Month: September 2025

Adv Mater. 2025 Aug 5:e2504765. doi: 10.1002/adma.202504765. Online ahead of print.

ABSTRACT

Cardiac patches to repair myocardial defects require mechanically stable materials that prevent bleeding and can be implanted via suturing. The current clinical standard, bovine pericardial patches (BPPs), serve this purpose but do not degrade or integrate with the myocardium, limiting their long-term effectiveness. Here, we present the reinforced cardiac tissue patch (RCPatch). This multimaterial patch comprises a stiffness-tuned, cardiomyocyte-infiltrated 3D metamaterial and a suturable, hydrogel-infiltrated mesh to reduce permeability and bleeding. Anisotropic metamaterials are designed and computationally optimized using a generative modeling approach and fabricated from poly(ε-caprolactone) (PCL) via volumetric 3D printing (VP). The metamaterial supports the infiltration of cardiomyocytes, which are viable and contract in vitro. The implantability and low blood permeability of the patch is enabled by adding a melt-electrowritten (MEW) mesh infiltrated with a fibrin hydrogel. In an acute large animal trial, the RCPatch was applied on an induced myocardial defect, where it withstood intraventricular blood pressure, prevented bleeding, and enabled hemodynamic restabilization (intraventricular pressure of 81 mmHg before, vs 66 mmHg after implantation). These findings establish a scalable framework for fabricating cardiac tissue patches that integrate mechanical reinforcement with biological function, offering a surgically implantable and future regenerative solution for intraventricular myocardial repair.

PMID:40761175 | DOI:10.1002/adma.202504765

J Cardiovasc Surg (Torino). 2025 Aug;66(4):291-298. doi: 10.23736/S0021-9509.25.13336-3.

ABSTRACT

BACKGROUND: Aortic Graft Infection (AGI) and Infective Native Aortic Aneurysm (INAA) require open repair with infection-resistant prostheses. Physician’s made xeno-pericardial grafts combine availability with freedom from reinfection, but mainly short-term results are reported. The aim is to examine the mid-term outcomes in aortic infections using stapled physician-made or pre-sutured bovine pericardium tube grafts.

METHODS: We report all patients who underwent in situ aortic reconstruction using pericardial tube grafts (prepared from pericardial patches using a surgical stapler or pre-sutured) for AGI or INAA between January 2019 and October 2024 at a single center. Perioperative outcomes and follow-up data were retrospectively collected.

RESULTS: Twenty-one patients (18 male, median age 72 years) underwent aortic surgery and implantation of a preformed (N.=5) or stapled physician-made (N.=16) pericardial tubes graft for an INAA (N.=7) or AGI (N.=14). All AGI patients had late infections (median time from primary surgery of 81 months), in nine cases associated with aorto-digestive fistula. One perioperative death was recorded. Patients treated for an AGI demonstrated a longer median length of stay (22 vs. 12 days; P=0.020) and higher intraoperative blood loss (1400 vs. 400 mL; P=0.025). Of the 20 patients surviving the index event, at a mean follow-up of 23±8 months, no aortic-related death, nor mechanical failure were recorded. One case of reinfection and reintervention has been observed (4.8%). All but one patient discontinued the antibiotic therapy after a median duration of 146 days.

CONCLUSIONS: Aortic repair with preformed and home-made stapled xeno-pericardial grafts is safe and provides durable infection-free survival at a mid-term follow-up.

PMID:40985629 | DOI:10.23736/S0021-9509.25.13336-3

Vasc Specialist Int. 2025 Jul 31;41:18. doi: 10.5758/vsi.250027.

ABSTRACT

PURPOSE: This study retrospectively evaluated the mid-term outcomes of thromboendarterectomy (TEA) for common femoral artery (CFA) disease in a Japanese cohort by comparing patients with chronic limb-threatening ischemia (CLTI) and intermittent claudication (IC).

MATERIALS AND METHODS: Sixty-three TEA procedures performed between 2011 and 2024 were analyzed. The primary endpoints focused on procedure-related outcomes such as patency and limb salvage, whereas overall survival was assessed as a key secondary outcome. The patients were divided into the CLTI (n=20) and IC (n=43) groups; the anesthesia type, additional revascularization, blood loss, hospital stay, complications, and survival were compared. Multivariable Cox regression analysis was performed to identify independent predictors of mortality.

RESULTS: Patients with CLTI had higher rates of local anesthesia, additional revascularization (all performed concomitantly), greater blood loss, and longer hospital stays. Despite the 100% technical success in both groups, 30-day mortality and complications occurred only in the CLTI group. Kaplan-Meier analysis showed similar patency and limb salvage rates between groups, whereas survival rates were significantly lower in patients with CLTI (P=0.037). Multivariable analysis revealed that CLTI itself was not an independent predictor of mortality; rather, a worse systemic status (e.g., higher American Society of Anesthesiologists classification) showed a trend toward poorer outcomes (P=0.051). No significant differences were found between the patch types.

CONCLUSION: TEA provides effective mid-term outcomes in patients with CFA disease, particularly those with IC. Although patients with CLTI show poorer survival, this appears to be driven more by systemic comorbidities than by the limb status itself. Careful preoperative assessment and holistic management of general health are essential to optimize outcomes, particularly in high-risk populations.

PMID:40739708 | PMC:PMC12311306 | DOI:10.5758/vsi.250027

Ann Vasc Surg. 2025 Jul 28;122:327-335. doi: 10.1016/j.avsg.2025.07.033. Online ahead of print.

ABSTRACT

BACKGROUND: To perform the preclinical evaluation of a new bridging stent for fenestrated endovascular aneurysm repair (FEVAR) in a dedicated animal model.

METHODS: A pararenal aneurysm was created in swines by suturing a bovine pericardium patch to the aorta, tailored to be compatible with available endografts. A cone beam computed tomography (CBCT) was performed to design custom-made fenestrated endograft. FEVARs were performed in hybrid room using retroperitoneal iliac accesses. Bridging stents were standard stents (BG, Begraft, Bentley) or new stents with a modified balloon to allow stent implantation and flaring in one step (BF, BeFlared, Bentley). Preoperative and postoperative CBCT were conducted to assess aneurysms anatomies and geometrical layout of the bridging stents.

RESULTS: Eleven pararenal aneurysms were created, all eligible for FEVAR. One animal died of aneurysm rupture at 64 days. Ten FEVARs were performed without complications after a mean delay from aneurysm creation of 90 days (range:43-119). Technical success was 90% (one type 1a endoleak). Ten BG and 10 BF were implanted successfully and showed comparable efficacy in all renal arteries which were all patent on completion angiogram; one type 1c endoleak in the BG group was observed and corrected by a redo inflation. No safety-related adverse events nor device malfunction were observed. The flaring dimensions and protrusion lengths were similar when comparing BF and BG.

CONCLUSION: A comprehensive evaluation of the safety and efficacy of a new bridging stent was possible by using the new pararenal aneurysm model to assess clinically relevant outcomes for FEVAR in real-life conditions.

PMID:40738451 | DOI:10.1016/j.avsg.2025.07.033