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1. Comparing the Host Reaction to CorMatrix and Different Cardiac Patch Materials Implanted Subcutaneously in Growing Pigs.

Author

UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - (SLuc) Service de chirurgie cardiovasculaire et thoracique, UCL - (MGD) Service d'anatomie pathologique, Mosala Nezhad, Zahra, Poncelet, Alain, Fervaille, Caroline, Gianello, Pierre, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - (SLuc) Service de chirurgie cardiovasculaire et thoracique, UCL - (MGD) Service d'anatomie pathologique, Mosala Nezhad, Zahra, Poncelet, Alain, Fervaille, Caroline, and Gianello, Pierre

Abstract

BACKGROUND: Comparing the structural changes, and local host reactions to CorMatrix (CorMatrix Cardiovascular Inc., Roswell, Georgia, United States) and different biomaterials implanted subcutaneously in growing pig model. METHODS: Four pigs harboring implanted patches of CorMatrix, Vascutek porcine pericardium (Vascutek; Scotland, United Kingdom), SJM bovine pericardium (St. Jude Medical, Inc., Minnesota, United States), and Gore-Tex (W. L. Gore & Associates GmbH, Flagstaff, Arizona, United States) were studied for 1, 3, 6, and 12 months. The explants were examined histologically. RESULTS: CorMatrix showed gradual and consistent patch resorption and subsiding inflammatory and fibrosis process. Full scaffold degradation and replacement by mild fibrosis and subcutaneous tissue were seen by 1 year. Xenopericardial patches remained intact, and the initially severe inflammatory and fibrotic reactions reduced gradually to moderate fibrosis and chronic inflammation. Gore-Tex showed foreign body reaction. CONCLUSIONS: Patches were biotolerated by pigs. Xenopericardial patches elicited encapsulating fibrosis and no remodeling. CorMatrix resorbs completely and degrades consistently without leaving residues. Lack of encapsulating fibrosis toward CorMatrix allows tissue ingrowth and matrix remodeling.

Published
2019

4. Experimental Aortic Valve Cusp Extension with CorMatrix in a Porcine Model.

Author

UCL - SSS/IREC/MONT - Pôle Mont Godinne, UCL - (MGD) Service d'anatomie pathologique, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (SLuc) Service de chirurgie cardiovasculaire et thoracique, UCL - (SLuc) Service de chirurgie et transplantation abdominale, Mosala Nezhad, Zahra, Poncelet, Alain, Fervaille, Caroline, de Kerchove, Laurent, Gianello, Pierre, UCL - SSS/IREC/MONT - Pôle Mont Godinne, UCL - (MGD) Service d'anatomie pathologique, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (SLuc) Service de chirurgie cardiovasculaire et thoracique, UCL - (SLuc) Service de chirurgie et transplantation abdominale, Mosala Nezhad, Zahra, Poncelet, Alain, Fervaille, Caroline, de Kerchove, Laurent, and Gianello, Pierre

Abstract

BACKGROUND : We tested the feasibility of using porcine small intestinal submucosal extracellular matrix (CorMatrix) for aortic valve (AV) repair in porcine model examining its resorption and remodeling potential. METHODS : The non-coronary cusp was replaced with CorMatrix in four animals for 120 days. Valve function was assessed by echocardiography. Explants were examined by histology, immunohistochemistry, and collagen assessment. RESULTS : CorMatrix was almost totally replaced with tissue resembling the native cusp with a partial two-layer architecture. However, function was lost due to thickening and calcification. CONCLUSIONS : Tested in high-pressure AV position in a pig model, CorMatrix degrades and remodels, but also loses function.

Published
2017

5. Pain, Quality of Life, and Clinical Outcomes after Robotic Lobectomy.

Author

UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - SSS/IREC/PNEU - Pôle de Pneumologie, ORL et Dermatologie, UCL - SSS/IREC/SLUC - Pôle St.-Luc, UCL - (SLuc) Service d'anesthésiologie, UCL - (SLuc) Service de pneumologie, UCL - (SLuc) Service de chirurgie cardiovasculaire et thoracique, Lacroix, Valérie, Mosala Nezhad, Zahra, Kahn, David, Steyaert, Arnaud, Poncelet, Alain, Pieters, Thierry, Noirhomme, Philippe, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - SSS/IREC/PNEU - Pôle de Pneumologie, ORL et Dermatologie, UCL - SSS/IREC/SLUC - Pôle St.-Luc, UCL - (SLuc) Service d'anesthésiologie, UCL - (SLuc) Service de pneumologie, UCL - (SLuc) Service de chirurgie cardiovasculaire et thoracique, Lacroix, Valérie, Mosala Nezhad, Zahra, Kahn, David, Steyaert, Arnaud, Poncelet, Alain, Pieters, Thierry, and Noirhomme, Philippe

