetrafluoroethylene (PTFE) are polymers successfully used as large diameter arterial grafts for peripheral vascular surgery. However, these prosthetic grafts are rarely used for coronary bypass surgery because of their low patency rates. Endothelialisation of the lumenal surface of these materials may improve their patency. This study aimed to compare the endothelialisation of PET, PTFE and pericardium by examining their seeding efficiency over time and the effect of various shear stresses on retention of endothelial cells. METHODS: Ovine endothelial cells at 4x10(5)cells/cm(2) were seeded onto PET, PTFE and pericardium, and cultured for 1-168 hours. Cell coverage was determined via en face immunocytochemistry and cell retention was quantified after being subjected to shear stresses ranging from 0.018 to 0.037N/m(2) for 15, 30 and 60 minutes. RESULTS: Endothelial cells adhered to all of the materials one hour post-seeding. PET exhibited better cell retention rate, ranging from 66.9+/-5.6% at 0.018N/m(2) for 15min to 44.7+/-1.9% at 0.037N/m(2) for 60 minutes, when compared to PTFE and pericardium (p<0.0001, three-way ANOVA). CONCLUSION: PET shows superior retention of endothelial cells during shear stress compare to PTFE and pericardium.

Animals↗
PubMed2001

Valvuloplasty with glutaraldehyde-treated autologous pericardium in patients with complex mitral valve pathology.

BACKGROUND: Severe mitral regurgitation associated with complex mitral valve disease often precludes successful surgical repair. The feasibility and the results of valvuloplasty with glutaraldehyde-treated autologous pericardium remain largely unknown. METHODS: The cases of 63 patients who underwent operation within an 11-year period were studied. A pretreated autologous pericardial patch was used for leaflet extension plasty, for paracommissural plasty, as a substitute for part of the leaflet, and for reimplantation of ruptured papillary muscles to eliminate severe mitral regurgitation. Patients with a severely calcified annulus after en bloc decalcification had straddling endoventricular pericardial patch annuloplasty for reconstruction of the affected atrioventricular groove. Chordal replacement with a strip of pericardium was chosen if no suitable chordae were available. Pericardium-reinforced suture annuloplasty was used in patients with acute endocarditis resistant to medical therapy. Associated valvuloplasty procedures with Carpentier techniques were also employed. RESULTS: There were no operative deaths in this series. At a mean follow-up of 61.1 months (range, 4 to 132 months), mitral regurgitation was absent or trivial in 92.1% of patients by echocardiography. Freedom from reoperation was 95.2% at 1 year and 5 years. Thromboembolic events have not been detected. Thirty percent of patients returned to sinus rhythm. Two patients required valve replacement. CONCLUSIONS: Our beneficial results indicate that glutaraldehyde-treated autologous pericardium is suitable for valvuloplasty. It provides durable and predictable repair of valves that might otherwise need to be replaced because of the complex mitral valve disease. The technique is reliable, allows further efficacious repair possibilities, and improves postoperative outcomes. Whether it can prevent late deterioration and calcification requires more investigation.

Adult↗
PubMed1976

Should the pericardium be closed after an open-heart operation?

A controlled clinical study was carried out to decide whether the pericardium should be left open or closed after open-heart operations. One hundred patients had the pericardium closed with interrupted silk, another 100 had the pericardium left open. Complications were alike except for the more frequent occurrence of a pericardial rub in the closed group (14 vs 3 patients), though the incidence of post-pericardiotomy syndrome was equal. There was no late tamponade. Two early reexplorations for bleeding were done in the open group, none in the closed. There were no postoperative deaths. In the patients who consented to postoperative angiography following revascularization procedures, the incidence of graft failure was equal in both groups. The pericardium should be closed after an open-heart operation. Morbidity and mortality are unchanged, and repeat cardiac exploration is safer.

Aortic Aneurysm↗
PubMed1990

Reduced tracheal growth after reconstruction with pericardium.

Four groups of piglets were used to test the use of pericardium and periosteum as free grafts in the repair of full thickness cervical tracheal defects. Pericardium provided an airtight, rapidly healing graft, but did not give sufficient structural rigidity to prevent narrowing and growth failure at the graft site. Composite grafts of pericardium and periosteum were also unsatisfactory, in that the periosteum failed to produce enough bone to prevent collapse of the graft. Since previous studies have shown that periosteal grafts result in good bone formation when applied alone or as an extramucosal support, it is concluded that the osteogenic potential is dependent on the available blood supply and speed of revascularization. It appears that the presence of pericardium in the composite grafts may have inhibited this property.

