Biomedical Engineering Reference
In-Depth Information
22
Pericardial Processing:
Challenges, Outcomes and Future Prospects
*
Escande Rémi
1,3
, Nizar Khelil
1
, Isabelle Di Centa
2
, Caroline Roques
1
,
Maguette Ba
1,3
, Fatima Medjahed-Hamidi
1
, Frederic Chaubet
1,3
,
Didier Letourneur
1,3
, Emmanuel Lansac
1,4
and Anne Meddahi-Pellé
1,3
1. Introduction
The pericardium is a biological tissue widely used as a biomaterial for tissue engineering
applications, including the construction of a variety of bioprostheses such as vascular grafts,
patches for abdominal or vaginal wall reparation and, more frequently, heart valves.
However, despite significant advances, some drawbacks have been found in these
bioprostheses such as biological matrix deterioration and tissue degeneration associated
with calcifications, even though xenopericardium or glutaraldehyde-treated autologous
pericardium were used.
In non-autologous pericardial processing, the pericardium must be decellularized in order
to remove cellular antigens and procalcific remnants while preserving extracellular matrix
integrity. A large variety of decellularization protocols exist, such as chemical, physical or
enzymatic methods. Additional cross-linking processing must be carried out to render the
tissue non-antigenic and mechanically strong.
So far, almost all bioprosthetic materials made of pericardium, and used in clinical practice,
are glutaraldehyde-treated bovine or porcine xenopericardium. However, long-term reports
are raising issues concerning their durability, especially highlighting the high risk of
calcification. Regarding heart valves, calcification currently represents the major drawback
leading to potential failure of the bioprosthesis.
The aim of this review is to present current issues, challenges, outcomes and future
prospects of pericardial processing, including decellularization and cross-linking steps.
Understanding current issues and improving pericardial processing will allow refining
bioprosthesis conception and patients' safety.
2. Characteristics of the pericardium
2.1 Localization and composition
The pericardium is a connective tissue sac surrounding the heart. It is composed by two
layers: a deeper layer closely adherent to the heart, the visceral serous pericardium, or
