Category: General

Acta Biomater. 2025 Nov 26:S1742-7061(25)00882-7. doi: 10.1016/j.actbio.2025.11.046. Online ahead of print.

ABSTRACT

Aortic stenosis (AS) is characterised by the narrowing and stiffening of the aortic valve, which restricts blood flow from the heart to the rest of the body. Severe AS is a life-threatening condition which affects 1.48 % of individuals aged 55 and older, with a four-year mortality rate of 44.9 % if left untreated. Minimally invasive treatment for AS involves the implantation of a bioprosthetic valve with porcine or bovine pericardium leaflets, which frequently succumb to failure due to regurgitation or stenosis caused in part by calcification and structural damage. The relationship between these two durability-limiting processes is debated, and the influence of device crimping on both factors is not comprehensively understood. This study aims to explore the relationship between calcification and structural damage and determine if device crimping affects these processes. First, porcine pericardium (PP) tissue was exposed to either in vitro calcification in unloaded conditions (calcification) or cyclic bulge loading in saline, without calcification (structural damage). Subsequently, PP was simultaneously calcified and cyclically loaded for 30 million cycles. Simultaneous calcification and loading led to dramatically increased calcification and structural damage, including tissue rupture. Device crimping was not found to have a significant impact on calcification or structural damage. However, fibre architecture was found to affect rupture location, and dramatically affect the rate of rupture of PP. This finding has implications for future bioprosthetic valve leaflet anti-calcification strategies, where tissue mechanics influenced by the underlying tissue fibre architecture should be considered to minimise both structural damage and calcification. STATEMENT OF SIGNIFICANCE: Porcine pericardium (PP) is a commonly used biomaterial, most frequently in the leaflets of bioprosthetic valves. These devices frequently succumb to failure due to regurgitation or stenosis caused in part by calcification and structural damage of their leaflets. This work shows that calcification and structural damage work together to accelerate failure of PP, with dramatically increased calcification and structural damage of PP, including rupture, when the tissue is exposed to both simultaneously. Fibre architecture of PP was found to affect rupture location, and dramatically affect rate of rupture. This finding has implications for bioprosthetic leaflet durability, where tissue mechanics influenced by the underlying tissue fibre architecture should be considered to minimise both structural damage and calcification and maximise valve durability.

PMID:41314445 | DOI:10.1016/j.actbio.2025.11.046

J Surg Case Rep. 2025 Nov 19;2025(11):rjaf920. doi: 10.1093/jscr/rjaf920. eCollection 2025 Nov.

ABSTRACT

Nutcracker syndrome is a rare condition caused by compression of the left renal vein between the abdominal aorta and the superior mesenteric artery. This results in increased venous pressure, leading to haematuria, flank pain, and pelvic discomfort, particularly in individuals with low body mass index. Diagnosis is often challenging due to nonspecific symptoms and overlap with other pelvic disorders. We report a case of a 49-year-old woman with persistent left flank pain, dysmenorrhea, and recurrent vaginal bleeding. Imaging confirmed compression of the left renal vein. A conservative approach with nutritional support was initially attempted, but due to ongoing symptoms, the patient underwent surgical transposition of the vein with patch angioplasty using bovine pericardium. This case underscores the need to consider Nutcracker syndrome in patients with unexplained haematuria and flank pain, especially in underweight women. We also review current diagnostic tools and treatment options for this uncommon vascular condition.

PMID:41268427 | PMC:PMC12628186 | DOI:10.1093/jscr/rjaf920

J Clin Med. 2025 Oct 31;14(21):7736. doi: 10.3390/jcm14217736.

ABSTRACT

Background: The Sandwich technique is a commonly adopted method for reinforcing the dissected aortic wall during acute Type A aortic dissection (ATAAD) repair, using either felt or bovine pericardial strips. However, complications such as anastomotic bleeding, distal anastomotic new entry (DANE) and persistent false lumen (PFL) remain major challenges. This study evaluated and compared the sealing efficacy of felt versus pericardium in a human cadaver model. Methods: ATAAD was simulated in 20 fresh human cadavers. Repairs were performed using the sandwich technique with either felt (n = 10) or pericardium (n = 10), followed by end-to-end prosthetic graft anastomosis. Procedure time was recorded. Following the repair, the aortas were perfused at 160/90 mmHg using a glycerol-water solution to assess fluid leakage (mL), DANE and PFL. Results: Median leakage was significantly lower in the pericardium group (67.5 mL [IQR 40-198.8]) compared to the felt group (315 mL [IQR 285-445], p = 0.002). Procedure times were comparable between groups. DANE occurred in 20% (pericardium) and 30% (felt) of cases, while PFL was observed in 30% of cases in both groups; differences were not statistically significant. Conclusions: The superior sealing properties of pericardium in this study suggest a promising approach for reducing leakage in ATAAD repair. While rates of DANE and PFL were comparable, the advantage of pericardium was confined to leakage reduction. These findings highlight the need for further research to determine whether this experimental benefit translates into improved clinical outcomes.

