Pericardial Graft Research Articles

Treatment of Peyronie’s disease by incomplete circumferential incision of the tunica albuginea and plaque with bovine pericardium graft

Objectives. To study the surgical treatment of Peyronie’s disease using a single incision in the tunica albuginea and fibrotic plaque and repair of the defect by bovine pericardium graft. Methods. Between April 1999 and May 2001, 33 patients who had had symptoms of Peyronie’s disease for more than 12 months and whose disease had been stable for more than 6 months underwent surgery. The reason for surgery was deformity of the penis that made sexual intercourse, even with erection, difficult or impossible. Two paraurethral incisions were made in Buck’s fascia to separate the neurovascular bundle from the tunica albuginea. An incomplete circumferential incision, forked at the extremities, was made in the tunica albuginea and in the plaque at the point of maximal curvature, followed by a septal incision for the lengthening of the short side of the penis. A bovine pericardium graft was used to repair the defect in the tunica. All procedures were performed by a single surgeon (P.H.E.). The average follow-up time was 19.4 months (range 5 to 30). Results. No rejection or retraction of the graft was observed. All patients maintained their state of preoperative erection, with the penis corrected in 87.9% of cases and with discrete curvature (less than 15°) in 12.1%. All recovered their ability to penetrate with no difficulty. In addition, an intraoperative average increase of 2.21 cm (range 1 to 4) occurred in the size of the penis. Conclusions. This procedure is effective for all types of penile deformity, regardless of the plaque characteristics.

Light and electron microscopic analyses of autologous pericardial tissue used as a small-diameter arterial graft in dogs.

As a form of small-diameter arterial graft, we implanted fresh autologous pericardium and pericardium treated with 0.6% glutaraldehyde in the bilateral carotid arteries of dogs and then compared the time-related changes of the grafts explanted after the predetermined periods. The pericardial grafts were implanted in 1 animal each for scheduled periods of 3 days, 2 weeks, 1 month, 3 months, and 6 months. The retrieved grafts were processed for light and electron microscopic analyses following gross observation. The glutaraldehyde-treated small-diameter pericardial vascular grafts showed a better endothelialization of the blood-contacting surface and a slower fragmentation of the collagen layers than the fresh grafts although it has yet to be proven whether these differences are so significant as to affect the patency results between the groups.

TUNICA VAGINALIS FOR CORRECTING PENILE CHORDEE IN A RABBIT MODEL: IS THERE A DIFFERENCE IN FLAP VERSUS GRAFT?

We compared tunica vaginalis applied as a flap versus a graft for covering defects in the ventral tunica albuginea in a rabbit model. We used 18 New Zealand White rabbits in the study. The urethra was mobilized off of the corpus cavernosum. A defect was created in the ventral aspect of the tunica albuginea by excising a 1 x 0.5 cm. rectangular area. The defect was covered by the testicular surface of tunica vaginalis as a vascularized flap in 9 animals and as a graft in 9. At 2, 6 and 12-week intervals 3 animals per group were sacrificed. Transverse sections of the penis at the repair site were stained with hematoxylin and eosin, and Masson's trichrome for microscopy. Autopsy revealed no contracture in any of the tunica vaginalis flaps. In contrast, the tunica vaginalis grafts had contracted by a mean of 22% (range 20% to 25%) at 2, 38% (range 30% to 44%) at 6 and 42% (range 38% to 48%) at 12 weeks. Microscopic examination of the tunica vaginalis flaps showed evidence of an intact blood supply and viable cremasteric muscle layer but no evidence of necrosis. Collagen remodeling and maturation was noted at 12 weeks. In tunica vaginalis grafts there was evidence of necrosis of all tunica vaginalis layers at 2 weeks with granulation tissue and active fibrosis at the periphery. At 6 and 12 weeks most necrotic tissue was replaced by fibrosis. Osseous metaplasia was identified in 1 graft at 12 weeks. The optimal use of tunica vaginalis for correction of chordee is as a flap rather than as a free graft. Grafts were associated with significant necrosis and contracture, of which neither was associated with flaps.

