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Medical science monitor basic research2014; 20; 1-8; doi: 10.12659/MSMBR.889915

Successful implantation of a decellularized equine pericardial patch into the systemic circulation.

Abstract: In the past, successful use of decellularized xenogenic tissue was shown in the pulmonary circulation. This study, however, evaluates a newly developed decellularized equine pericardial patch under high pressure circumstances. Methods: Seven decellularized equine pericardial scaffolds were implanted into the descending aorta of the juvenile sheep. The implanted patches were oversized to evaluate the durability of the decellularized tissue under high surface tension (Law of Laplace). After 4 months of implantation, all decellularized patches were inspected by gross examination, light microscopy (H&E, Serius red, Gomori, Weigert, and von Kossa straining), and immunohistochemical staining. Results: The juvenile sheep showed fast recovery after surgery. There was no mortality during follow-up. At explantation, only limited adhesion was seen at the surgical site. Gross examination showed a smooth and pliable surface without degeneration, as well as absence of aneurysmatic dilatation. Light microscopy showed a well preserved extracellular scaffold with a monolayer of endothelial cells covering the luminal side of the patch. On the outside part of the patch, a well developed neo-vascularization was seen. Host fibroblasts were seen in all layers of the scaffolds. There was no evidence for structural deterioration or calcification of the decellularized equine pericardial scaffolds. Conclusions: In the juvenile sheep, decellularized equine tissue showed no structural deterioration, but regeneration and remodeling processes at systemic circulation.
Publication Date: 2014-01-10 PubMed ID: 24407027PubMed Central: PMC3936916DOI: 10.12659/MSMBR.889915Google Scholar: Lookup
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  • Journal Article
  • Research Support
  • Non-U.S. Gov't

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

The research evaluated the use of newly developed decellularized equine pericardial patches and tested them under high pressure situations in the aorta of juvenile sheep. After four months, the patches showed no structural deterioration and had been successfully covered by a layer of endothelial cells, with new vasculature outside of the patch, indicating promising potential for further usage within systemic circulation.

Methods

  • In this study, the researchers implanted seven decellularized pericardial scaffolds, originated from horse hearts, into the descending aorta of juvenile sheep. The implants were oversized on purpose to test the durability of the decellularized tissue when subjected to high surface tension.
  • After four months of implantation, all patches were thoroughly inspected in several ways including gross examination, as well as light and immunohistochemical microscopy.

Results

  • The juvenile sheep exhibited fast recovery after the surgical procedure. No deaths occurred during the follow-up period.
  • At the time of explantation, very limited adhesion was observed at the surgical site, suggesting that the implanted patches were well-tolerated by the host organism.
  • Fine examination revealed that the implants maintained a smooth and pliable surface, showing no signs of degeneration, and there was no aneurysmatic dilation observed.
  • The microscopic examination also revealed a layer of endothelial cells firmly covering the luminal side of the patch, which is a positive indication that the host organism was accepting the implanted patch.
  • New capillaries were formed at the outer part of the patch, which indicates the process of neo-vascularization. In addition, host fibroblasts were seen throughout the scaffolds, suggestive of integration and regeneration.
  • The researchers did not find any evidence of structural deterioration or calcification in the decellularized equine pericardial scaffolds, strongly indicating their durability and successful adaptation.

Conclusions

  • The researchers concluded that the use of decellularized equine tissue in the systemic circulation of juvenile sheep was successful. This was evident because the tissue did not exhibit signs of structural degradation and, instead, the implanted patches underwent regeneration and remodeling processes after the operation.
  • This study thus offers promise and supports the efficacy of using decellularized equine pericardial tissue for further research and potentially as a strategy in medical and surgical treatments.

Cite This Article

APA
Dohmen PM, da Costa F, Lopes SV, Vilani R, Bloch O, Konertz W. (2014). Successful implantation of a decellularized equine pericardial patch into the systemic circulation. Med Sci Monit Basic Res, 20, 1-8. https://doi.org/10.12659/MSMBR.889915

Publication

ISSN: 2325-4416
NlmUniqueID: 101597444
Country: United States
Language: English
Volume: 20
Pages: 1-8

Researcher Affiliations

Dohmen, Pascal Maria
  • Department of Cardiac Surgery, Heart Center Leipzig, Univeristy of Leipzig, Leipzig, Germany.
da Costa, Francisco
  • Department of Cardiac Surgery, Santa Casa Hospital, Curitiba, Brazil.
Lopes, Sergio Vega
  • Department of Cardiac Surgery, Santa Casa Hospital, Curitiba, Brazil.
Vilani, Ricardo
  • Department of Veterinary Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Brazil.
Bloch, Oliver
  • Department of Cardiovascular Surgery, Charité Hospital, Medical University Berlin, Berlin, Germany.
Konertz, Wolfgang
  • Department of Cardiovascular Surgery, Charité Hospital, Medical University Berlin, Berlin, Germany.

