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PATH3308 > 25. Cardiac Prostheses > Flashcards

25. Cardiac Prostheses Flashcards

1
Q

What are the three types of cardiovascular diseases?

A

Vacular related diseases
Valve related diseases
Muscle related diseases

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2
Q

What are some examples of vascular related diseases?

A

Atherosclerosis

Aneurisms

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3
Q

What are some examples of valve related diseases?

A

Incompetence

Stenosis

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4
Q

What are some muscle related diseases?

A

Muscle failure
Aneurisms
Septal defects

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5
Q

What are the two types of “cardiac prostheses” available (sources)?

A

Mechanical/synthetic substitutes

Biological subtitutes

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6
Q

What are some types of mechanical cardiac prostheses?

A

Coronry artery substitutes
Patch material
Heart valves

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7
Q

What are some biological cardiac prostheses?

A 
Cardiovascular patches (pericardium)
Vascular conduits (aorta, coronary arteries)
Heart valves
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8
Q

What are some advantages of mechanic/synthetic prostheses?

A

Availability
Durability
Variety

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9
Q

What are the advantages of biological prostheses?

A

Availability
Physiological flow
Variety

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10
Q

What are the disadvantages of mechanical cardiac prostheses?

A

Thromboembolic (clots form)
Coagulation
Haemolytic (burst blood vessels)

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11
Q

What are the disadvantages of biological cardiac prostheses?

A

Calcification
Degeneration
Cannot resist wear and tear - need to provide a scaffold that can serve as a framework for regeneration

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12
Q

What does tissue engineering mean?

A

Manipulation of biological molecules and cells for the purpose of creating new structures capable of normal physiological activities

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13
Q

What goes into a viable prosthesis?

A

Donor cells

Scaffold

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14
Q

What are the cell sources of tissue engineered prostheses?

A 
Vascular endothelial cells
Vascular interstitial cells
Arterial myofibroblasts
Venous myofibroblasts
Mesenchymal stem cells
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15
Q

What cardiovascular structures can you tissue engineer?

A

Biomaterials
Heart valves
Blood vessels
Myocardium

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16
Q

What are the ideal cardiovascular prostheses qualities?

A

1) Readily available
2) Hemodynamic flow properties
3) Biocompatible
4) Regenerate/growth
5) Viable

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17
Q

How is the scaffold prepared?

A 
Decellularised
Removal of antigenicity
Stabilisation of matrix
Growth activation
Sterilisation
18
Q

How is the scaffold decellularised?

A

Surfactants
Freezing/thawing
Sodium hydroxide

19
Q

How is the antigenicity of the scaffold removed?

A

Surfactant
Nucleases
Crosslinking
Sodium hydroxide

20
Q

How is a scaffolds matrix stabilised?

A

Cross linking

Polymer incorporation

21
Q

How is growth activation achieved on scaffold?

A

Growth factors
Protein incorporation
Amino acid supplementation
Physical activation (signalling from surrounding tissue)

22
Q

How is a scaffold sterilized?

A

Chemicals (prop oxide, aldehydes, peracetic acid)
Physical (heat, radiation, gas)
Combination

23
Q

What are the 3 scaffold models?

A

non-biodegradable scaffold - (synthetic)
- repopulate in vitro/vivo with autogenous cells
Biodegradable scaffold - (biologic/synthetic)
-repopulate in vitro / in vivo with autogenous cells
Allograft / xenograft matrix
- repopulate in vivo with autogenous cells

24
Q

Can you crosslink a decellularised allograft/xenograft?

A

Yes with carbodiimides

25
Q

What is an example of a synthetic biodegradable scaffold?

A

Polyglycolic acid (PGA) and poly-L-lactic acid (PLLA) fibers (Purac)

Valve

Seeded with sheep mesenchymal stem cells

26
Q

What are the advantages of a biodegradable scaffold?

A

Easily replaced

Pliable

27
Q

What are the disadvantages of a biodegradable scaffold?

A

Toxic (polymers)
Unpredictable
Immunogenic

28
Q

What are the advantages of a non-biodegradable scaffold?

A

Durable
Non - immunogenic
Pliable

29
Q

What are the disadvantages of a non-biodegradable scaffold?

A

No- replacement
No - remodeling
Foreign body response

30
Q

What can you make a matrix patch scaffold from?

A

Pericardium (bovine, Ovine, porcine, Human)
Extracted collagen (sheet or Gel) - xenogeneic
Polymers

31
Q

What you make a heart valve scaffold from?

A

Pericardium (bovine, ovine, procine, human)
Heart valve structure - xenogeneic / human
Polymers

32
Q

What can you make a blood vessel scaffold from?

A

Artery from bovine, ovine, porcine, kangaroo, human
Vein from bovine, ovine, porcine, kangaroo, human
Polymers

33
Q

How can you make myocardium matrix?

A

“Muscle flap” augmentation
Stem cells (injection)
Stem cell vehicle

34
Q

What occurs in the tissue regeneration cascade?

A

1) Cell seeding (in vitro) / infiltration (host tissue)
2) Cell duplication (“Growth”)
3) Cell trans-differentiation (“Transformation”)
4) Remodeling (neo-collagen, neo-capillaries etc)

35
Q

What factors affect tissue remodeling?

A

Physical stimuli (movement, pressure, pH)
Degeneration (“Wear and tear”, enzymatic)
Cell type (growth factors)
Chemical stimuli

36
Q

What is the process for placing human cells on animal scaffold in vitro?

A

Harvest fibroblasts from Human Saphenous vein
Establish fibroblast cell line
Confirm cell type

37
Q

What are the requirements of a bioreactor?

A 
Isolated
Temperature controlled
Flow (physiological)
Gas Exchange
Media Exchange
38
Q

What are the 3 types of bioreactors?

A

Pulsatile
Laminar
Forward flow

39
Q

What are some advantages associated with bioreactors?

A

Visible observations
Adjust PH levels
Study Morphology
Temp, gas exchange, growth factors all adjustable

40
Q

What are the disadvantages of a bioreactor?

A 
Sterility 
Synchronisation
Cost
Technical failure
Limited time

PATH3308 (21 decks)

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