A COMPARISON OF DERMAL AND CADAVERIC PERICARDIAL GRAFTS IN THE MODIFIED HORTON-DEVINE PROCEDURE FOR PEYRONIE’S DISEASE

Penile curvature due to Peyronie's disease is often treated with plaque incision or excision and grafting. The advantages of various graft materials have long been debated. We studied the outcomes of dermal and cadaveric pericardial grafts after plaque incision or excision for Peyronie's disease. We retrospectively evaluated all modified Horton-Devine procedures performed between February 1998 and April 2000. Dermal graft harvested from the lower abdomen or commercially available cadaveric pericardium was used to cover the corporeal defect. A followup telephone questionnaire was administered to determine patient satisfaction and function. We reviewed the records of 27 men, including 18 and 9 who received a dermal and pericardial graft, respectively. We successfully contacted 24 patients, including 15 with a dermal and 9 with a pericardial graft, to evaluate satisfaction. Average postoperative followup was 10 months. Of the 24 patients, 22 reported successful coitus and 15 (63%) needed assistance to achieve erection rigid enough for satisfactory coitus. Eight patients reported recurrent curvature, which was minimal and did not hamper sexual function. Overall 11 of the 15 patients with a dermal and 8 of the 9 with a pericardial graft would undergo the surgery again or recommend it to others. The results of the dermal and cadaveric pericardial grafts were comparable. The minimal preoperative preparation, decreased patient morbidity and pliability of cadaveric pericardium make it an attractive suitable graft substitute in the modified Horton-Devine procedure. Longer followup and larger patient series are needed to confirm the advantages of cadaveric pericardium.

Long-term follow-up on use of pericardial graft in the surgical management of Peyronie's disease.

We have previously reported on the use of Tutoplast cadaveric pericardium as an alternative material for grafting the tunica albugineal defect after Peyronie's plaque excision with satisfactory results in 11 patients. We now review long-term outcomes in this cohort of men. Eleven patients with significant penile curvature interfering with sexual intercourse were evaluated after at least 12 months of conservative therapy. All patients underwent pre-operative evaluation, including penile duplex Doppler ultrasound studies. Chemically processed and gamma-irradiated pericardium (Biodynamics International, Parsippany, NJ) was used to graft the cavernosal defect after surgical excision of the penile plaque. Three patients simultaneously underwent placement of penile prostheses secondary to documented erection problems identified at duplex Doppler ultrasound evaluation. The long-term postoperative complications and erectile function were evaluated with a mean follow-up of 30 months (range 25-35 months). All patients reported resolution of penile curvature allowing for normal sexual function after a mean follow-up of the first 14 months. Thirty months after placement of cadaveric pericardium, the three prosthetic patients still reported excellent sexual function. For the eight patients who did not undergo placement of a prosthesis, three with small to medium plaque size (<2 x 5 cm) continued to do well. The remaining five patients with a large plaque size (>2 x 5 cm) did well initially, but later reported difficulty maintaining erection due to venous leakage, thus they are currently using either a vacuum constriction device or an Actis ring. Three out of these five venous leakage patients had ventral plaques; two had dorsal plaques, one of significant size (4 x 5 cm). We conclude that for those patients who do not undergo placement of a prosthesis, a better long-term outcome is observed when the plaque is small to medium in size (<2 x 5 cm) and dorsally located. Patients with ventral plaque, extreme curvature, or plaque size >4 x 5 cm were more likely to have venoocclusive dysfunction, necessitating further intervention.

Evaluation of cadaveric pericardium in the rat for the surgical treatment of Peyronie’s disease

Objectives. To evaluate the intermediate-term efficacy of cadaveric pericardium (Tutoplast) as a grafting material in the surgical correction of Peyronie’s disease using a rat model. Peyronie’s disease is a connective tissue disorder of the tunica albuginea. When less invasive modalities fail to correct the penile deformity, surgical excision of the plaque and coverage with various grafting materials has been advocated. Methods. Twenty male Sprague-Dawley rats (300 to 325 g) constituted the study population. The animals were divided into two groups: group 1, control rats (n = 10) and group 2, rats that underwent wedge excision of the tunica albuginea and replacement with cadaveric pericardial grafts (n = 10). All rats underwent electrical stimulation of the cavernosal nerve to assess erectile function after 4 months. Tissues obtained after death were stained with trichrome and Verhoff’s van Giesen for collagen and elastic fibers. Results. Erectile function as studied by cavernosal nerve stimulation was not significantly different in either group ( P >0.05), and histologic studies of penile cross sections of the pericardial graft group revealed a mild to moderate degree of fibrosis surrounding the patch at 4 months. Conclusions. We found that pericardial cadaveric grafts in a rat model are a suitable tunica albuginea substitute. They allow for penile expansion after cavernosal nerve stimulation and are strong enough to withstand normal intracorporeal pressures. Our early experimental data in the rat support the use of pericardial cadaveric material for coverage of excised Peyronie’s plaques. However, long-term follow-up in humans is mandatory.