MeSH Terms

  • Animals
  • Blood Circulation / physiology
  • Calcification, Physiologic
  • Female
  • Horses
  • Immunohistochemistry
  • Pericardium / cytology
  • Prosthesis Implantation
  • Sheep
  • Tissue Engineering
  • Tissue Scaffolds / chemistry

References

This article includes 49 references
  1. Ozkara A, Mert M, Cetin G, Saltik L, Sarioglu T. Right ventricular outflow tract reconstruction for tetralogy of fallot with abnormal coronary artery: experience with 35 patients.. J Card Surg 2006 Mar-Apr;21(2):131-6.
  2. Jonas RA, Freed MD, Mayer JE Jr, Castaneda AR. Long-term follow-up of patients with synthetic right heart conduits.. Circulation 1985 Sep;72(3 Pt 2):II77-83.
    pubmed: 3161661
  3. Mayer JE Jr. Uses of homograft conduits for right ventricle to pulmonary artery connections in the neonatal period.. Semin Thorac Cardiovasc Surg 1995 Jul;7(3):130-2.
    pubmed: 7548318
  4. Smaill BH, McGiffin DC, Legrice IJ, Young AA, Hunter PJ, Galbraith AJ. The effect of synthetic patch repair of coarctation on regional deformation of the aortic wall.. J Thorac Cardiovasc Surg 2000 Dec;120(6):1053-63.
    pubmed: 11088026doi: 10.1067/mtc.2000.110187google scholar: lookup
  5. Kirklin JK, Kirklin JW, Blackstone EH, Milano A, Pacifico AD. Effect of transannular patching on outcome after repair of tetralogy of Fallot.. Ann Thorac Surg 1989 Dec;48(6):783-91.
    pubmed: 2596914doi: 10.1016/0003-4975(89)90671-1google scholar: lookup
  6. Valente M, Laborde F, Thiene G, Milano A, Talenti E, Gallix P. Glutaraldehyde-fixed bovine iliac veins used as bioprosthetic conduits: an experimental animal study.. J Card Surg 1992 Jun;7(2):156-62.
  7. Fiddler GI, Gerlis LM, Walker DR, Scott O, Williams GJ. Calcification of glutaraldehyde-preserved porcine and bovine xenograft valves in young children.. Ann Thorac Surg 1983 Mar;35(3):257-61.
    pubmed: 6830360doi: 10.1016/s0003-4975(10)61554-8google scholar: lookup
  8. Langer R, Vacanti JP. Tissue engineering.. Science 1993 May 14;260(5110):920-6.
    pubmed: 8493529doi: 10.1126/science.8493529google scholar: lookup
  9. Dohmen PM, Lembcke A, Holinski S, Kivelitz D, Braun JP, Pruss A, Konertz W. Mid-term clinical results using a tissue-engineered pulmonary valve to reconstruct the right ventricular outflow tract during the Ross procedure.. Ann Thorac Surg 2007 Sep;84(3):729-36.
  10. Dohmen PM, da Costa F, Yoshi S, Lopes SV, da Souza FP, Vilani R, Wouk AF, da Costa M, Konertz W. Histological evaluation of tissue-engineered heart valves implanted in the juvenile sheep model: is there a need for in-vitro seeding?. J Heart Valve Dis 2006 Nov;15(6):823-9.
    pubmed: 17152791
  11. Boyd WD, Johnson WE 3rd, Sultan PK, Deering TF, Matheny RG. Pericardial reconstruction using an extracellular matrix implant correlates with reduced risk of postoperative atrial fibrillation in coronary artery bypass surgery patients.. Heart Surg Forum 2010 Oct;13(5):E311-6.
    pubmed: 20961831doi: 10.1532/hsf98.20091184google scholar: lookup
  12. Neethling WM, Strange G, Firth L, Smit FE. Evaluation of a tissue-engineered bovine pericardial patch in paediatric patients with congenital cardiac anomalies: initial experience with the ADAPT-treated CardioCel(R) patch.. Interact Cardiovasc Thorac Surg 2013 Oct;17(4):698-702.