PMID:41227132 | PMC:PMC12609355 | DOI:10.3390/jcm14217736

EJVES Vasc Forum. 2025 Sep 20;64:183-185. doi: 10.1016/j.ejvsvf.2025.09.006. eCollection 2025.

ABSTRACT

INTRODUCTION: Primary venous leiomyosarcoma is an unusual and aggressive tumour; its presentation on the renal vein is rare. This case study presents a 50 year old man with severe obesity who was incidentally diagnosed with a left renal vein leiomyosarcoma during pre-operative evaluations for a cholecystectomy. Following a multidisciplinary discussion with oncology and vascular surgeons, the patient underwent complete resection of the left renal vein along with the mass.

TECHNIQUE: This article proposes an innovative surgical technique for the reconstruction of the left renal vein in case of a left renal vein leiomyosarcoma. Reconstruction was achieved using a physician made biological stent graft, employing a nitinol bare stent wrapped in a pericardial patch. The video provides a step by step explanation of the procedure. Isolation and the surgical technique for the reconstruction of the left renal vein following en bloc resection of the leiomyosarcoma are shown, followed by reconstruction of the vein using a nitinol stent covered with bovine pericardium. Several precautions were adopted to minimise the risk of intestinal fistula, including heterotopic graft re-implantation and omentoplasty.

DISCUSSION: Complete surgical excision remains the cornerstone of vein sarcoma treatment and offers the best chance for disease control. The literature has only reported en bloc resection of renal vein sarcomas with nephrectomy. This case report presents an innovative surgical technique for left renal vein replacement, showing a potential alternative in the management of this rare condition in order to preserve the vein.

PMID:41210915 | PMC:PMC12595132 | DOI:10.1016/j.ejvsvf.2025.09.006

Surg Case Rep. 2025;11(1):25-0457. doi: 10.70352/scrj.cr.25-0457. Epub 2025 Oct 18.

ABSTRACT

INTRODUCTION: We encountered a case in whom ventricular septal rupture (VSR) repair was performed only through right atriotomy. A few cases of VSR repair using the right atrial approach have been reported in the literature. We report our experiences with focusing on the surgical technique.

CASE PRESENTATION: The patient was a 79-year-old woman who was admitted to the emergency room with dizziness and vomiting. Echocardiography showed inferior myocardial infarction and posterior VSR. Emergency percutaneous coronary artery intervention was performed on the proximal right coronary artery and recanalization was achieved. Delayed surgery was planned because of the stability of her hemodynamics. Sandwich repair using two bovine pericardial patches was performed only through right atriotomy on the 14th day of hospitalization under intra-aortic balloon pumping (IABP). The location of the VSR was identified by saline injection through the left ventricular vent. A VSR 18 mm in length was observed after resection of several trabeculae. A 3.5 × 2.5 cm oval patch of bovine pericardium was placed on the left side of VSR and another patch was attached to the right side to cover the VSR with 8 pieces of monofilament-interrupted U sutures. She was discharged from the hospital on the 108th POD after long ventilatory management and temporary hemodialysis.

CONCLUSIONS: VSR of the posterior interventricular septum due to inferior myocardial infarction is a good candidate for the right atrial approach. It is important to diagnose the location and shape of the VSR in advance. The location of the VSR can be identified by saline injection through the left ventricular vent and resection of several trabeculae is essential to expose the whole VSR. The right atrial approach can minimize impairment of the ventricular function and may be a promising approach for VSR repair.

PMID:41170126 | PMC:PMC12571518 | DOI:10.70352/scrj.cr.25-0457

Ann Surg Oncol. 2026 Feb;33(2):1719-1720. doi: 10.1245/s10434-025-18545-6. Epub 2025 Oct 19.