Abstract

Background To evaluate pulmonary function, pain, and quality of life at midterm after robotic lobectomy performed in a single institution. Methods Sixty-five consecutive patients underwent robotic thoracic surgery over 32 months using a complete four-arm portal technique. Sixty-one patients underwent lobectomies predominantly for stage I non-small cell lung cancer. Pulmonary function tests were repeated at midterm follow-up. Pain and quality of life were evaluated during the follow-up on a subgroup of 39 patients, excluding the learning period. Results At a mean of 7-month follow-up, there was no significant difference in preoperative and midterm postoperative pulmonary function. A total of 62.5% of the patients reported a variable intensity of discomfort or pain at the surgical site, with a mean pain intensity score of 2.1 ± 1.4. Mean pain interference score were weak (1.8 ± 1.9), with patients with moderate pain reporting significantly higher pain interference scores than those with mild pain (p = 0.0025). Only one patient suffered from neuropathic-like pain. Quality of life was globally favorable and related to the pain level, with a significant interference on the physical component. Conclusion Robotic lobectomy does not appear to have an impact on midterm pulmonary function. Persistent postoperative pain is mild, nonneuropathic-like, with weak interference on daily activities. Quality of life is satisfactory but related to the pain level.

Published
2017

6. Outcome of patch materials used in aortic valve repair : examining CorMatrix® bioscaffold as suitable cardiac tissue substitute

Author

UCL - SSS/IREC/CHEX-Pôle de chirgurgie expérimentale et transplantation, UCL - SSS/IREC/CARD-Pôle de recherche cardiovasculaire, UCL - Faculté de médecine et médecine dentaire, El Khoury , Gébrine, Gianello, Pierre, Poncelet, Alain, Beauloye, Christophe, de Kerchove, Laurent, Weynand, Birgit, Bové, Thierry, Mosala Nezhad, Zahra, UCL - SSS/IREC/CHEX-Pôle de chirgurgie expérimentale et transplantation, UCL - SSS/IREC/CARD-Pôle de recherche cardiovasculaire, UCL - Faculté de médecine et médecine dentaire, El Khoury , Gébrine, Gianello, Pierre, Poncelet, Alain, Beauloye, Christophe, de Kerchove, Laurent, Weynand, Birgit, Bové, Thierry, and Mosala Nezhad, Zahra

Abstract

Aortic valve repair’s longevity is affected by failure mechanisms such as fibrosis, calcification and degeneration. New generation engineered patches such as CorMatrix® (SIS-ECM) are appealing options with much publicized potentials and advantages to aid growth and longevity. We developed clinical and experimental studies investigating the current clinical status of AV patch repair, then we took the clinical question to laboratory benches for experimental investigation on the potentials of CorMatrix® patch. This thesis contributes to the knowledge on the subject and affords evidence of originality. We studied the long-term outcome of patch use in non-rheumatic AV repair and found no differences between autologous or bovine pericardial patches. We established the safety of variable surgical techniques and identified multiple patches and valve-patient related influencing factors. Our progressive and chronic experimental studies examined CorMatrix® in couple of novel complex models. We revealed new data on its in vivo reaction and observed consistent lack of remodelling in allograft models; questioning the true potential and safety of the CorMatrix® for cardiac repair., (MED - Sciences médicales) -- UCL, 2017

Published
2017

7. Calcific Degeneration of CorMatrix 4 Years After Bicuspidization of Unicuspid Aortic Valve.

Author

UCL - (SLuc) Service de chirurgie cardiovasculaire et thoracique, UCL - (SLuc) Service d'anatomie pathologique, UCL - SSS/IREC/GAEN - Pôle d'Hépato-gastro-entérologie, UCL - SSS/IREC/SLUC - Pôle St.-Luc, Mosala Nezhad, Zahra, Baldin, Paméla, Poncelet, Alain, El Khoury, Gebrine, UCL - (SLuc) Service de chirurgie cardiovasculaire et thoracique, UCL - (SLuc) Service d'anatomie pathologique, UCL - SSS/IREC/GAEN - Pôle d'Hépato-gastro-entérologie, UCL - SSS/IREC/SLUC - Pôle St.-Luc, Mosala Nezhad, Zahra, Baldin, Paméla, Poncelet, Alain, and El Khoury, Gebrine

Abstract

We report the long-term outcomes of a 12-year-old boy who underwent bicuspidization of a severely stenotic unicuspid aortic valve with CorMatrix small intestinal submucosal extracellular matrix (CorMatrix Cardiovascular, Roswell, GA). CorMatrix supported favorable immediate surgical and echocardiographic outcomes and maintained stable growing functional dynamics for 2 years. At 52.5 months in situ, however, the valve failed with severe calcification, fibrosis, and retraction necessitating a redo operation. Reconstructive operations with CorMatrix are feasible, but this result questions its capacity for constructive remodeling in left-sided valve repair.