    pmc: PMC3781795pubmed: 23832918doi: 10.1093/icvts/ivt268google scholar: lookup
  13. Gerdisch MW, Akinwande AO, Matheny RG. Use of a novel acellular xenograft as a patch for aortic annular enlargement during aortic valve replacement.. Innovations (Phila) 2010 Jan;5(1):60-2.
    pubmed: 22437278doi: 10.1097/imi.0b013e3181cbb421google scholar: lookup
  14. Gauvin R, Marinov G, Mehri Y, Klein J, Li B, Larouche D, Guzman R, Zhang Z, Germain L, Guidoin R. A comparative study of bovine and porcine pericardium to highlight their potential advantages to manufacture percutaneous cardiovascular implants.. J Biomater Appl 2013 Nov;28(4):552-65.
    pubmed: 23142967doi: 10.1177/0885328212465482google scholar: lookup
  15. Mather C, Treuting P. Onchocerca armillata contamination of a bovine pericardial xenograft in a human patient with repaired tetralogy of Fallot.. Cardiovasc Pathol 2012 May-Jun;21(3):e35-8.
    pubmed: 21831660doi: 10.1016/j.carpath.2011.07.004google scholar: lookup
  16. Martin M, Trouvin JH. Risk of transmission of Creutzfeldt-Jakob disease via blood and blood products. The French risk-analysis over the last 15 years.. Transfus Clin Biol 2013 Sep;20(4):398-404.
    pubmed: 23910008doi: 10.1016/j.tracli.2013.06.001google scholar: lookup
  17. Bloch O, Golde P, Dohmen PM, Posner S, Konertz W, Erdbrügger W. Immune response in patients receiving a bioprosthetic heart valve: lack of response with decellularized valves.. Tissue Eng Part A 2011 Oct;17(19-20):2399-405.
    pubmed: 21557643doi: 10.1089/ten.tea.2011.0046google scholar: lookup
  18. Dohmen PM, da Costa F, Holinski S, Lopes SV, Yoshi S, Reichert LH, Villani R, Posner S, Konertz W. Is there a possibility for a glutaraldehyde-free porcine heart valve to grow?. Eur Surg Res 2006;38(1):54-61.
    pubmed: 16490995doi: 10.1159/000091597google scholar: lookup
  19. Dohmen PM, da Costa F, Yoshi S. An experimental study of decellularized xenografts implanted into the aortic position with 4 months of follow-up. J Clin Experiment Cardiol 2012;S4:004.
  20. Scholl FG, Boucek MM, Chan KC, Valdes-Cruz L, Perryman R. Preliminary experience with cardiac reconstruction using decellularized porcine extracellular matrix scaffold: human applications in congenital heart disease.. World J Pediatr Congenit Heart Surg 2010 Apr;1(1):132-6.
    pubmed: 23804734doi: 10.1177/2150135110362092google scholar: lookup
  21. Tremblay D, Zigras T, Cartier R, Leduc L, Butany J, Mongrain R, Leask RL. A comparison of mechanical properties of materials used in aortic arch reconstruction.. Ann Thorac Surg 2009 Nov;88(5):1484-91.
  22. Hesslein PS, McNamara DG, Morriss MJ, Hallman GL, Cooley DA. Comparison of resection versus patch aortoplasty for repair of coarctation in infants and children.. Circulation 1981 Jul;64(1):164-8.
    pubmed: 7237715doi: 10.1161/01.cir.64.1.164google scholar: lookup
  23. Brown JW, Ruzmetov M, Hoyer MH, Rodefeld MD, Turrentine MW. Recurrent coarctation: is surgical repair of recurrent coarctation of the aorta safe and effective?. Ann Thorac Surg 2009 Dec;88(6):1923-30; discussion 1930-1.
