Extracellular Matrix Patches for Endarterectomy Repair.

Patch repair is the preferred method for arteriotomy closure following femoral or carotid endarterectomy. Choosing among available patch options remains a clinical challenge, as current evidence suggests roughly comparable outcomes between autologous grafts and synthetic and biologic materials. Biologic patches have potential advantages over other materials, including reduced risk for infection, mitigation of an excessive foreign body response, and the potential to remodel into healthy, vascularized tissue. Here we review the use of decellularized extracellular matrix (ECM) for cardiovascular applications, particularly endarterectomy repair, and the capacity of these materials to remodel into native, site-appropriate tissues. Also presented are data from two post-market observational studies of patients undergoing iliofemoral and carotid endarterectomy patch repair as well as one histologic case report in a challenging iliofemoral endarterectomy repair, all with the use of small intestine submucosa (SIS)-ECM. In alignment with previously reported studies, high patency was maintained, and adverse event rates were comparable to previously reported rates of patch angioplasty. Histologic analysis from one case identified constructive remodeling of the SIS-ECM, consistent with the histologic characteristics of the endarterectomized vessel. These clinical and histologic results align with the biologic potential described in the academic ECM literature. To our knowledge, this is the first histologic demonstration of SIS-ECM remodeling into site-appropriate vascular tissues following endarterectomy. Together, these findings support the safety and efficacy of SIS-ECM for patch repair of femoral and carotid arteriotomy.

Pericardial reconstruction using an extracellular matrix implant correlates with reduced risk of postoperative atrial fibrillation in coronary artery bypass surgery patients.

BACKGROUND: Postoperative atrial fibrillation (AF) is a significant complication following open heart surgery, with potentially serious clinical and economic implications. To assess the effect of a novel procedure, pericardial reconstruction using a porcine-derived extracellular matrix (ECM) implant, on the risk of postoperative AF after primary isolated coronary artery bypass grafting (CABG), we performed a retrospective comparison of the incidence of postoperative AF in patients who underwent this procedure versus an untreated control group. METHODS: We performed a retrospective comparison of the incidence of postoperative AF in 111 patients who underwent a pericardial reconstruction procedure with the CorMatrix ECM for Pericardial Closure (CorMatrix Cardiovascular, Atlanta, GA, USA) following primary isolated CABG, versus a control group of 111 patients who did not undergo pericardial reconstruction. RESULTS: Postoperative AF occurred in 43 of 111 control patients (39%; lower control limit [LCL], 30%; upper control limit [UCL], 49%) but in only 20 of 111 treated patients (18%; LCL, 11%; UCL, 27%). This result represents a 54% reduction in relative risk in the treatment group (P < .001). There was a small but statistically insignificant decrease in the hospital length of stay for the treated patients. The 2 treatment groups exhibited similar postoperative complication profiles. CONCLUSIONS: In this retrospective study, pericardial reconstruction with the ECM implant contributed directly to a statistically significant and clinically meaningful reduction in the rate of postoperative AF in patients undergoing primary isolated CABG. A prospective multicenter randomized trial has been planned to further test this approach.

Outcomes after unilateral lung volume reduction.

BACKGROUND: For patients with end-stage emphysema undergoing lung volume reduction surgery (LVRS), we have preferred a bilateral (BLVRS) approach to achieve maximum benefit with a single procedure. A unilateral (ULVRS) approach has been used in certain patients in whom BLVRS is contraindicated. METHODS: Between January 1993 and December 2006, 43 consecutive patients underwent ULVRS. The study excluded patients undergoing giant bullectomy. Relative contraindications for BLVRS were unilateral emphysema, 21; unilateral emphysema plus other factors, 2; and other factors alone, 10. Preoperative pulmonary rehabilitation was required. Postrehabilitation data were used as the baseline for analyses. Outcome measurements for ULVRS were compared with BLVRS results. RESULTS: After ULVRS, the mean increase in forced expiratory volume in 1 second (FEV(1)) from postrehabilitation values was 32% at 6 months (p

Quinolizidine alkaloids from Sophora alopecuroides.

A new matrine-type alkaloid, 7alpha-hydroxysophoramine (1), was isolated from the aerial parts of Sophora alopecuroides together with eight known alkaloids, 12beta-hydroxysophocarpine (2), sophoramine (3), 14beta-hydroxymatrine, matrine, sophoridine, sophocarpine, adenocarpine, and baptifoline. The structures of compounds 1-3 were confirmed through single-crystal X-ray diffraction analysis.

Respiratory dysautonomia in leprosy.

Autonomic neuropathy in leprosy has been reported recently. 25 cases of polar lepromatous leprosy with and without lepra-reaction and 25 normal control, have been studied for respiratory dysautonomia. In 12 cases out of 25 (48%) involvement of sympathetic respiratory reflexes has been observed. Possible causes of the same are discussed.