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Endothelialization and Inflammatory Reactions After Intracardiac Device Implantation

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Cell Biology and Translational Medicine, Volume 17

Part of the book series: Advances in Experimental Medicine and Biology ((CBTMED,volume 1401))

Abstract

Background: Due to the advances in catheter-based interventional techniques, a wide range of heart diseases can now be treated with a purely interventional approach. Little is yet known regarding biological effects at the intracardiac implantation site or the effects on endothelialization and vascular inflammation in an in vivo environment. Detailed knowledge of ongoing vascular response, the process of endothelialization, and possible systemic inflammatory reactions after implantation is crucial for the clinical routine, since implants usually remain in the body for a lifetime.

Methods: For this narrative review, we conducted an extensive profound PubMed analysis of the current literature on the endothelialization processes of intracardially implanted devices, such as persistent foramen ovale (PFO) occluders, atrial septal defect (ASD) occluders, left atrial appendage (LAA) occluders, transcatheter aortic valve implantations (TAVIs), and leadless pacemakers. Additionally, the known biological activities of common metallic and synthetic components of intracardiac devices in an “in vivo” setting have been evaluated.

Results: Nitinol, an alloy of nickel and titanium, is by far the most commonly used material found in intracardiac devices. Although allergies to both components are known, implantation can be performed safely in the vast majority of patients. Depending on the device used, endothelialization can be expected within a time frame of 3–6 months. For those patients with a known allergy, gold coating may be considered as a viable alternative.

Conclusion: Based on our analysis, we conclude that the vast majority of devices are made of a material that is both safe to implant and nontoxic in long-term treatment according to the current knowledge. The literature on the respective duration of endothelialization of individual devices however is highly divergent.

The authors declare that there is no conflict of interests regarding the publication of this paper. All companies have granted image rights to depict their devices in this article.

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Abbreviations

ASD:

Atrial Septal Defect

ASO:

Amplatzer Septal Occluder

ATP:

Adenosine Triphosphate

CMs:

Cardiomyocytes

DAMPs:

Damage-Associated Patterns

ECs:

Endothelial Cells

ECM:

Extracellular Matrix

EPCs:

Endothelial Progenitor Cells

GSO:

Gore Septal Occluder

HMGB1:

High-mobility Group B1

HSPs:

Heat Shock Proteins

ICAM-1:

Intercellular Adhesion Molecule 1

IFN-γ:

Interferon Gamma

LAA:

Left Atrial Appendage

MERTK:

Myeloid–Epithelial–Reproductive Tyrosine Kinase

MMPs:

Matrix Metalloproteinases

MI:

Myocardial Infarction

NOAC:

New/“Non-Vitamin K” – Oral Anticoagulants

PCI:

Percutaneous Coronary Intervention

PDGF:

Platelet-Derived Growth Factor

PET:

Polyethylene Terephthalate

PFO:

Persistent Foramen Ovale

PRRs:

Pattern Recognition Receptors

RAGE:

Receptor for Advanced Glycation End Products

ROS:

Reactive Oxygen Species

SMCs:

Smooth Muscle Cells

TAVI:

Transcatheter Aortic Valve Implantation

TGF-β:

Transforming Growth Factor Beta

TLRs:

Toll-Like Receptors

Treg:

Regulatory T-cells

VEGF:

Vascular Endothelial Growth Factor

VSD:

Ventricular Septal Defect

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. We would like to express our gratitude to the companies mentioned in the journal for permission to reprint the product images.

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  1. Christoph Edlinger and Vera Paar have equally Contributed to this chapter.

Authors and Affiliations

  1. Department of Cardiology, Heart Center Brandenburg, Bernau/Berlin, Germany

    Christoph Edlinger, Eleni Lalou, Christian Butter, Victoria Dworok & Marwin Bannehr

  2. Brandenburg Medical School (MHB) “Theodor Fontane”, Neuruppin, Germany

    Christoph Edlinger, Salma Haj Kheder, Eleni Lalou, Christian Butter, Victoria Dworok & Marwin Bannehr

  3. Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria

    Christoph Edlinger, Vera Paar, Elke Boxhammer, Uta C. Hoppe, Kristen Kopp & Michael Lichtenauer

  4. Department of Cardiology, Caritas Clinic Pankow, Berlin, Germany

    Florian Krizanic

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    Kursad Turksen

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Edlinger, C. et al. (2022). Endothelialization and Inflammatory Reactions After Intracardiac Device Implantation. In: Turksen, K. (eds) Cell Biology and Translational Medicine, Volume 17. Advances in Experimental Medicine and Biology(), vol 1401. Springer, Cham. https://doi.org/10.1007/5584_2022_712

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