  24. Hehrlein FW, Mulch J, Rautenburg HW, Schlepper M, Scheld HH. Incidence and pathogenesis of late aneurysms after patch graft aortoplasty for coarctation.. J Thorac Cardiovasc Surg 1986 Aug;92(2):226-30.
    pubmed: 3736080
  25. DeSanto A, Bills RG, King H, Waller B, Brown JW. Pathogenesis of aneurysm formation opposite prosthetic patches used for coarctation repair. An experimental study.. J Thorac Cardiovasc Surg 1987 Nov;94(5):720-3.
    pubmed: 2959820
  26. Bromberg BI, Beekman RH, Rocchini AP, Snider AR, Bank ER, Heidelberger K, Rosenthal A. Aortic aneurysm after patch aortoplasty repair of coarctation: a prospective analysis of prevalence, screening tests and risks.. J Am Coll Cardiol 1989 Sep;14(3):734-41.
    pubmed: 2768722doi: 10.1016/0735-1097(89)90119-8google scholar: lookup
  27. Dietl CA, Torres AR, Favaloro RG, Fessler CL, Grunkemeier GL. Risk of recoarctation in neonates and infants after repair with patch aortoplasty, subclavian flap, and the combined resection-flap procedure.. J Thorac Cardiovasc Surg 1992 Apr;103(4):724-31; discussion 731-2.
    pubmed: 1548914
  28. Monaghan RA, Meban S. Expanded polytetrafluoroethylene patch in hernia repair: a review of clinical experience.. Can J Surg 1991 Oct;34(5):502-5.
    pubmed: 1913399
  29. Wilson SE, Krug R, Mueller G, Wilson L. Late disruption of Dacron aortic grafts.. Ann Vasc Surg 1997 Jul;11(4):383-6.
    pubmed: 9236995doi: 10.1007/s100169900065google scholar: lookup
  30. Backer CL, Paape K, Zales VR, Weigel TJ, Mavroudis C. Coarctation of the aorta. Repair with polytetrafluoroethylene patch aortoplasty.. Circulation 1995 Nov 1;92(9 Suppl):II132-6.
    pubmed: 7586396doi: 10.1161/01.cir.92.9.132google scholar: lookup
  31. Moulton AL, de Leval MR, Macartney FJ, Taylor JF, Stark J. Rastelli procedure for transposition of the great arteries, ventricular septal defect, and left ventricular outflow tract obstruction. Early and late results in 41 patients (1971 to 1978).. Br Heart J 1981 Jan;45(1):20-8.
    pmc: PMC482484pubmed: 7193040doi: 10.1136/hrt.45.1.20google scholar: lookup
  32. Williams DB, Danielson GK, McGoon DC, Puga FJ, Mair DD, Edwards WD. Porcine heterograft valve replacement in children.. J Thorac Cardiovasc Surg 1982 Sep;84(3):446-50.
    pubmed: 7109674
  33. Lloyd TR, Marvin WJ Jr, Mahoney LT, Lauer RM. Balloon dilation valvuloplasty of bioprosthetic valves in extracardiac conduits.. Am Heart J 1987 Aug;114(2):268-74.
    pubmed: 2955689doi: 10.1016/0002-8703(87)90489-3google scholar: lookup
  34. Roussin R, Belli E, Lacour-Gayet F, Godart F, Rey C, Bruniaux J, Planché C, Serraf A. Aortic arch reconstruction with pulmonary autograft patch aortoplasty.. J Thorac Cardiovasc Surg 2002 Mar;123(3):443-8; discussion 449-50.
    pubmed: 11882814doi: 10.1067/mtc.2002.120733google scholar: lookup
  35. Mirsadraee S, Wilcox HE, Watterson KG, Kearney JN, Hunt J, Fisher J, Ingham E. Biocompatibility of acellular human pericardium.. J Surg Res 2007 Dec;143(2):407-14.
    pubmed: 17574597doi: 10.1016/j.jss.2007.01.026google scholar: lookup
  36. Schulte HD, Bircks W, Frenzel H, Horstkotte D, Jungblut RM, Oubari M. Patch-graft enlargement of the aortic root using autologous pericardium (long-term results).. Thorac Cardiovasc Surg 1983 Aug;31(4):219-23.