Published
2017

8. CRT-500.03 Examining the Remodeling of CorMatrix as a Trileaflet Valve Conduit in Heterotopic Position in Growing Pig Model

Author

UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - (SLuc) Service de chirurgie cardiovasculaire et thoracique, UCL - (MGD) Service d'anatomie pathologique, Mosala Nezhad, Zahra, Poncelet, Alain, de Kerchove, Laurent, Fervaille, Caroline, Boullin , Xavier, Dehoux, Jean-Paul, El Khoury, Gebrine, Gianello, Pierre, CRT16 CARDOPVASCULAR RESEARCH TECHNOLOGIES, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - (SLuc) Service de chirurgie cardiovasculaire et thoracique, UCL - (MGD) Service d'anatomie pathologique, Mosala Nezhad, Zahra, Poncelet, Alain, de Kerchove, Laurent, Fervaille, Caroline, Boullin , Xavier, Dehoux, Jean-Paul, El Khoury, Gebrine, Gianello, Pierre, and CRT16 CARDOPVASCULAR RESEARCH TECHNOLOGIES

Published
2016

9. Small intestinal submucosa extracellular matrix (CorMatrix®) in cardiovascular surgery: a systematic review.

Author

UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - (SLuc) Service de chirurgie cardiovasculaire et thoracique, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - (MGD) Service d'anatomie pathologique, UCL - SSS/IREC/MONT-Pôle Mont Godinne, Mosala Nezhad, Zahra, Poncelet, Alain, de Kerchove, Laurent, Gianello, Pierre, Fervaille, Caroline, El Khoury, Gebrine, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - (SLuc) Service de chirurgie cardiovasculaire et thoracique, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - (MGD) Service d'anatomie pathologique, UCL - SSS/IREC/MONT-Pôle Mont Godinne, Mosala Nezhad, Zahra, Poncelet, Alain, de Kerchove, Laurent, Gianello, Pierre, Fervaille, Caroline, and El Khoury, Gebrine

Abstract

Extracellular matrix (ECM) derived from small intestinal submucosa (SIS) is widely used in clinical applications as a scaffold for tissue repair. Recently, CorMatrix® porcine SIS-ECM (CorMatrix Cardiovascular, Inc., Roswell, GA, USA) has gained popularity for 'next-generation' cardiovascular tissue engineering due to its ease of use, remodelling properties, lack of immunogenicity, absorbability and potential to promote native tissue growth. Here, we provide an overview of the biology of porcine SIS-ECM and systematically review the preclinical and clinical literature on its use in cardiovascular surgery. CorMatrix® has been used in a variety of cardiovascular surgical applications, and since it is the most widely used SIS-ECM, this material is the focus of this review. Since CorMatrix® is a relatively new product for cardiovascular surgery, some clinical and preclinical studies published lack systematic reporting of functional and pathological findings in sufficient numbers of subjects. There are also emerging reports to suggest that, contrary to expectations, an undesirable inflammatory response may occur in CorMatrix® implants in humans and longer-term outcomes at particular sites, such as the heart valves, may be suboptimal. Large-scale clinical studies are needed driven by robust protocols that aim to quantify the pathological process of tissue repair.

Published
2016

10. Erratum: Experimental Aortic Valve Cusp Extension with CorMatrix in a Porcine Model.

Author

UCL - SSS/IREC/MONT - Pôle Mont Godinne, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (MGD) Service d'anatomie pathologique, UCL - (SLuc) Service de chirurgie cardiovasculaire et thoracique, UCL - (SLuc) Service de chirurgie et transplantation abdominale, Mosala Nezhad, Zahra, Poncelet, Alain, Fervaille, Caroline, de Kerchove, Laurent, Gianello, Pierre, UCL - SSS/IREC/MONT - Pôle Mont Godinne, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (MGD) Service d'anatomie pathologique, UCL - (SLuc) Service de chirurgie cardiovasculaire et thoracique, UCL - (SLuc) Service de chirurgie et transplantation abdominale, Mosala Nezhad, Zahra, Poncelet, Alain, Fervaille, Caroline, de Kerchove, Laurent, and Gianello, Pierre

Published
2016

11. Endovascular resection of the native aortic valve before transcatheter aortic valve implantation: state of the art and review

