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Assessment of the healing process after percutaneous implantation of a cardiovascular device: a systematic review

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Abstract

The healing process, occurring after intra-cardiac and intra-vascular device implantation, starts with fibrin condensation and attraction of inflammatory cells, followed by the formation of fibrous tissue that slowly covers the device. The duration of this process is variable and may be incomplete, which can lead to thrombus formation, dislodgement of the device or stenosis. To better understand this process and the neotissue formation, animal models were developed: small (rats and rabbits) and large (sheep, pigs, dogs and baboons) animal models for intra-vascular device implantation; sheep and pigs for intra-cardiac device implantation. After intra-vascular and intra-cardiac device implantation in these animal models, in vitro techniques, i.e. histology, which is the gold standard and scanning electron microscopy, were used to assess the device coverage, characterize the cell constitution and detect complications such as thrombosis. In humans, optical coherence tomography and intra-vascular ultrasounds are both invasive modalities used after stent implantation to assess the structure of the vessels, atheroma plaque and complications. Non-invasive techniques (computed tomography and magnetic resonance imaging) are in development in humans and animal models for tissue characterization (fibrosis), device remodeling evaluation and device implantation complications (thrombosis and stenosis). This review aims to (1) present the experimental models used to study this process on cardiac devices; (2) focus on the in vitro techniques and invasive modalities used currently in humans for intra-vascular and intra-cardiac devices and (3) assess the future developments of non-invasive techniques in animal models and humans for intra-cardiac devices.

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Acknowledgements

The figures were reprinted: Fig. 1: reprinted from Circulation: Cardiovascular Interventions 2009;2:90–96, by Foth et al., Immunohistochemical characterization of neotissues and tissue reactions to septal defect-occlusion devices, Figure n°1, Copyright 2009, with permission from Wolters Kluwer Health, Inc. Fig. 2: reprinted from JACC: Cardiovascular Interventions 2013;6[5]:523−32, by Farooq et al., Intracoronary optical coherence tomography and histology of overlapping everolimus-eluting bioresorbable vascular scaffolds in a porcine coronary artery model the potential implications for clinical practice, Figure n°7, Copyright 2013, with permission from Elsevier Inc. Fig. 3: reprinted from JACC: Cardiovascular Interventions 2012;5[1]:12–20, by Guagliumi et al., Examination of the in vivo mechanisms of late drug-eluting stent thrombosis-Findings from optical coherence tomography and intravascular ultrasound imaging, Figure n°1, Copyright 2012, with permission from Elsevier Inc.

Funding

This study received financial support from the French Government as part of the “Investments of the Future” program managed by the National Research Agency (ANR), Grant reference ANR-10-IAHU-04.

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Authors and Affiliations

  1. IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, 33600, Pessac- Bordeaux, France

    Elodie Perdreau, Zakaria Jalal, Richard D. Walton, Jérôme Naulin, Julie Magat, Bruno Quesson, Hubert Cochet, Olivier Bernus & Jean-Benoît Thambo

  2. Université de Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, 33000, Bordeaux, France

    Elodie Perdreau, Zakaria Jalal, Richard D. Walton, Jérôme Naulin, Julie Magat, Bruno Quesson, Hubert Cochet, Olivier Bernus & Jean-Benoît Thambo

  3. INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, 33000, Bordeaux, France

    Elodie Perdreau, Zakaria Jalal, Richard D. Walton, Jérôme Naulin, Julie Magat, Bruno Quesson, Hubert Cochet, Olivier Bernus & Jean-Benoît Thambo

  4. Congenital and Pediatric Cardiology Unit, Bordeaux University Hospital (CHU), 33600, Pessac, France

    Zakaria Jalal & Jean-Benoît Thambo

  5. Bordeaux University Hospital (CHU), Cardiothoracic Pole, 33600, Pessac, France

    Hubert Cochet

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  1. Elodie Perdreau
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Perdreau, E., Jalal, Z., Walton, R.D. et al. Assessment of the healing process after percutaneous implantation of a cardiovascular device: a systematic review. Int J Cardiovasc Imaging 36, 385–394 (2020). https://doi.org/10.1007/s10554-019-01734-2

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