Key result
Industrial processing of pericardial patches induces collagen network destruction and tissue loosening, initiating degeneration that continues after implantation and limits graft longevity.
Why the study?
While autologous pericardium is the gold standard for reconstructive surgical procedures in children, processed xenograft tissues are widely used, prompting investigation into structural differences and alterations caused by industrial processing.
Does industrial processing alter the structural integrity of pericardial tissues used for reconstructive surgery?
Observational (n=10)
No
Does industrial processing alter the structural integrity of pericardial tissues used for reconstructive surgery?
Industrial processing induces structural degeneration in pericardial patches, which may negatively impact graft longevity in pediatric reconstructive surgeries.
Processed pericardial patches show structural variations; leaves open optimal material selection for pediatric reconstruction pending clinical outcomes.
Background: Autologous pericardium is considered gold standard for various reconstructive surgical procedures in children. However, processed bovine, equine, and porcine pericardial tissue are also widely used. We investigated structural differences and analyzed alterations caused by industrial processing. Additionally human and equine pericardium explants, used during aortic valve reconstruction were analyzed. Methods: Pericardial tissues (native, processed and explanted) were gathered and stained with HE and EvG to visualize collagen as well as elastic fibers. Fiber structures were visualized by light and polarization microscopy. Antibody staining against CD 3, CD 20, and CD 68 was performed to identify inflammation. Results: Native pericardium of different species showed small differences in thickness, with bovine pericardium being the thickest [bovine: 390 μm (± 40.6 μm); porcine: 223 μm (± 30.1 μm); equine: 260 μm (± 28.4 μm)]. Juvenile pericardium was 277 μm (± 26.7 μm). Single collagen bundle diameter displayed variations (~3-20 μm). Parallel collagen fibers were densely packed with small inter-fibrillary space. After industrial tissue processing, loosening of collagen network with inter-fibrillary gapping was observed. Pericardium appeared thicker (mean values ranging from 257-670 μm). Processed tissue showed less birefringence under polarized light. All analyzed tissues showed a small number of elastic fibers. Fibrosis, calcification and inflammatory processes of autologous and equine pericardium were observed in patient explants. Conclusion: None of the analyzed tissues resembled the exact structure of the autologous pericardial explant. Degeneration of pericardium starts during industrial processing, suggesting a potential harm on graft longevity in children. A careful surgical approach prior to the implantation of xenografts is therefore needed.
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Peivandi et al. (2022) conducted an observational in Congenital heart disease requiring aortic valve reconstruction (n=10). Industrially processed pericardial patches vs. Native pericardium was evaluated on Histological structure, thickness, and degeneration of pericardial tissue. Industrial processing of pericardial patches induces collagen network destruction and tissue loosening, initiating degeneration that continues after implantation and limits graft longevity.
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