Author

UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - SST/IMMC/MEED - Mechatronic, Electrical Energy, and Dynamics Systems, UCL - (SLuc) Service de chirurgie cardiovasculaire et thoracique, Navarra, Emiliano, Mosala Nezhad, Zahra, Bollen, Xavier, Gielen, Charles-Edouard, Mastrobuoni, Stefano, de Kerchove, Laurent, Raucent, Benoît, Astarci, Parla, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - SST/IMMC/MEED - Mechatronic, Electrical Energy, and Dynamics Systems, UCL - (SLuc) Service de chirurgie cardiovasculaire et thoracique, Navarra, Emiliano, Mosala Nezhad, Zahra, Bollen, Xavier, Gielen, Charles-Edouard, Mastrobuoni, Stefano, de Kerchove, Laurent, Raucent, Benoît, and Astarci, Parla

Abstract

Transcatheter aortic valve implantation was introduced into clinical practice in 2002 as a rescue approach in patients presenting with symptomatic severe aortic stenosis but not eligible for conventional aortic valve replacement. This technique allows implantation of a balloon expandable bioprosthesis without resection of the native aortic valve. Several complications are described as a consequence of the residual highly calcified valve being squeezed against the aortic wall by the stent of the implant. This can result in deformation of the metal stent and paravalvular leakage, risk of occlusion of the coronary ostia, or central and peripheral embolization of valvular debris. To avoid these complications, many authors suggest the possibility to resect and remove the native aortic valve before transcatheter aortic valve implantation. In this field, different authors have described possible techniques and different sources of energy to resect the calcified valve. In this article, we review the development of these experimental techniques and discuss future prospects in this field.

Published
2016

12. Erratum : Pain, Quality of Life, and Clinical Outcomes after Robotic Lobectomy

Author

UCL - SSS/IONS/NEUR - Clinical Neuroscience, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - SSS/IREC/PNEU - Pôle de Pneumologie, ORL et Dermatologie, UCL - (SLuc) Service d'anesthésiologie, UCL - (SLuc) Service de chirurgie cardiovasculaire et thoracique, UCL - (SLuc) Service de pneumologie, Lacroix, Valérie, Mosala Nezhad, Zahra, Kahn, David, Steyaert, Arnaud, Poncelet, Alain, Pieters, Thierry, Noirhomme, Philippe, UCL - SSS/IONS/NEUR - Clinical Neuroscience, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - SSS/IREC/PNEU - Pôle de Pneumologie, ORL et Dermatologie, UCL - (SLuc) Service d'anesthésiologie, UCL - (SLuc) Service de chirurgie cardiovasculaire et thoracique, UCL - (SLuc) Service de pneumologie, Lacroix, Valérie, Mosala Nezhad, Zahra, Kahn, David, Steyaert, Arnaud, Poncelet, Alain, Pieters, Thierry, and Noirhomme, Philippe

Published
2016

13. Remodeling of subcutaneously implanted cardiac tissue substitutes in growing swine model

Author

UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, Mosala Nezhad, Zahra, Poncelet, Alain, Fervaille, Caroline, Dehoux, Jean-Paul, El Khoury, Gebrine, Gianello, Pierre, 17th Belgian Surgical Week, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, Mosala Nezhad, Zahra, Poncelet, Alain, Fervaille, Caroline, Dehoux, Jean-Paul, El Khoury, Gebrine, Gianello, Pierre, and 17th Belgian Surgical Week

Published
2016

20. How to perform valve sparing reimplantation in a tricuspid aortic valve

Author

de Kerchove, Laurent, Mosala Nezhad, Zahra, Boodhwani, Munir, El Khoury, Gebrine, UCL - (SLuc) Service de chirurgie cardiovasculaire et thoracique, and UCL - (MGD) Service de chirurgie cardio-vasculaire et thoracique

Subjects
Art of Operative Techniques, cardiovascular system
Abstract

Aortic valve sparing procedures are increasingly being used to treat aortic root pathologies. Reimplantation of the aortic valve, first described by Dr Tirone David, is a technically demanding procedure whose long-term results are critically dependent on perfect intraoperative restoration of valve anatomy and function. There exists significant variation in how this procedure is performed by different surgeons, which is likely contributory to the heterogeneity in reported results. We describe a systematic approach to aortic valve reimplantation procedure focusing on key technical aspects.

Published
2012

22. Controversial remodeling of CorMatrix patch implanted as a trileaflet valve : experimental study in pigs

Author

UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - (SLuc) Service de chirurgie cardiovasculaire et thoracique, UCL - (MGD) Service d'anatomie pathologique, UCL - SSS/IREC/MONT - Pôle Mont Godinne, Mosala Nezhad, Zahra, de Kerchove, Laurent, Fervaille, Caroline, Boullin, Xavier, Weynand, Birgit, Dehoux, Jean-Paul, El Khoury, Gebrine, Gianello, Pierre, 16th Belgian Surgical Week, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - (SLuc) Service de chirurgie cardiovasculaire et thoracique, UCL - (MGD) Service d'anatomie pathologique, UCL - SSS/IREC/MONT - Pôle Mont Godinne, Mosala Nezhad, Zahra, de Kerchove, Laurent, Fervaille, Caroline, Boullin, Xavier, Weynand, Birgit, Dehoux, Jean-Paul, El Khoury, Gebrine, Gianello, Pierre, and 16th Belgian Surgical Week