Animals↗
PubMed1999

Behavior of vital and killed autologous pericardium in the descending aorta of sheep.

OBJECTIVES: Cardiovascular implants of fresh autologous pericardium produced mixed results including fibrosis with retraction or thinning and dilatation. The reasons for these differences are unknown but may involve activation of cells intrinsic to the tissue implant. To better understand the behavior of autologous pericardial implants, we studied the outcomes of vital pericardium (fresh) versus ethanol-killed pericardium. METHODS: Fresh and ethanol-killed autologous pericardium was transplanted as a patch, a conduit, or a rectangular flap bisecting the lumen in the descending aorta of sheep. The implants, recovered at 1, 5, 10, 15, and 30 days, were evaluated macroscopically and microscopically and by immunohistologic studies. RESULTS: Fresh implants showed good preservation with fibrin deposition on day 15. Microscopically, cells positive for alpha-actin and von Willebrand-related antigen appeared in the fibrin by day 10. By day 30 the flap was fibrotic and retracted whereas the patch and conduit retained their original appearance on the luminal aspect. An endothelium-like layer expressing von Willebrand-related antigen was present in the patch and conduit but absent in the flap. In contrast, the ethanol-killed implants were free of fibrin by day 10. By day 30, there were no signs of fibrosis or retraction, and a surface layer of cells expressing von Willebrand-related antigen, characteristic of endothelial cells, was present on all implants. All ethanol-killed implants were repopulated by host cells. CONCLUSION: The transluminal flap is an interesting model for studying the behavior of intraluminal autologous pericardial cardiovascular implants. Killing of the pericardial implants alleviated the fibrosis and tissue retraction observed with fresh flap implants.

Actins↗
PubMed1993

Congenital partial and complete absence of the pericardium.

Between 1952 and 1991, 15 Mayo patients were found to have partial or complete absence of the pericardium at the time of a cardiovascular surgical procedure. One patient with complete absence of the left pericardium had symptoms possibly related to the pericardial abnormality. This 42-year-old man had severe insufficiency of the tricuspid valve attributable to chordal rupture of the anterior leaflet, possibly precipitated by complete displacement of the heart into the left pleural space. Excision of the ruptured chordae and plication of the anterior flail leaflet rendered a competent tricuspid valve. In two patients, a small defect in the pericardium was repaired. Three patients who underwent operation for complex congenital heart disease died: two early postoperatively and one late after a reoperation. In the other 12 patients, no early or late postoperative complications were encountered. Although rare and usually asymptomatic, complete and partial deficiency of the pericardium may lead to serious complications such as cardiac valvular insufficiency or incarceration of cardiac tissue.

Adult↗
PubMed2001

Ostrich pericardium, a biomaterial for the construction of valve leaflets for cardiac bioprostheses: mechanical behaviour, selection and interaction with suture materials.

The mechanical behavior of ostrich pericardium was studied for the purpose of assessing its utility in the construction of bioprosthetic cardiac valve leaflets. The tissue was tested biaxially using a hydraulic simulator that subjected it to increasing stress until rupture. One hundred eighty trials were performed, 36 with unsutured pericardium and four series of 36 trials each with pericardium sutured with silk, Prolene, nylon or Gore-Tex. The samples were tested in pairs from three different pericardial regions. One sample from each pair (the predictive specimen) was assessed according to morphological and mechanical criteria, while the other (the predicted or selectable specimen) was subjected only to morphological analysis. The findings show that ostrich pericardium treated with glutaraldehyde according to standard methods has an excellent resistance to rupture in biaxial testing, withstanding stresses of up to 100 MPa, and never lower than 30 MPa. Its resistance to rupture is lowered by suturing, a loss that is less pronounced when silk sutures are used. The results with Gore-Tex are very homogeneous and the elastic behavior of the pericardium/suture unit appears to be similar to that of unsutured tissue, suggesting that the interaction between the two biomaterials is minor. Similar results were observed in the series sutured with Prolene and nylon. The use of paired samples makes it possible to closely estimate the mechanical behavior of the tissue in a given zone by determining that of its mate. The statistical study shows that this estimation is not conditioned by the suture employed, thus validating this approach and providing more precise criteria for tissue selection.

Animals↗
PubMed2002

Bovine pericardium for dural graft: clinical results in 22 patients.