Examination: Treating Glaucoma with Drainage Devices and Pericardial Grafts

Examination: Treating Glaucoma with Drainage Devices and Pericardial Grafts

Treating Glaucoma with Drainage Devices and Pericardial Grafts

Glaucoma is caused by a sustained elevation of intraocular pressure due to the decreased drainage of aqueous humor from the anterior chamber of the eye. There are many types of glaucoma, which, if left untreated, may have devastating results for the patient. Glaucoma can remain uncontrolled after medical and surgical interventions. Glaucoma drainage device implants with pericardial graft placements often are helpful in relieving the effects of glaucoma and increasing the patient's quality of life.

Anterior cervical micro-dural repair of cerebrospinal fluid fistula after surgery for ossification of the posterior longitudinal ligament: Technical note

Background Cerebrospinal fluid (CSF) fistulas may occur during anterior cervical surgery performed for the resection of ossification of the posterior longitudinal ligament (OPLL), as OPLL occasionally erodes to and through the dura. These fistulas have been variously managed with gelfoam, dural substitutes sutured in place, fibrin glue, lumbar drains, and lumboperitoneal shunts. However, more adequate dural repair is now feasible with the 1.4-mm microdural titanium stapler. Methods A 59-year-old female with OPLL and moderate to severe myelopathy (Nurick Grade IV) had a C3-C7 anterior corpectomy with fusion using Orion plates followed by a C3-T1 posterior wiring and fusion with halo application. During the anterior approach, a 5-mm CSF fistula at C4-C5 was directly repaired under the operating microscope using a 1.4-mm microdural stapler, bovine pericardial graft, and fibrin glue. Immediately postoperatively, a lumboperitoneal shunt was also placed. Results Postoperatively, her myelopathy improved to a mild to moderate level (Nurick Grade II). Her acute left deltoid plegia resolved within 3 months. Conclusions The 1.4-mm microdural stapler makes “watertight” closure of anterior cervical CSF fistulas more feasible.

Ochrobactrum anthropi bacteremia: case report and review of the literature.

Ochrobactrum anthropi bacteremia: case report and review of the literature.

Long-segment congenital tracheal stenosis: Treatment by slide-tracheoplasty

Background/Purpose: The prognosis of long-segment funnelshaped congenital tracheal stenosis improved with surgical management by enlargement-tracheoplasty with a pericardial patch. However, the final outcome is not always satisfying mainly because of the complications related to the pericardial graft and because of misdiagnosed associated cardiovascular malformations. The objective of the report is to show a further improvement of the prognosis by a thorough preoperative planning and the use of a slidetracheoplasty for the cure of the stenosis, to avoid the major drawbacks of enlargement tracheoplasties. Methods: Two children, 7 months and 3 years old, underwent a bronchoesophagoscopy, spiral computed tomography, an echocardiogram, and a heart catheterization. The tracheal stenosis and the associated severe cardiovascular malformations were cured during a single operative session under cardiopulmonary bypass; the tracheal stenosis was corrected by a slide-tracheoplasty. Results: The postoperative period was remarkably uneventful and the recovery extremely quick (hospital stay of 18 and 17 days). The midterm results are excellent, and the tracheal growth is not impaired (follow-up of 3 1 2 and 3 years). Conclusions: According to the authors' experience and to the literature, the slide-tracheoplasty seems to be the most efficient surgical procedure for correction of long-segment funnel-shaped congenital tracheal stenosis. But the success of the treatment depends also on a complete preoperative diagnosis allowing a 1-stage surgical treatment of all associated thoracic malformations.

Superior vena cava syndrome caused by chronic hemodialysis catheters: Autologous reconstruction with a pericardial tube graft

Superior vena cava (SVC) syndrome caused by long-term use of indwelling catheters is an infrequent but increasingly common complication. Because collateralization often is sufficient, surgical treatment rarely is indicated. We present a case of a patient with severe symptomatic SVC syndrome as a result of the long-term use of indwelling hemodialysis catheters. The SVC was reconstructed with a pericardial tube graft. Magnetic resonance angiography performed 13 months after the operation showed patency of the graft. The patient continues to be free of symptoms. (J Vasc Surg 1998;28:556-60.)