Published
2015

23. Surgical anatomy of the aortic root: implication for valve-sparing reimplantation and aortic valve annuloplasty.

Author

UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - SSS/IREC/MORF - Pôle de Morphologie, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - (SLuc) Service de chirurgie cardiovasculaire et thoracique, UCL - (SLuc) Service de chirurgie plastique, de Kerchove, Laurent, Jashari, Ramadan, Boodhwani, Munir, Duy, Khanh Tran, Lengelé, Benoît, Gianello, Pierre, Mosala Nezhad, Zahra, Astarci, Parla, Noirhomme, Philippe, El Khoury, Gebrine, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - SSS/IREC/MORF - Pôle de Morphologie, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - (SLuc) Service de chirurgie et transplantation abdominale, UCL - (SLuc) Service de chirurgie cardiovasculaire et thoracique, UCL - (SLuc) Service de chirurgie plastique, de Kerchove, Laurent, Jashari, Ramadan, Boodhwani, Munir, Duy, Khanh Tran, Lengelé, Benoît, Gianello, Pierre, Mosala Nezhad, Zahra, Astarci, Parla, Noirhomme, Philippe, and El Khoury, Gebrine

Abstract

BACKGROUND: To enhance the reproducibility of aortic valve-sparing reimplantation and annuloplasty, we analyzed the topographic relationship between the ventriculoaortic junction (VAJ), basal ring (BR), and sinotubular junction (STJ). The root base thickness is also quantified. METHOD: Fifty-eight fresh human aortic valves were analyzed. The root was dissected to the limit where the aortic wall terminates into the cardiac structures (VAJ). Root height was measured externally from the STJ to the VAJ and internally from the STJ to the BR defined as the plane passing through the cusps nadir. The root base thickness was measured at the BR and orthogonal to the internal wall; except at the right coronary sinus, where it was measured between the BR internally and the VAJ externally. Measurements were taken at the middle of the 3 sinuses and commissures. RESULTS: The VAJ is at the same level as the BR from the noncoronary sinus (-0.1 ± 0.9 mm) to the left coronary sinus (0.5 ± 1.3 mm); it is above the BR from the left/right commissure (4.6 ± 1.4 mm) to the right/non commissure (2.5 ± 1.6 mm). The external root height was highest at the non/left commissure (21.5 ± 2.6 mm) followed by the right/non commissure (19.2 ± 2.3 mm) then the left/right commissure (15.7 ± 2.2 mm) (P < .05). The mean root base thickness was 3.2 mm, ranging from 1 ± 0 mm at the left/non commissure to 6.2 ± 1.2 mm at the right coronary sinus (P < .001). CONCLUSIONS: The VAJ is not planar; it is above the level of the BR from the left/right to the right/non commissure. As a consequence, the external height of the non/left commissure is greater than the other 2 commissures. These findings should be taken into consideration when performing aortic valve-sparing reimplantation or external annuloplasty.

Published
2015

24. How to perform valve sparing reimplantation in a tricuspid aortic valve.

Author

UCL - (SLuc) Service de chirurgie cardiovasculaire et thoracique, UCL - (MGD) Service de chirurgie cardio-vasculaire et thoracique, de Kerchove, Laurent, Mosala Nezhad, Zahra, Boodhwani, Munir, El Khoury, Gebrine, UCL - (SLuc) Service de chirurgie cardiovasculaire et thoracique, UCL - (MGD) Service de chirurgie cardio-vasculaire et thoracique, de Kerchove, Laurent, Mosala Nezhad, Zahra, Boodhwani, Munir, and El Khoury, Gebrine

Abstract

Aortic valve sparing procedures are increasingly being used to treat aortic root pathologies. Reimplantation of the aortic valve, first described by Dr Tirone David, is a technically demanding procedure whose long-term results are critically dependent on perfect intraoperative restoration of valve anatomy and function. There exists significant variation in how this procedure is performed by different surgeons, which is likely contributory to the heterogeneity in reported results. We describe a systematic approach to aortic valve reimplantation procedure focusing on key technical aspects.