BACKGROUND: Bovine pericardium has widely been used for grafts in cardiac surgery and seems to have suitable properties for use as a dural graft. We report our experience of using locally processed bovine pericardium for dural grafts in 22 patients undergoing cranial operations. METHODS: 22 patients were analysed prospectively and followed-up for a maximum 3 years. All available records and information regarding the indication for grafting, graft size, complications and outcome were collected and analysed. RESULTS: Indications for grafting included neurosurgical, tumour, congenital and trauma patients. Outcomes were classified as good or excellent in 20 patients, whereas in two patients death was not related to surgical closure but more to malignant intracranial hypertension. In no patient was the dural graft a significant factor in the outcome. Bovine pericardium was found to be easily sutured and watertight using standard 4-0 silk suture. This material is relatively inexpensive compared to other non-synthetic grafts. CONCLUSION: In this clinical assessment, our bovine pericardium better known as Lyolemb was found to be an excellent dural graft material for local and eventual international consumption.

Adolescent↗
PubMed2000

Malignancies involving the pericardium.

Malignancies rarely arise from the pericardium. Mesothelioma, the most common of these, is usually unresectable and almost always incurable. Malignancies may secondarily involve the pericardium by direct extension. Carcinoma of the lung and malignant thymoma with limited direct invasion of the pericardium both can undergo complete and potentially curative resections, but adjuvant therapy is usually indicated. More frequently, malignancies involve the pericardium by a process of retrograde lymphangitic spread or hematogenous dissemination. These patients present with a symptomatic pericardial effusion and occasionally pericardial tamponade. Subxiphoid pericardiostomy and drainage is a safe procedure that provides effective and durable symptomatic relief in these terminally ill patients. More aggressive open procedures should be reserved for loculated or recurrent pericardial effusions.

Antimetabolites, Antineoplastic↗
PubMed1989

Symptomatic congenital complete absence of the left pericardium. Case report and review of the literature.

A fully documented case of complete absence of the left pericardium in a 44-year-old male is presented. Complaints of acute chest pain were caused by strangulation of the heart between the pulmonary ligament and the diaphragm. Preoperative electrocardiogram, chest X-ray and echocardiography showed 'classic' signs as described in the literature. A CAT scan suggested absence of the left pericardium, the definitive diagnosis was made with the aid of thoracoscopy. This case of total absence of the left pericardium is the first documented one requiring thoracic surgery. The defect was closed through a left-lateral thoracotomy using an allograft of pig pericardium.

Adult↗
PubMed2000

A comparative study of bovine pericardium (periguard) and homologous sclera as lower eyelid spacer graft analogs in New Zealand white rabbits.

PURPOSE: To compare bovine pericardium (Periguard; Bio-Vascular, Inc., St. Paul, MN, U.S.A.) and homologous sclera as spacer graft analogs in a rabbit model. METHODS: A nonrandomized experimental animal study was conducted. Elliptical subconjunctival implants were placed in one lower eyelid each of 10 rabbits. Five rabbits received homologous sclera implants, and five received bovine pericardium implants. The rabbits were killed 7 weeks later, and the lower eyelids were examined clinically and histopathologically. RESULTS: Rabbit eyelids implanted with Periguard had a more marked inflammatory reaction and more significant collagen lamellar disruption than eyelids implanted with homologous sclera, although clinically they appeared quite similar. CONCLUSIONS: Although bovine pericardium elicited a more intense inflammatory response at the histopathologic level, both implants were similarly tolerated at the clinical level. These findings are consistent with animal and human investigations of bovine pericardium in other parts of the body, and warrant further studies into its potential use in the human eyelid.

Animals↗
PubMed2001

Bovine pericardium as a wrapping for orbital implants.