Rapid intraoperative construction of autologous small caliber blood vessels.

Autologous pericardium, briefly tanned in glutaraldehyde, is an excellent biomaterial when used in various cardiac procedures, including repair and replacement of heart valves. A generalized lack of calcification and an absence of inflammatory response in these combined experiences has led the authors to consider the use of treated autologous pericardium for the construction of substitute small caliber blood vessels. Rapid, intraoperative construction of a vascular graft from autologous pericardium, briefly treated in 0.62% glutaraldehyde, is accomplished through the use of two concentric, mating helical stents that support a rectangular pattern of tissue into a cylindrical, nonkinking, compliant conduit. A disposable automated assembly tool provides for precise assembly of the tissue and stents. The tools and methods for construction of vascular grafts from nonvascular tissue are known as the Rapidgraft (Ramus Medical Technologies, Santa Barbara, CA). The technique can be used with any suitable tissue. Accelerated fatigue test studies have confirmed that stent supported pericardial grafts are capable of withstanding physiologic pressures and flows beyond 7 equivalent years. Six autologous pericardial grafts measuring 5 mm in diameter by 5.5 cm in length showed 100% patency beyond 5 months in a growing calf carotid artery model. Pathological examination of explanted grafts confirm the presence of a continuous endothelial lined surface, infiltration of the tissue by fibrous connective tissue such that the individual layers of the pericardial vessel wall could not be identified, and there was no inflammatory response. Based on the encouraging results in animal studies, a small multicenter clinical trial has been initiated to evaluate the performance of the Rapidgraft as a replacement conduit for the radial artery in cases in which the radial artery has been harvested as a coronary artery bypass conduit. Results from the radial artery trial will be used as an indication to evaluate the Rapidgraft as a coronary artery substitute. We conclude that the material properties, including the biological origin of a vessel wall, may be significant determinants of graft patency, and that the Rapidgraft may be an answer to the need for small caliber arterial graft with the potential for long-term patency and durability.

LONG-TERM SURVIVAL AFTER RESECTION OF A MEDIASTINAL METASTASIS FROM A RENAL CELL CARCINOMA

J Thorac Cardiovasc Surg 1998;115:1218-9

Pericardial Patch Grafts in Glaucoma Implant Surgery

The authors determine the safety and effectiveness of pericardial patch grafts in glaucoma implant surgery. A retrospective chart review was conducted on all patients who underwent a glaucoma implant procedure with the use of a pericardial patch graft to cover the subconjunctival portion of the tube at The New York Eye and Ear Infirmary between September 1, 1995 and June 30, 1996. Charts were assessed for evidence of delle formation, graft rejection, graft-related infection, graft thinning, or tube erosion. Forty-four eyes of 44 patients were enrolled. Mean follow-up was 10.2 +/- 4.0 months (range, 2.3 to 18.6 months). Infection, tube erosion, graft rejection, and graft-related inflammation did not occur. Five eyes were noted to have asymptomatic thinning of the patch without evidence of tube erosion. Preserved human cadaveric pericardial patch grafts appear to be well-tolerated for use with glaucoma drainage devices. As with other grafting material, potential for graft thinning is possible and further long-term experience is needed.

Severe Stenosis of the Left Main Coronary Artery With Endarterectomy and Graft: 33-Year Follow-up

In 1964, a patient with symptomatic, severe left main coronary artery stenosis underwent operative treatment. Endarterectomy and pericardial patch grafting were performed successfully. The original operation is described, and the 33-year follow-up is provided.

Resultados imediatos e tardios da correção cirúrgica da dissecção aguda da aorta (tipo A)