Published
2013

25. Aortic valve repair with patch in non-rheumatic disease: indication, techniques and durability†.

Author

Mosala Nezhad, Zahra, de Kerchove, Laurent, Hechadi, Jawad, Tamer, Saadallah, Boodhwani, Munir, Poncelet, Alain, Noirhomme, Philippe, Rubay, Jean, and El Khoury, Gebrine

Subjects
*RHEUMATISM, *MITRAL valve, *PERICARDIUM, *HOSPITAL mortality, *CARDIAC patients, AORTIC valve surgery
Abstract

OBJECTIVES To analyse the long-term outcomes of aortic valve (AV) repair with biological patch in patient with non-rheumatic valve disease. METHODS From 1995 to 2011, 554 patients underwent elective (AV) repair; among them, 57 (mean age 45 ± 17 years) had cusp restoration using patch for non-rheumatic valve disease. Seven (12%) patients had unicuspid valve, 30 (53%) patients had bicuspid valve and 20 (35%) had tricuspid valve. Autologous pericardium was used in 26 patients (7 treated, 19 non-treated), bovine pericardium in 26, autologous tricuspid valve leaflet in 4 and aortic homograft cusp in 1. Patching was used to repair perforation (n = 20, 35%), commissural defect (n = 18, 32%), raphe repair (n = 17, 30%) or for cusp extension (n = 2, 3.5%). Echocardiographic and clinical follow-up was 98% complete and mean follow-up was 72 ± 42.5 months. RESULTS No hospital mortality. At 8 years, overall survival was 90 ± 5% and freedom from valve-related death was 96 ± 3%. Two patients (3.5%) needed early reoperation for aortic regurgitation (AR); they underwent re-repair and the Ross procedure, respectively. Late reoperation was necessary in 9 patients (16%) for AR (n = 4), stenosis (n = 3) or mixed disease (n = 2). They had the Ross procedure (n = 6) or prosthetic valve replacement (n = 3) with no mortality. At 8 years, freedom from reoperation was 75 ± 9%. Freedom from reoperation was slightly higher in tricuspid compared with non-tricuspid valves (92 ± 7 vs 68 ± 11%, P = 0.18) and slightly higher for bovine (95 ± 5%) compared with autologous pericardium (73 ± 11%, P = 0.38), but differences were statistically not significant. In tricuspid valves, freedom from reoperation was higher in perforation repair compared with other techniques (100 vs 50 ± 35%, P = 0.02). In bicuspid valves, freedom from reoperation was similar between different repair techniques (P = 0.38). Late echocardiography showed AR 0-1 in 30 (53%) patients, AR 2 in 12 (21%) and no AR ≥ 3. Three patients presented a mean transvalvular gradient of 30–40 mmHg. Thromboembolic events occurred in 2 patients (0.6%/patient-year), bleeding events in 1 (0.3% /patient-year) and no endocarditis occurred. CONCLUSIONS AV repair with biological patch is feasible for various aetiologies. The techniques are safe and medium-term durability is acceptable, even excellent for perforation repair in tricuspid valve morphology. Bovine pericardium is a good alternative to autologous pericardium. [ABSTRACT FROM AUTHOR]

Published
2014
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26. Comparing the Host Reaction to CorMatrix and Different Cardiac Patch Materials Implanted Subcutaneously in Growing Pigs.

Author

Mosala Nezhad Z, Poncelet A, Fervaille C, and Gianello P

Subjects
Age Factors, Allografts, Animals, Cardiac Surgical Procedures adverse effects, Cattle, Foreign-Body Reaction metabolism, Foreign-Body Reaction pathology, Heterografts, Subcutaneous Tissue metabolism, Subcutaneous Tissue pathology, Swine, Swine, Miniature, Time Factors, Biocompatible Materials toxicity, Cardiac Surgical Procedures instrumentation, Extracellular Matrix transplantation, Foreign-Body Reaction etiology, Membranes, Artificial, Pericardium transplantation, Polytetrafluoroethylene toxicity, Subcutaneous Tissue surgery
Abstract

Background: Comparing the structural changes, and local host reactions to CorMatrix (CorMatrix Cardiovascular Inc., Roswell, Georgia, United States) and different biomaterials implanted subcutaneously in growing pig model., Methods: Four pigs harboring implanted patches of CorMatrix, Vascutek porcine pericardium (Vascutek; Scotland, United Kingdom), SJM bovine pericardium (St. Jude Medical, Inc., Minnesota, United States), and Gore-Tex (W. L. Gore & Associates GmbH, Flagstaff, Arizona, United States) were studied for 1, 3, 6, and 12 months. The explants were examined histologically., Results: CorMatrix showed gradual and consistent patch resorption and subsiding inflammatory and fibrosis process. Full scaffold degradation and replacement by mild fibrosis and subcutaneous tissue were seen by 1 year. Xenopericardial patches remained intact, and the initially severe inflammatory and fibrotic reactions reduced gradually to moderate fibrosis and chronic inflammation. Gore-Tex showed foreign body reaction., Conclusions: Patches were biotolerated by pigs. Xenopericardial patches elicited encapsulating fibrosis and no remodeling. CorMatrix resorbs completely and degrades consistently without leaving residues. Lack of encapsulating fibrosis toward CorMatrix allows tissue ingrowth and matrix remodeling., Competing Interests: Patch materials were donated with no influence on the study design or outcome. No commercial affiliation or conflict of interest., (Georg Thieme Verlag KG Stuttgart · New York.)