PURPOSE: We report the use of bovine pericardium as an alternative wrapping for porous orbital implants after enucleation. METHODS: We retrospectively reviewed the records of all patients who received a bovine pericardium-wrapped orbital implant after enucleation by the authors between August 1, 1996, and December 1, 1999. RESULTS: Eighty patients underwent placement of bovine pericardium-wrapped orbital implants. The average age at the time of implantation was 49.3 years (range, 5 years to 83 years). The mean follow-up interval was 11.8 months (range, 2 to 41 months). There were no intraoperative complications. No patient had secondary systemic infection or showed evidence of rejection. There was no clinical evidence to suggest that vascularization of the porous implant was unusually delayed, and there were no complications after secondary drilling and placement of a coupling post. Four (5%) of 80 patients had complications requiring removal of the spherical implant. All 4 patients had hydroxyapatite implants. Two patients had significant exposure requiring removal of the implant at 2 months after surgery; 1 patient had a chronic fistulous tract with secondary infection 3 years after surgery: and 1 patient had chronic orbital pain requiring removal of the implant at 1 year after surgery. CONCLUSIONS: The incidence of implant exposure was less than 4%. This compares favorably to the incidence of exposure of 9% to 21% reported in recent literature. Other complications were few and of minimal clinical significance. The authors conclude that bovine pericardium is a viable option to sclera as a wrapping for porous orbital implants.

Adolescent↗
PubMed2002

Efficacy and safety of recurrent pterygium surgery using human processed pericardium.

PURPOSE: To investigate the safety and efficacy of human processed pericardium used as an onlay after pterygium excision. METHODS: Twenty-five eyes of 25 patients (11 female, 14 male) with recurrent pterygium were included in this study. The median age was 50 years (range 24-89 years). Twenty-eight percent of the eyes previously had been operated on two or more times. The mean follow-up was 9.4 months (+/- 2.1 months, range 8-15 months). Following bare-sclera surgical removal of recurrent pterygium, a patch of processed human pericardium was sutured to cover the area of excision. The pericardium was not covered with conjunctiva, nor were adjuvant radiation or antimetabolite administered. All patients were treated with a combination of dexamethasone 0.1% / chloramphenicol drops three times per day for 1 month. Ketorolac tromethamine 0.5% three times per day was added to this regimen after complete corneal reepithelialization. RESULTS: Recurrence (any growth >1 mm onto the cornea) was detected in 12 patients (48%). The mean time of recurrence was 4.1 +/- 1.7 months. Three patients (12.0%) presented a regrowth of fibrovascular tissue not reaching 1 mm of the cornea. Pyogenic granulomas occurred in three patients, and all of them required surgical excision. Corneal thinning was present in one patient and was treated with a therapeutic contact lens and artificial tears with complete resolution and vascularization of the thinned area. No decrease in visual acuity was observed in any patient. CONCLUSIONS: The use of processed pericardium in pterygium surgery is a safe procedure but is associated with a relatively high rate of recurrence. It should only be considered as an option in managing recurrent pterygium when conjunctival autografting is not an available alternative.

Adult↗
PubMed2003

Conjunctival melting syndrome associated with the use of bovine pericardium wrapping material.

PURPOSE: To report 18 cases of unusually large, early conjunctival breakdown occurring with the use of bovine pericardium wrapping material for orbital implants. METHODS: Retrospective case series. The clinical course and histopathologic features of 18 cases of early conjunctival breakdown in patients who had undergone orbital implantation of bovine pericardium-wrapped hydroxyapatite or porous polyethylene are reviewed. RESULTS: Eighteen patients presented with unusually large (average 13.44 mm) conjunctival defects over bovine pericardium-wrapped implants. The average time from enucleation to exposure was approximately 4 months. Implants had to be removed in 8 of 18 cases. There was clinical and histologic evidence of tissue inflammation and conjunctival melting. CONCLUSIONS: The conjunctival melting phenomenon we report herein is alarming. We have abandoned the use of bovine pericardium as a wrapping material for implants after enucleation because of the unfavorable results.

Adolescent↗
PubMed2004

Processed human pericardium barrier for gold weight implantation.

PURPOSE: To determine the safety and efficacy of processed human pericardium as a barrier material for gold weight implantation. METHODS: In this retrospective, noncomparative case series, all patients undergoing gold weight implantation with human pericardium barrier between November 2000 and May 2002 were studied. Charts were reviewed for surgical indications, gold weight size, follow-up interval, and complications. RESULTS: Twenty-three eyelids of 23 patients underwent gold weight implantation with processed human pericardium barrier material. There were 15 female and 8 male patients. Mean patient age was 53 years (range, 22 to 78 years). Indications for surgery included extruded implant (4 eyelids), thin tissues overlying existing implant (3 eyelids), thin anterior lamellar eyelid tissues (6 eyelids), radiotherapy (1 eyelid), and requirement for long-term gold weight therapy (9 eyelids). Mean follow-up was 11 months (range, 3 to 36 months). Acceptable tissue coverage was found in 23 of 23 eyelids. There were no complications of infection, extrusion, or thinning of overlying tissues. One patient had prolonged eyelid edema and erythema that resolved spontaneously 3 months after surgery. CONCLUSIONS: Human pericardium appears to be well tolerated on at least a short-term basis within the eyelid when used as a barrier material for gold weight implantation.