Realizamos uma análise retrospectiva do tratamento cirúrgico da dissecção aguda da aorta do tipo A no período compreendido entre janeiro de 1986 a dezembro de 1996. Foram tratados 64 pacientes com idade média de 52,6 ± 10,9 anos, sendo a maioria do sexo masculino (64,1%). Em 17 casos (26,6%) havia rotura intrapericárdica da dissecção; a fenda de origem da dissecção encontrava-se na aorta ascendente em 58 pacientes (90,6%) e no arco aórtico nos demais (9,4%). O tratamento básico compreendeu a ressecção da aorta ascendente com substituição por prótese de pericárdio bovino, embora outras técnicas tenham sido empregadas em um pequeno número de pacientes, no início de nossa experiência. A hipotermia profunda com parada cardiocirculatória foi usada em 32,8% dos pacientes, de forma crescente nos últimos anos. A valva aórtica do paciente foi preservada em 76,5% das vezes. A mortalidade global foi de 28,1% (18 pacientes), porém significativamente menor nos últimos 4 anos (17,8%). Na evolução tardia houve 4 óbitos, sendo 2 de causa indeterminada e os outros 2 por AVC e embolia pulmonar, respectivamente. Reoperações foram necessárias em 7 pacientes, sem mortalidade, sendo a causa principal da reoperação a progressão da insuficiência aórtica. Nesse período de observação não houve falência estrutural das biopróteses nem dos enxertos de pericárdio bovino. Esta experiência nos reforça uma tática mais radical no tratamento das dissecções agudas do tipo A, com maior liberdade na substituição da valva aórtica e na utilização da hipotermia profunda em quase todos os pacientes.

Late evaluation with spiral computed tomography of smooth bovine pericardium grafts

To evaluate morphologically by spiral computed tomography (SCT) bovine pericardial grafts as aortic substitutes. Ten patients were submitted to aortic graft evaluation with SCT. There were 8 ascending and 2 descending grafts. Examination was done after 2 to 7 years post operative. Ages ranged from 49 to 67 years, with 6 male and 4 female patients. All had implanted smooth surface naked pericardial grafts. Surgical result was good in all. Distal dissection persisted in some cases. One had a peri-graft hematoma, 5 had no structural changes and 4 presented mild graft dilatation. There were no graft calcification or pseudoaneurysm. Glutaraldehyde preserved naked smooth surface bovine pericardial aortic grafts present satisfactory structural aspect, as seen by SCT, at medium term follow-up. Mild dilatation may be seen in some cases.

Proposição de técnica endocavitária para remodelamento ventricular esquerdo

Left ventricular remodeling by partial ventriculectomy is a recent proposition for palliation in dilated cardiomyopathy when cardiac transplantation is contraindicated. This procedure carries a high morbimortality due to myocardial ischemia, necrosis and arrhythmias. This paper presents a technique for endocavitary left ventricular remodeling which maintains the hearts morpho-functional architecture without myocardial resection. Under extracorporeal circulation and hypothermic cardioplegia, a left atriotomy is done, the anterior mitral leaflet removed and a triangular shaped bovine pericardial graft (aproximately 2 x 6 x 6 cm) is implanted inside the left ventricular cavity with 3-0 Polipropilene anclosed in Dacron felt. The graft is sutured in a divergent way from the apex to the mitral ring, at the middle of the septum and at the posterior papillary muscle. This produces an internal plication with ventricular cavity reduction. Myocardium and coronary circulation are preserved. The base of the triangular graft is sutured to the mitral annulus and the mitral bioprosthesis is implanted. The procedure was employed in 8 patients with dilated cardiomyopathy, not candidates to transplantation, 2 females and 6 males, ranging from 24 to 58 years. Five had mitral regurgitation. All were in hospital, at class IV (NYHA). Mortality was 25% (2 cases): 1 in the hospital and 1 at 3 months p.o. The table shows the echocardiographic parameters for LV function: Pre-operative Post-operative Cardiac output (L/min) 2,6 ± 0,4 3,8 ± 0,7 p<0,001 Cardiac index 1,9 ± 0,9 2,7 ± 0,6 p<0,005 Ejection fraction 21,5 ± 4,0 37,8 ± 1,2 p<0,05 Intracavitary left ventricular remodeling presented a satisfactory result related to mortality and morbidity, with functional improvement over the short term. Longer follow-up is needed to evaluate its role, which might be a bridge to transplantation. A limitation exists in the necessity for replacing the mitral valve.

Ochrobactrum anthropi Meningitis Associated With Cadaveric Pericardial Tissue Processed With a Contaminated Solution—Utah, 1994

From October 22 through November 3, 1994, three cases of Ochrobactrum anthropi meningitis were diagnosed among pediatric patients at a hospital in Utah (hospital A). The three patients had undergone neurosurgical procedures in which pericardial grafts processed at hospital B were used to close defects of the dura mater. This report summarizes the case investigations, which document that the cases resulted from human pericardial tissue grafts contaminated with O. anthropi.