Surgeons at St. Vincent’s East are implementing the latest in tissue repair technology that is allowing patients to remodel their own cardiovascular tissue following open heart surgery. Atlanta-based CorMatrix Cardiovascular, Inc. has developed the extra cellular matrix (ECM) biomaterial devices that harness the body’s innate ability to repair damaged cardiovascular tissue.

 

Stanley Lochridge, MD and his colleagues at Cardio-Thoracic Surgeons P.C. primarily use the ECM technology to close the pericardium following open heart surgery and have used it on more than 2,000 patients at St. Vincent’s East and St. Vincent’s Birmingham since 2007. “When we do a bypass, we can close the pericardium using this patch to make it look anatomically like it did before the surgery,” Lochridge says.

 

The CorMatrix ECM™ is made from small intestinal submucosa derived from pig jejunum and has been used as an acellular biologic scaffold in many different surgical applications, Lochridge says. In its natural form, the ECM consists primarily of several types of collagens, with smaller but significant amounts of glycosaminogylcans, glycoproteins and growth factors. During surgery, the CorMatrix ECM is sutured onto the opening in the native pericardium. Following implantation, tissues adjacent to the ECM matrix deliver cells and nutrients, and the matrix itself recruits marrow-derived cells from the periphery, which can then differentiate into tissue-specific cells.

 

The cells quickly enter the ECM material, Lochridge adds, and blood vessel remodeling follows, allowing more nutrients and cells to enter the matrix. “The anogenic material comes to us dry, and we open and reconstitute it. When implanted, the ECM acts as a scaffold into which the patient’s cells migrate and integrate, stimulating the patient’s natural wound-healing mechanisms,” he says. “As the wound heals, the scaffold is absorbed by the body and is excreted into the patient’s urine.”

 

Closure of the pericardium is beneficial because it restores the natural barrier between the heart and chest wall. “It protects the heart and underlying grafts that were applied to the heart. Perhaps the biggest long-term advantage of using the ECM is that it is easier and safer to re-access the heart if a subsequent procedure is needed,” Lochridge says.

 

He says that they have had the opportunity to do follow-up operations on patients more than 12 months after the pericardium was closed. “They have what looks like a normal pericardium.”

 

Lochridge adds that they have also used the ECM for arterial patches and buttresses for extra strength. This material degenerates and goes away where the artificial Teflon and Dacron patches used in the past stayed in the body and increased the risk of infection. “We have also used the ECM to reconstruct the chambers of the heart,” he says. “One patient had a tumor in his heart and we used it to construct the inside and outside chamber. He is doing well two years post-op.”

 

Lochridge says that in addition to allowing reconstruction of the normal anatomy of the heart sac, use of this material has accomplished a number of things. “About 30 percent of people have atrial fibrillation after heart surgery. We think closing the pericardium has reduced that number to 10 percent,” he says. “The ECM has also minimized bleeding. We leave a tube inside and outside the patch so we can tell where any bleeding is coming from.”