    pubmed: 6195757doi: 10.1055/s-2007-1021983google scholar: lookup
  37. Dalichau H, Hannekum A, Niehues B, Irion A, Herse B. Hemodynamic and angiographic late results following enlargement of narrow aortic root using autologous pericardium in prosthetic aortic valve replacement.. Thorac Cardiovasc Surg 1985 Oct;33(5):288-95.
    pubmed: 2416083doi: 10.1055/s-2007-1014143google scholar: lookup
  38. Cheung DT, Choo SJ, Grobe AC, Marchion DC, Luo HH, Pang DC, Favara BE, Oury JH, Duran CM. Behavior of vital and killed autologous pericardium in the descending aorta of sheep.. J Thorac Cardiovasc Surg 1999 Dec;118(6):998-1005.
    pubmed: 10595970doi: 10.1016/s0022-5223(99)70093-0google scholar: lookup
  39. Dohmen PM, Lembcke A, Holinski S, Pruss A, Konertz W. Ten years of clinical results with a tissue-engineered pulmonary valve.. Ann Thorac Surg 2011 Oct;92(4):1308-14.
  40. Konertz W, Angeli E, Tarusinov G, Christ T, Kroll J, Dohmen PM, Krogmann O, Franzbach B, Pace Napoleone C, Gargiulo G. Right ventricular outflow tract reconstruction with decellularized porcine xenografts in patients with congenital heart disease.. J Heart Valve Dis 2011 May;20(3):341-7.
    pubmed: 21714427
  41. Honge JL, Funder J, Hansen E, Dohmen PM, Konertz W, Hasenkam JM. Recellularization of aortic valves in pigs.. Eur J Cardiothorac Surg 2011 Jun;39(6):829-34.
    pubmed: 21055964doi: 10.1016/j.ejcts.2010.08.054google scholar: lookup
  42. Dohmen PM. Tissue engineered aortic valve.. HSR Proc Intensive Care Cardiovasc Anesth 2012;4(2):89-93.
    pmc: PMC3484929pubmed: 23440902
  43. Stelly M, Stelly TC. Histology of CorMatrix bioscaffold 5 years after pericardial closure.. Ann Thorac Surg 2013 Nov;96(5):e127-9.
  44. Quarti A, Nardone S, Colaneri M, Santoro G, Pozzi M. Preliminary experience in the use of an extracellular matrix to repair congenital heart diseases.. Interact Cardiovasc Thorac Surg 2011 Dec;13(6):569-72.
    pubmed: 21979987doi: 10.1510/icvts.2011.280016google scholar: lookup
  45. Schomisch SJ, Yu L, Wu Y, Pauli EM, Cipriano C, Chak A, Lash RH, Ponsky JL, Marks JM. Commercially available biological mesh does not prevent stricture after esophageal mucosectomy.. Endoscopy 2014 Feb;46(2):144-8.
    pmc: PMC5515588pubmed: 24218305doi: 10.1055/s-0033-1344997google scholar: lookup
  46. Weber SS, Annenberg AJ, Wright CB, Braverman TS, Mesh CL. Early pseudoaneurysm degeneration in biologic extracellular matrix patch for carotid repair.. J Vasc Surg 2014 Apr;59(4):1116-8.
    pubmed: 23809202doi: 10.1016/j.jvs.2013.05.012google scholar: lookup
  47. Lofland GK, O'Brien JE Jr, Gandy KL, Dennis PA, Marshall JA, Mastbergen RK, Hopkins RA. Initial pediatric cardiac experience with decellularized allograft patches.. Ann Thorac Surg 2012 Mar;93(3):968-71.
  48. Umashankar PR, Arun T, Kumary TV. Effect of chronic inflammation and immune response on regeneration induced by decellularized bovine pericardium.. J Biomed Mater Res A 2013 Aug;101(8):2202-9.
    pubmed: 23281204doi: 10.1002/jbm.a.34535google scholar: lookup
  49. Dohmen PM, Konertz W. Tissue-engineered heart valve scaffolds.. Ann Thorac Cardiovasc Surg 2009 Dec;15(6):362-7.
    pubmed: 20081743