Published
2019
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27. Pain, Quality of Life, and Clinical Outcomes after Robotic Lobectomy.

Author

Lacroix V, Mosala Nezhad Z, Kahn D, Steyaert A, Poncelet A, Pieters T, and Noirhomme P

Subjects
Activities of Daily Living, Adult, Aged, Aged, 80 and over, Belgium, Carcinoma, Non-Small-Cell Lung pathology, Carcinoma, Non-Small-Cell Lung physiopathology, Female, Humans, Lung Neoplasms pathology, Lung Neoplasms physiopathology, Male, Middle Aged, Neoplasm Staging, Pain Measurement, Pain, Postoperative diagnosis, Pain, Postoperative psychology, Pneumonectomy methods, Recovery of Function, Respiratory Function Tests, Retrospective Studies, Risk Factors, Surveys and Questionnaires, Time Factors, Treatment Outcome, Carcinoma, Non-Small-Cell Lung surgery, Lung Neoplasms surgery, Pain, Postoperative etiology, Pneumonectomy adverse effects, Quality of Life, Robotic Surgical Procedures adverse effects
Abstract

Background  To evaluate pulmonary function, pain, and quality of life at midterm after robotic lobectomy performed in a single institution. Methods  Sixty-five consecutive patients underwent robotic thoracic surgery over 32 months using a complete four-arm portal technique. Sixty-one patients underwent lobectomies predominantly for stage I non-small cell lung cancer. Pulmonary function tests were repeated at midterm follow-up. Pain and quality of life were evaluated during the follow-up on a subgroup of 39 patients, excluding the learning period. Results  At a mean of 7-month follow-up, there was no significant difference in preoperative and midterm postoperative pulmonary function. A total of 62.5% of the patients reported a variable intensity of discomfort or pain at the surgical site, with a mean pain intensity score of 2.1 ± 1.4. Mean pain interference score were weak (1.8 ± 1.9), with patients with moderate pain reporting significantly higher pain interference scores than those with mild pain ( p  = 0.0025). Only one patient suffered from neuropathic-like pain. Quality of life was globally favorable and related to the pain level, with a significant interference on the physical component. Conclusion  Robotic lobectomy does not appear to have an impact on midterm pulmonary function. Persistent postoperative pain is mild, nonneuropathic-like, with weak interference on daily activities. Quality of life is satisfactory but related to the pain level., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (Georg Thieme Verlag KG Stuttgart · New York.)

Published
2017
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30. Experimental Aortic Valve Cusp Extension with CorMatrix in a Porcine Model.

Author

Mosala Nezhad Z, Poncelet A, Fervaille C, de Kerchove L, and Gianello P

Subjects
Absorbable Implants, Animals, Aortic Valve diagnostic imaging, Aortic Valve pathology, Aortic Valve physiopathology, Biopsy, Calcinosis etiology, Calcinosis pathology, Calcinosis physiopathology, Cardiac Surgical Procedures adverse effects, Collagen metabolism, Echocardiography, Extracellular Matrix pathology, Feasibility Studies, Immunohistochemistry, Models, Animal, Sus scrofa, Time Factors, Aortic Valve surgery, Cardiac Surgical Procedures instrumentation, Extracellular Matrix transplantation
Abstract

Background  We tested the feasibility of using porcine small intestinal submucosal extracellular matrix (CorMatrix) for aortic valve (AV) repair in porcine model examining its resorption and remodeling potential. Methods  The non-coronary cusp was replaced with CorMatrix in four animals for 120 days. Valve function was assessed by echocardiography. Explants were examined by histology, immunohistochemistry, and collagen assessment. Results  CorMatrix was almost totally replaced with tissue resembling the native cusp with a partial two-layer architecture. However, function was lost due to thickening and calcification. Conclusions  Tested in high-pressure AV position in a pig model, CorMatrix degrades and remodels, but also loses function., (Georg Thieme Verlag KG Stuttgart · New York.)

Published
2017
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31. CorMatrix valved conduit in a porcine model: long-term remodelling and biomechanical characterization.

