Background, establishment and initial experiences of the Danish cardiovascular homograft biobank.

Odense University Hospital is a major tertiary vascular hospital in Scandinavia, performing approx. 200 aortic repairs annually. This article presents the rationale behind this endeavor and the early outcomes of the initial implantation of locally processed homografts. All patients receiving a homograft were identified from the established homograft biobank database and their medical records were reviewed after obtaining consent. All surgeons in charge of homograft implantations were semi structured interviewed regarding the harvesting procedure, the tools for detecting available homografts, their quality and delivery. The National board of Health approved the biobank fulling the EU Directive of Tissues and Cells after 18 months of preparation. From May 6, 2021, to March 1, 2023, 26 patients had a homograft implantation, with 7 for mycotic aneurysms, 10 for aorto-iliac graft infection, 6 for infra-inguinal graft infection, and 3 for graft infection in thoracic aorta. Six (23%) were emergently performed. Two (7.7%) died within 30 days postoperatively, both following in situ replacement of an infected aortoiliac graft, corresponding to a 20% mortality in this subgroup. The incidence of reinfections was 19.2%; one each in the mycotic aneurysm group, the aortoiliac graft infection group, and the thoracic graft infection group. After 90 days, two patients were diagnosed with aorto-enteric fistula. All involved surgeons could easily identify available suitable homografts, and within 2 h have homografts of acceptable quality and requested dimensions. The establishment of the Danish Cardiovascular Homograft Biobank was straightforward and effectively serves cardiovascular procedures performed 24/7. Additionally, the initial experiences seem comparable to others experiences.

Transplantation of cryopreserved cardiovascular homografts.

Due to degeneration, homografts were since the 1950s only used strictly for replacement of complex arterial segments and lesions incl. the aortic valve, replacement of infected arterial prostheses, and vascular access for patients on haemodialysis. During the 1990s, rate-differentiated freezing methods and anti-crystallization agents proved to prevent crystallisation, and more widespread use with expanded indications incl. coronary and lower limb bypasses began justified by promising midterm results. In 2021, the first Scandinavian homograft biobank was founded in Odense in Denmark. This review summarises the history and the experiences from this biobank.

Experimental comparative study of a novel drug-eluting arteriovenous graft in a sheep model.

Background: Arteriovenous (AV) grafts often develop severe complications of stenosis due to neointimal proliferation that occurs either at the venous anastomosis site or at the outflow receiving vein. This study compares primary patency during 12 months of follow up for a new experimental Biomodics© interpenetrating polymer network (IPN) drug-eluting graft prototype with state-of-the-art GORE® ACUSEAL (ACUSEAL) in an AV graft model in sheep. Methods and results: An end-to-end bypass from the common carotid artery to the jugularis vein was performed bilaterally in 12 sheep. The usage of ACUSEAL or the IPN, both 6.0 mm in diameter, was determined via randomization. The sheep were followed up every 4 weeks with ultrasonic duplex scanning to determine patency; the experienced observer was blinded to the randomization. One sheep died after 11 days, and the final sample accordingly consisted of 11 animals. When comparing neointimal hyperplasia after 12 months in the two grafts, Fisher's exact test showed a significant difference with none out of 11 in the IPN grafts and 9 out of 11 in the ACUSEAL graft (p < 0.001). However, the Biomodics© IPN exhibited severe deterioration over time. Conclusions: Almost all of the grafts occluded during the 12 months of follow up. Although the zwitterion-bounded interpenetrating drug eluting polymer network showed signs to impair neointimal hyperplasia and thrombosis, age-related degeneration hindered demonstrating a potential improvement in patency.

An Antibiotic-Loaded Silicone-Hydrogel Interpenetrating Polymer Network for the Prevention of Surgical Site Infections.

Surgical site infections (SSIs) are among the most frequent healthcare-associated infections, resulting in high morbidity, mortality, and cost. While correct hygiene measures and prophylactic antibiotics are effective in preventing SSIs, even in modern healthcare settings where recommended guidelines are strictly followed, SSIs persist as a considerable problem that has proven hard to solve. Surgical procedures involving the implantation of foreign bodies are particularly problematic due to the ability of microorganisms to adhere to and colonize the implanted material and form resilient biofilms. In these cases, SSIs may develop even months after implantation and can be difficult to treat once established. Locally applied antibiotics or specifically engineered implant materials with built-in antibiotic-release properties may prevent these complications and, ultimately, require fewer antibiotics compared to those that are systemically administered. In this study, we demonstrated an antimicrobial material concept with intended use in artificial vascular grafts. The material is a silicone-hydrogel interpenetrating polymer network developed earlier for drug-release catheters. In this study, we designed the material for permanent implantation and tested the drug-loading and drug-release properties of the material to prevent the growth of a typical causative pathogen of SSIs, Staphylococcus aureus. The novelty of this study is demonstrated through the antimicrobial properties of the material in vitro after loading it with an advantageous combination, minocycline and rifampicin, which subsequently showed superiority over the state-of-the-art (Propaten) artificial graft material in a large-animal study, using a novel porcine tissue-implantation model.

Induction of autoimmune abdominal aortic aneurysm in pigs - A novel large animal model.

BACKGROUND: Abdominal aortic aneurysm (AAA) is a common disease with a high mortality. Many animal models have been developed to further understand the pathogenesis of the disease, but no large animal model has been developed to investigate the autoimmune aspect of AAA formation. The aim of this study was to develop a large animal model for abdominal aortic aneurysm induction through autoimmunity by performing sheep-to-pig xenotransplantation. METHODS: Six pigs underwent a xenotransplantation procedure where the infrarenal porcine aorta was replaced by a decellularized sheep aorta. In the following 47 days, the AP-diameter of the xenografts was measured using ultrasound once a week. All xenografts were harvested for histological analyses. RESULTS: All the xenografts formed aneurysms with a mean increase in AP-diameter of 80.98 ± 30.20% (p < 0.005). The ultrasound measurements demonstrated a progressive aneurysmal expansion with no sign of halting towards the end of the follow-up period. Histology showed destruction of tunica media and the elastic tissue, neointimal hyperplasia, adventitial thickening with neovascularization, infiltration of lymphocytes and granulocytes, and in some cases intramural haemorrhaging. CONCLUSION: We developed a novel large animal AAA model by infrarenal aortic sheep-to-pig xenograph transplantation resulting in autoimmune AAA induction with continuously progressive aneurysmal growth. This model can be used to provide a better understand the autoimmune aspect of AAA formation in large animals.