Citations

This article has been cited 13 times.
  1. Peivandi AD, Martens S, Asfour B, Martens S. Grafts and Patches: Optimized but Not Optimal Materials for Congenital Heart Surgery. Pediatr Cardiol 2023 Jun;44(5):996-1002.
    doi: 10.1007/s00246-023-03153-6pubmed: 37038028google scholar: lookup
  2. Whitehead KM, Hendricks HKL, Cakir SN, de Castro Brás LE. ECM roles and biomechanics in cardiac tissue decellularization. Am J Physiol Heart Circ Physiol 2022 Sep 1;323(3):H585-H596.
    doi: 10.1152/ajpheart.00372.2022pubmed: 35960635google scholar: lookup
  3. Peivandi AD, Martens S, Heitplatz B, Guseva A, Mueller KM, Martens S. Industrial Processing Induces Pericardial Patch Degeneration. Front Surg 2022;9:881433.
    doi: 10.3389/fsurg.2022.881433pubmed: 35711712google scholar: lookup
  4. Elassal AA, Al-Radi OO, Zaher ZF, Dohain AM, Abdelmohsen GA, Mohamed RS, Fatani MA, Abdelmotaleb ME, Noaman NA, Elmeligy MA, Eldib OS. Equine pericardium: a versatile alternative reconstructive material in congenital cardiac surgery. J Cardiothorac Surg 2021 Apr 23;16(1):110.
    doi: 10.1186/s13019-021-01494-ypubmed: 33892770google scholar: lookup
  5. Gaggi G, Di Credico A, Izzicupo P, Sancilio S, Di Mauro M, Iannetti G, Dolci S, Amabile G, Di Baldassarre A, Ghinassi B. Decellularized Extracellular Matrices and Cardiac Differentiation: Study on Human Amniotic Fluid-Stem Cells. Int J Mol Sci 2020 Aug 31;21(17).
    doi: 10.3390/ijms21176317pubmed: 32878275google scholar: lookup
  6. Grefen L, König F, Grab M, Hagl C, Thierfelder N. Pericardial tissue for cardiovascular application: an in-vitro evaluation of established and advanced production processes. J Mater Sci Mater Med 2018 Nov 3;29(11):172.
    doi: 10.1007/s10856-018-6186-6pubmed: 30392024google scholar: lookup
  7. Schlegel F, Salameh A, Oelmann K, Halling M, Dhein S, Mohr FW, Dohmen PM. Injectable tissue engineered pulmonary heart valve implantation into the pig model: A feasibility study. Med Sci Monit Basic Res 2015 Jun 24;21:135-40.
    doi: 10.12659/MSMBR.894838pubmed: 26104851google scholar: lookup
  8. Smit FE, Dohmen PM. Cardiovascular tissue engineering: where we come from and where are we now?. Med Sci Monit Basic Res 2015 Jan 27;21:1-3.
    doi: 10.12659/MSMBR.893546pubmed: 25623227google scholar: lookup
  9. Christ T, Dohmen PM, Holinski S, Schönau M, Heinze G, Konertz W. Suitability of the rat subdermal model for tissue engineering of heart valves. Med Sci Monit Basic Res 2014 Dec 10;20:194-9.
    doi: 10.12659/MSMBR.893088pubmed: 25491131google scholar: lookup
  10. Smit FE, Dohmen PM. Bio-artificial heart as ultimate treatment of end-stage heart failure. Med Sci Monit Basic Res 2014 Oct 16;20:161-3.
    doi: 10.12659/MSMBR.892287pubmed: 25321347google scholar: lookup
  11. Shariat Rad P, Khazaei M, Ghanbari E, Rashidi M, Rezakhani L. Recent advances in pericardium extracellular matrix for tissue regeneration, along with a short insight into artificial intelligence. Front Med Technol 2025;7:1503153.
    doi: 10.3389/fmedt.2025.1503153pubmed: 40901559google scholar: lookup
  12. Sun M, LaSala VR, Giuglaris C, Blitzer D, Jackman S, Ustunel S, Rajesh K, Kalfa D. Cardiovascular patches applied in congenital cardiac surgery: Current materials and prospects. Bioeng Transl Med 2025 Jan;10(1):e10706.
    doi: 10.1002/btm2.10706pubmed: 39801761google scholar: lookup
  13. Weixler VHM, Kuschnerus K, Romanchenko O, Ovroutski S, Cho MY, Berger F, Sigler M, Sinzobahamvya N, Photiadis J, Murin P. Mid-term performance of decellularized equine pericardium in congenital heart surgery. Interact Cardiovasc Thorac Surg 2022 Nov 7;36(3).
    doi: 10.1093/icvts/ivac269pubmed: 36342192google scholar: lookup