FIG. 1.

Method for SASG delivery through lateral thoracotomy (A), or by minimally invasive SASG-VATS (B–G). (A) Epicardial implantation of 3D graft onto the LV scar area. Inset showing premade FG containing angiogenic spheroids. (B) For delivery of spheroids and fibrin to form an epicardial patch in situ, a 2-mm straight forward telescope was inserted through a 3-mm incision at the eighth intercostal space, mid-axillar line. (C) A fibrin/DPBS and spheroids mixture was loaded into a 16G catheter using a 1-mL syringe, which was then inserted into the thorax through an incision made at the fourth intercostal space, parasternal line. (D) Surgical wounds after VATS procedure. Note small wounds size compared to previous thoracotomy. (E–G) The partially gelled fibrin/DPBS/spheroids mixture was deposited epicardially onto the scar area under video-thoracoscopic visualization. The mixture was then allowed to polymerize completely before the next batch was applied. This process was repeated three times until the scar area was totally covered with spheroids. (H–J) The same procedure (without spheroids) was done for fibrin controls (FG-VATS). CL-MSC, cord-lining mesenchymal stem cells; SASG, subamnion-CL-MSC angiogenic spheroids-enriched grafts; FG, fibrin graft; VATS, video-assisted thoracoscopic surgery; LV, left ventricular; 3D, three-dimensional. Color images available online at www.liebertpub.com/scd