Enhanced Endothelialization Using Resveratrol-Loaded Polylactic Acid-Coated Left Atrial Appendage Occluders in a Canine Model

Figures

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  Figure 1. Schematic of the resveratrol and PLA coating on the LAA occluder. LAA, left atrial appendage; PLA, polylactic acid.

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  Figure 2. LAA occluder implantation in the canine model. (a) Illustration of transcatheter interventional closure of the LAA with the noncoated occluder and the resveratrol-loaded PLA-coated occluder. (b) Illustration of the study design. (c) TEE examination during LAAO and follow-up. (d) Angiography-guided implantation (left) and residual flow examination (right). (e) Angiography image after implantation. (f) Macroscopic evaluation showing the device in situ from the outside view. (g) Plain and enhanced computed tomography of the LAA occluder in situ during follow up. LAA, left atrial appendage; LAAO, left atrial appendage occlusion; PLA, polylactic acid; TEE, transesophageal echocardiography.

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  Figure 3. Photographs and representative SEM images of the neoendocardial coverage on the noncoated occluder and the resveratrol-loaded PLA-coated occluder at 14 days (a and b, respectively), 28 days (c and d, respectively), and 90 days (e and f, respectively). Scale bar: 50 μm in the SEM images. In (iii), the yellow triangles indicate erythrocytes. PLA, polylactic acid; SEM, scanning electron microscopy.

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  Figure 4. Histological examination of the LAA occluder implanted in the canine LAA. H&E photograph of the noncoated occluder and the resveratrol-loaded PLA-coated occluder at 14 days (a and b, respectively), 28 days (c and d, respectively), and 90 days (e and f, respectively). The blue boxes in (i) are shown at 5× magnification in (ii), 10× magnification in (iii), and 20× magnification in (iv). The yellow triangles indicate infiltrated leukocytes. Scale bar: 5000 μm in (i), 500 μm in (ii), 200 μm (iii), and 100 μm in (iv). LAA, left atrial appendage; H&E, hematoxylin and eosin; PLA, polylactic acid.

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  Figure 5. Gross anatomical image of the surface of the resveratrol-loaded PLA-coated LAA occluder at 28 days in the experimental group with incomplete endothelialization. LAA, left atrial appendage; PLA, polylactic acid.

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  Figure 6. TEE showing PDL. One dog in the control group that was sacrificed at 14 days had PDL of 3.2 mm at the upper edge of the occluder (a). One dog in the control group that was sacrificed at 28 days had PDL of 3.7 mm at the lower edge of the occluder (b). PDL, peri-device leakage; TEE, transesophageal echocardiography.