ABSTRACT

BACKGROUND: Abdominal malignant tumors sometimes involve the inferior vena cava (IVC).^1-4 In such cases, radical resection, including IVC resection and reconstruction, is a critical component of curative treatment.^3,4 Although patch repair or synthetic tube grafts are used for IVC reconstruction, synthetic grafts may carry risks of infection and thrombosis.^5-7 Although tubularized bovine pericardium grafts have shown favorable outcomes, the technical details are not well documented.^1,8-11 CASE PRESENTATION: IVC patch reconstruction using bovine pericardial grafts was performed in three cases. In one, the patch extended over more than two-thirds of the circumference, and the reconstruction was carried out in an irregular shape to preserve the branch of the left renal vein. By using a tubularized bovine pericardium graft, a smooth shape enabled easier reconstruction of the branches. A 33-year-old woman presented with an initially unresectable large leiomyosarcoma invading the IVC and hepatic veins. After chemotherapy shrank the tumor, surgical resection, including right nephrectomy, partial hepatectomy, and IVC resection, was performed. A 14 cm tube graft was created in the operating room using bovine pericardium, and this was anastomosed to the IVC. Elevated left renal vein pressure indicated side-to-end anastomosis. Postoperative computed tomography confirmed graft patency, and the patient was discharged uneventfully on postoperative day 10.

CONCLUSIONS: We present the technical details of IVC resection and reconstruction using a tubularized bovine pericardium graft, along with left renal vein reconstruction.

PMID:41110024 | DOI:10.1245/s10434-025-18545-6

Medicina (Kaunas). 2025 Oct 10;61(10):1814. doi: 10.3390/medicina61101814.

ABSTRACT

Background and Objectives: Adequate buccal bone thickness is critical for long-term peri-implant health and stability. When residual alveolar bone volume is insufficient, guided bone regeneration (GBR) is a widely adopted technique. While non-resorbable membranes provide structural support, they carry a higher risk of complications and require secondary surgery. Resorbable collagen membranes, offer promising biological properties and easier clinical handling, yet clinical data remain limited. This prospective cohort study aimed to evaluate the clinical and radiographic outcomes of horizontal GBR using a native, non-cross-linked resorbable porcine pericardium membrane fixed with titanium pins, in conjunction with simultaneous implant placement. Materials and Methods: Eighteen patients (26 implants) with horizontal alveolar defects (<6 mm) underwent implant placement and GBR with deproteinized bovine bone mineral and a porcine pericardium collagen membrane. Horizontal bone gain and buccal bone thickness were measured at baseline and 6 months post-operatively. Post-operative complications, patient-reported outcomes (PROMs), and peri-implant tissue health were assessed up to 1 year post-loading. Results: Mean bone gain was 2.95 ± 0.95 mm, and all sites achieved a buccal bone thickness ≥ 1.5 mm. No membrane-related complications occurred. PROMs revealed low morbidity. At 1-year follow-up, marginal bone loss averaged 0.54 ± 0.7 mm, mean probing depth was 2.79 ± 0.78 mm, 92% of sites exhibited keratinized mucosa ≥ 2 mm. Conclusions: Native resorbable porcine pericardium membranes, when combined with DBBM and mechanical stabilization, seem to be effective for horizontal bone regeneration.

PMID:41155801 | PMC:PMC12566594 | DOI:10.3390/medicina61101814

Interdiscip Cardiovasc Thorac Surg. 2025 Nov 6;40(11):ivaf236. doi: 10.1093/icvts/ivaf236.

ABSTRACT

OBJECTIVES: Although rare, aorto-oesophageal fistula remains one of the most critical diseases in cardiovascular surgery. The lack of prospective studies or large case series leads to an absence of evidence-based therapeutic concepts.

METHODS: We conducted a retrospective analysis of patients treated for aorto-oesophageal fistula between 2014 and 2023. Primary endpoints of analysis were 30-day mortality and median survival; subgroup analysis was performed for aetiology as well as treatment strategy. Additionally, a systematic search was conducted for all studies researching treatment of the disease, including ≥5 patients and published within the last 10 years.