Author

Mosala Nezhad Z, Poncelet A, de Kerchove L, Fervaille C, Banse X, Bollen X, Dehoux JP, El Khoury G, and Gianello P

Subjects
Animals, Calcinosis pathology, Feasibility Studies, Fibrosis, Inflammation pathology, Models, Animal, Swine, Aorta, Thoracic surgery, Bioprosthesis, Blood Vessel Prosthesis, Extracellular Matrix
Abstract

Objectives: Porcine small intestinal submucosa extracellular matrix (CorMatrix; CorMatrix Cardiovascular, Rosewell, GA) is a relatively novel tissue substitute used in cardiovascular applications. We investigated the biological reaction and remodelling of CorMatrix as a tri-leaflet valved conduit in a pig model. We hypothesized that CorMatrix maintains a durable architecture as a valved conduit and remodels to resemble surrounding tissues., Methods: We fashioned the valved conduit using a 7 × 10 cm 4-ply CorMatrix sheet and placed it in the thoracic aorta of seven landrace pigs for 3, 4, 5 and 6 months. Biodegradation, replacement by native tissue, strength and durability were examined by histology, immunohistochemistry and mechanical testing., Results: Four pigs, one per time frame, completed the study. The conduit lost its original architecture as a tri-leaflet valve due to cusp immobility, subsequent attachment to the wall segment and consequent maintenance of a thick arterial wall-like structure. Scaffold resorption was incomplete, with disorganized inconsistent spatial and temporal degradation even at 6 months. Fibrosis, scarring and calcification started at 4 months and chronic inflammation persisted. The partially remodelled scaffold did not resemble the aortic wall, suggesting impaired remodelling. Mechanical testing showed progressive weakening of the tissues over time, which were liable to breakage., Conclusions: CorMatrix is biodegradable; however, it failed to remodel in a structured and anatomical fashion in an arterial environment. Progressive mechanical and remodelling failure in this scenario might be explained by the complexity of the conduit design and the host's chronic inflammatory response, leading to early fibrosis and calcification., (© The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Published
2017
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32. Surgical anatomy of the aortic root: implication for valve-sparing reimplantation and aortic valve annuloplasty.

Author

de Kerchove L, Jashari R, Boodhwani M, Duy KT, Lengelé B, Gianello P, Mosala Nezhad Z, Astarci P, Noirhomme P, and El Khoury G

Subjects
Adult, Aged, Cadaver, Female, Humans, Male, Middle Aged, Reproducibility of Results, Tissue Donors, Aorta, Thoracic anatomy & histology, Aorta, Thoracic surgery, Aortic Valve anatomy & histology, Aortic Valve surgery, Aortic Valve Insufficiency surgery, Cardiac Valve Annuloplasty methods, Heart Valve Prosthesis Implantation methods
Abstract

Background: To enhance the reproducibility of aortic valve-sparing reimplantation and annuloplasty, we analyzed the topographic relationship between the ventriculoaortic junction (VAJ), basal ring (BR), and sinotubular junction (STJ). The root base thickness is also quantified., Method: Fifty-eight fresh human aortic valves were analyzed. The root was dissected to the limit where the aortic wall terminates into the cardiac structures (VAJ). Root height was measured externally from the STJ to the VAJ and internally from the STJ to the BR defined as the plane passing through the cusps nadir. The root base thickness was measured at the BR and orthogonal to the internal wall; except at the right coronary sinus, where it was measured between the BR internally and the VAJ externally. Measurements were taken at the middle of the 3 sinuses and commissures., Results: The VAJ is at the same level as the BR from the noncoronary sinus (-0.1 ± 0.9 mm) to the left coronary sinus (0.5 ± 1.3 mm); it is above the BR from the left/right commissure (4.6 ± 1.4 mm) to the right/non commissure (2.5 ± 1.6 mm). The external root height was highest at the non/left commissure (21.5 ± 2.6 mm) followed by the right/non commissure (19.2 ± 2.3 mm) then the left/right commissure (15.7 ± 2.2 mm) (P < .05). The mean root base thickness was 3.2 mm, ranging from 1 ± 0 mm at the left/non commissure to 6.2 ± 1.2 mm at the right coronary sinus (P < .001)., Conclusions: The VAJ is not planar; it is above the level of the BR from the left/right to the right/non commissure. As a consequence, the external height of the non/left commissure is greater than the other 2 commissures. These findings should be taken into consideration when performing aortic valve-sparing reimplantation or external annuloplasty., (Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Published
2015
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33. How to perform valve sparing reimplantation in a tricuspid aortic valve.

Author

de Kerchove L, Mosala Nezhad Z, Boodhwani M, and El Khoury G

Abstract

Aortic valve sparing procedures are increasingly being used to treat aortic root pathologies. Reimplantation of the aortic valve, first described by Dr Tirone David, is a technically demanding procedure whose long-term results are critically dependent on perfect intraoperative restoration of valve anatomy and function. There exists significant variation in how this procedure is performed by different surgeons, which is likely contributory to the heterogeneity in reported results. We describe a systematic approach to aortic valve reimplantation procedure focusing on key technical aspects.

Published
2013
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