Adult↗
PubMed2002

The telescoping suture--Part 1: Does this technique improve the mechanical behavior of a biomaterial?: Calf pericardium.

The authors study the mechanical behavior of calf pericardium employed in the construction of cardiac valve leaflets when subjected to telescoping suture, followed by tensile stress until rupture. One hundred twenty pericardial tissue samples were employed, 60 cut from root-to-apex and another 60 cut in transverse direction. Each of these two groups consisted of 12 control samples that were left unsutured and four sets of 12 samples each that were rejoined by telescoping suture using silk, Prolene, nylon or Gore-Tex., and subjected to tensile stress. At the rupture of the sutured tissues, the tensile stress of the suture materials ranged between 57.54 MPa for the series sewn lengthwise with Gore-tex and 114.08 MPa for the series sewn crosswise with silk. At these levels of stress, the deformation of the suture thread was much less marked than that of the calf pericardium, and internal stresses were produced that were difficult for the biomaterial to absorb. There was a loss of real load in all the sutured series when the observed resistance to rupture, expressed in kilograms, was compared with the estimated value. This loss of resistance did not invalidate the telescoping suture technique since the resistance to rupture was still much greater than that associated with suturing the two edges of the cut pericardium together. This report confirms the deleterious role of the shear force generated in the pericardium by the suture.

Animals↗
PubMed2002

The telescoping suture--Part II: A novel method to improve the mechanical behavior of a new biomaterial: ostrich pericardium.

Ostrich pericardium, sutured using a telescoping or overlapping technique, was studied to determine its mechanical behavior. From each of 12 pericardial sacs, four contiguous strips were cut longitudinally, from root to apex, and another four contiguous strips were cut in transverse direction. One of the strips in each set of four was used as an unsutured control and the remaining three were sutured by overlapping 0.5 cm of the tissue and sewing with Gore-tex, Prolene or Pronova. These 96 samples were then subjected to tensile testing along their major axes until rupture. The tensile stresses recorded in the suture materials at the moment tears appeared in the pericardium ranged between 55.99 MPa and 70.23 MPa for Gore-tex in samples cut in the two directions. Shear stress became ostensible at 56 MPa, with clearly evident tears. However, microfracture of the collagen fibers must be produced at much lower stress levels. The comparison of the resistance in kilograms (machine-imposed), without taking into account the sections in which the load was applied, demonstrated only a slight loss of load when the telescoping suture was employed in ostrich pericardium samples. Ostrich pericardium may continue to be an alternative biological material for the construction of heart valve leaflets.

Animals↗
PubMed1994

Glutaraldehyde treated autologous pericardium in complete repair of tetralogy of Fallot.

Pericardium has been used for decades to facilitate the repair of tetralogy of Fallot (TOF). The impact of glutaraldehyde preserved autologous pericardium when used as a right ventricular outflow tract (RVOFT) patch in TOF was analyzed in 36 consecutive children undergoing complete transventricular repair. In 18 (group I) the pericardium was treated in conventional fashion (harvested and preserved in saline solution). In the other patients, the pericardium was treated in 0.625% glutaraldehyde solution for 20 minutes and then washed in saline prior to being implanted as an RVOFT patch (group II). The perioperative (prior to hospital discharge) as well as the 6-month postoperative Doppler echocardiograms were assessed with 100% follow-up. The studies were evaluated and graded by blinded observers for the presence and severity of an RVOFT dilatation (+0 to +4) relative to the size of the aortic valve annulus. The age of patients in group I and group II (29 months, 34 months) were similar as was the incidence of transannular patching (44%, 41%). Postrepair hemodynamics revealed no significant difference in the right ventricular/left ventricular pressure ratios (42%, 41%) or in the systolic RVOFT pressure (24 mmHg, 29 mmHg). The predischarge echocardiograms showed no outflow tract (OFT) dilation in either group. There was no morbidity or mortality in either group. At approximately 6 months postoperatively (6.2 mo, 5.7 mo), 72% of group I patients had RVOFT diameters that were larger (+1, +2) than the predischarge diameters when reviewed by three observers. In group II there was a single patient with dilatation of the RVOFT and this graded as +1.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