RESULTS: In the collective of 10 patients, 4 manifested as primary fistula, while in 6 patients the fistula occurred secondary to previous thoracic endovascular aortic repair. Median duration to manifestation post-TEVAR was 20.1 months (34.1). Initial treatment consisted of TEVAR or TEVAR-relining in 7 cases, followed by bovine open aortic replacement (n = 1) or partial bovine patch repair (n = 2) when viable. Treatment of the oesophagus consisted of primary suture (n = 1) or oesophagectomy (n = 5) with gastric pull-up or colon interposition. Overall 30-day mortality was 40%, and overall median survival was 7.5 months (12.8). Patients receiving surgical treatment of the oesophagus exhibited longer survival than patients who did not (12.8 months [4.7] vs 0.35 months [0.4]). Across the reviewed literature, the strongest effect on survival originates from surgical treatment of the oesophagus. Specific surgical strategies as well as patient characteristics vary widely.

CONCLUSIONS: We found TEVAR effective in stabilizing the initial haemorrhage. Short-interval oesophagectomy seems to improve survival and should be considered in most patients. Open aortic replacement with bovine pericardium is a viable option. Interventional treatment options alone do not appear to be sufficient.

PMID:41105160 | PMC:PMC12622961 | DOI:10.1093/icvts/ivaf236

JTCVS Tech. 2025 Sep 19;34:95-99. doi: 10.1016/j.xjtc.2025.08.027. eCollection 2025 Dec.

ABSTRACT

OBJECTIVE: We report the results of assessment of the Normo valve and the Normo operation using bioengineering methods.

METHODS: The Normo valve, made from bovine pericardium using a specially designed template and the flexible ring (27-mm Duran; Medtronic Inc), was installed into the pulsatile circulatory simulator. A 27-mm bioprosthetic valve (Mosaic; Medtronic Inc) was used as a control. The hydrodynamic performance of the Normo valve and bioprosthesis was investigated and compared. To assess the original template design, we created modified templates with slight alterations for both leaflets. The 4 types of valve made using these modified templates were tested to evaluate their hydrodynamic performance relative to the original design. In addition, finite element analysis was conducted to evaluate the relationship between leaflet stress and the distance between 2 major papillary muscles with the distances set at 18 mm, 24 mm, 30 mm, and 36 mm.

RESULTS: The waveforms of the Normo valve and bioprosthesis showed a similar pattern. As for the large leaflet, the Normo valve made from original design template revealed lowest pressure gradient compared to other 2 types. As for the small leaflet, the Normo valve made from original design template showed lowest pressure gradient with greatest forward flow. The stress on the leaflet increased for the distance between 2 papillary muscles at 18 mm and 36 mm.

CONCLUSIONS: The data obtained from the bioengineering method confirm the validity of the Normo valve’s design. Furthermore, the results show preferable positioning for the fixation of the leg to 2 papillary muscles.

PMID:41368376 | PMC:PMC12683050 | DOI:10.1016/j.xjtc.2025.08.027

Colloids Surf B Biointerfaces. 2026 Feb;258:115210. doi: 10.1016/j.colsurfb.2025.115210. Epub 2025 Oct 18.

ABSTRACT

The present study explores the development and characterization of a thermosensitive composite hydrogel derived from decellularized bovine pericardium (DPC) and MXene nanosheets intended for myocardial repair applications. The hydrogels were prepared by integrating Ti₃C₂T_x MXene nanosheets into the DPC matrix, resulting in thermosensitive composite gels with varying MXene concentrations (0.1-0.8 %). Their properties were assessed in terms of the gelation kinetics, mechanical strength, conductivity, and biocompatibility. Our findings indicate that the incorporation of MXene significantly enhanced the storage modulus of the hydrogels, reduced the gelation time, and preserved the structural integrity. Electrical conductivity increased with MXene concentration, with DPC-0.8 %M achieving conductivity levels closely resembling those of the native myocardial tissue. In vitro biocompatibility evaluation using H9c2 cardiomyocytes demonstrated that MXene-containing DPC hydrogels supported high cell viability and promoted cell proliferation without significant toxicity. Intramyocardial injection of the DPC-0.8 %M hydrogel into the infarcted region of rats with myocardial infarction resulted in a notable improvement in cardiac function, significant thickening of the ventricular wall, and considerable enhancement in myocardial regeneration. These findings underscore the potential of DPC-0.8 %M hydrogels to augment myocardial repair by providing mechanical support, facilitating electrical conductivity, and supporting cellular survival, thereby offering a promising strategy for cardiac tissue engineering and repair following myocardial infarction.

PMID:41129948 | DOI:10.1016/j.colsurfb.2025.115210