1. Effects of envelopes on cardiac implantable electronic device pocket healing: A head-to-head preclinical evaluation.
- Author
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Virmani R, Philippon F, Mittal S, Finn A, Kudlik D, Kirchhof N, Lexcen D, and Kassotis J
- Subjects
- Animals, Sheep, Pacemaker, Artificial adverse effects, Absorbable Implants, Anti-Bacterial Agents pharmacology, Anti-Bacterial Agents therapeutic use, Wound Healing, Defibrillators, Implantable, Disease Models, Animal
- Abstract
Background: The healing response to cardiac implantable electronic device (CIED) implantation results in inflammation that can lead to fibrous pocket formation, which may disrupt pocket healing or complicate future interventions., Objective: The purpose of this study was to assess CIED pocket healing with use of the second-generation TYRX absorbable antibacterial envelope (T2), the next-generation (NG) TYRX absorbable antibacterial envelope under development, and the CanGaroo® extracellular matrix envelope (ECM) compared to no envelope., Methods: A total of 110 CIEDs were implanted in an ovine model, either with (T2, NG, or ECM) or without envelopes. Histopathologic and morphometric analyses were completed at several timepoints after implant (3 days, 7 days, 4 weeks, 12 weeks, 24 weeks). An independent pathologist completed a blinded histopathology assessment of the pockets., Results: TYRX (T2/NG) pockets showed similar inflammatory and healing profiles to controls with more rapid provisional matrix formation compared to controls and ECM. ECM pockets exhibited increased acute (3 and 7 days) and chronic (24 weeks) inflammation. T2/NG had almost complete (T2) or complete (NG) absorption by week 12. ECM remained present at week 24 and was associated with significantly thicker capsules (ECM 0.80 ± 0.14 mm; NG 0.37 ± 0.10 mm; control 0.56 ± 0.17 mm)., Conclusion: Compared to ECM, pockets with TYRX showed less inflammation, more rapid provisional matrix formation, faster absorption, and thinner capsules. TYRX pockets had low inflammation comparable to controls with accelerated provisional matrix deposition and tissue adhesion. The healing response to CIEDs used with TYRX fosters the formation of a well-healed pocket, which may bring patient benefit beyond its proven infection reduction., Competing Interests: Disclosures Dr Virmani reports being on the advisory board for Medtronic. Dr Philippon reports research grants and lectures for Medtronic. Dr Mittal reports being a consultant for Medtronic. Dr Finn reports research grants from Medtronic; and being a consultant for Medtronic. D’Anne Kudlik, Dr Kirchhof, and Lexcen report employment by Medtronic. Dr Kassotis reports being a consultant for Medtronic., (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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