Porcine Small Intestinal Submucosa May Be a Suitable Material for Norwood Arch Reconstruction

Jacobsen, Roni M.; Mitchell, Michael E.; Woods, Ronald K.; Loomba, Rohit S.; Tweddell, James S.

doi:10.1016/j.athoracsur.2018.06.033

Cited by 12 publications

(6 citation statements)

References 25 publications

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“…Several technical modi cations have been introduced since Norwood's original description and the Jonas approach, including complete ductal excision [17], the use of prosthetic patch material such as bovine [18] or porcine pericardium [10], the use of autologous material [19] and the interdigitating technique [20].…”

Section: Different Arch Reconstruction and Techniquesmentioning

confidence: 99%

“…Two surgical schools of thought are distinguished in this setting: one is to use a minimal amount of xenogenous or other patch material for arch repair [5,6], or even no patch material at all [7,8], in order to yield a high native tissue-patch ratio with the idea of promoting superior long-term aortic arch longitudinal and anterior-posterior growth. The other is to employ abundant amounts of patch-material as needed based on the idea of enabling elongation and creating anterio-posterior space below the small curvature at the time of the repair, leading hypothetically to the same long-term native tissue growth but fewer left hilar complications [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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“Less patch more growth?”: comparing two different schools of thought in aortic arch reconstruction techniques during Norwood I

Uzdenov¹,

Ballazhi²,

Kroll³

et al. 2023

Preprint

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Background: We compared two different philosophies at one institution with respect to arch-geometry and clinical results: no/minimal patch vs. abundant patch augmentation. Methods: Single center retrospective analysis of the interstage angiographies of 82 patients: 41 (50%) underwent stage I Norwood-type palliation with minimal/no patch material for arch augmentation (Group 1, 2001-2011), and 41 (50%) with an abundant use of patch material (Group 2, 2011-2019). Aortic arch angle, distal arch:descending ratio, planimetry of whole arch, left hilar space were quantified. Clinical endpoints were all interstage interventions on the aortic arch, left pulmonary artery and readmissions due to left lung atelectasis and respiratory failure. Results: Arch angles were more acute in Group 1 (81°±13,2 vs. 90°±10,28, P = .012), with no difference in left hilar space (0,28±0,08 vs. 0,29±0,06, P = .43). Distal arch:descending ratio was smaller in Group 1 (0,72±0,2 vs 0,86±0,19, P = .04). Interstage interventions on the aortic arch and descending aorta were provided in 17 (41,5%) patients in Group 1 versus 19 (46,3%) patients in Group 2. Transcatheter interventions on the left pulmonary artery were necessary in 18 Group 1 patients versus 18 Group 2 patients (43,9%). Unilateral left lung atelectasis and respiratory failure occurred in 2 patients (4,4%) in Group 1 and in 3 patients (7,3%) in Group 2. Conclusions: Abundant patch material is associated with less acute aortic arch angles and leads to significantly better distal arch growth. However, this theoretical geometric benefit did not lead to greater left hilar space, nor did it prove to be superior with respect to interstage-interventions on left hilar structures. Mid-term no clinical effect was detected but future long-term effects are substantial.

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Section: Different Arch Reconstruction and Techniquesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“Less patch more growth?”: comparing two different schools of thought in aortic arch reconstruction techniques during Norwood I

Uzdenov¹,

Ballazhi²,

Kroll³

et al. 2023

Preprint

View full text Add to dashboard Cite

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“…Congenital heart defects affect ∼9 of 1,000 newborns (7) and often require corrective surgery at an early age. Invasive treatment of congenital cardiac defects results in an increased life expectancy and can significantly improve quality-of-life (8).…”

Section: Congenital Heart Diseasementioning

confidence: 99%

Tissue Engineered Materials in Cardiovascular Surgery: The Surgeon's Perspective

Durko

Yacoub

Kluin

2020

Front. Cardiovasc. Med.

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In cardiovascular surgery, reconstruction and replacement of cardiac and vascular structures are routinely performed. Prosthetic or biological materials traditionally used for this purpose cannot be considered ideal substitutes as they have limited durability and no growth or regeneration potential. Tissue engineering aims to create materials having normal tissue function including capacity for growth and self-repair. These advanced materials can potentially overcome the shortcomings of conventionally used materials, and, if successfully passing all phases of product development, they might provide a better option for both the pediatric and adult patient population requiring cardiovascular interventions. This short review article overviews the most important cardiovascular pathologies where tissue engineered materials could be used, briefly summarizes the main directions of development of these materials, and discusses the hurdles in their clinical translation. At its beginnings in the 1980s, tissue engineering (TE) was defined as "an interdisciplinary field that applies the principles of engineering and the life sciences toward the development of biological substitutes that restore, maintain, or improve tissue function" (1). Currently, the utility of TE products and materials are being investigated in several fields of human medicine, ranging from orthopedics to cardiovascular surgery (2-5). In cardiovascular surgery, reconstruction and replacement of cardiac and vascular structures are routinely performed. Considering the shortcomings of traditionally used materials, the need for advanced materials that can "restore, maintain or improve tissue function" are evident. Tissue engineered substitutes, having growth and regenerative capacity, could fundamentally change the specialty (6). This article overviews the most important cardiovascular pathologies where TE materials could be used, briefly summarizes the main directions of development of TE materials along with their advantages and shortcomings, and discusses the hurdles in their clinical translation.

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“…This retrospective study reports our early experience which combines two relatively novel strategies—the dunked technique for RV‐PA conduit interposition instead of a traditional mBTS and a curved xenopatch for augmentation of the hypoplastic aortic arch instead of autologous pericardium or other patch materials …”

Section: Commentmentioning

confidence: 99%

“…In contrast, the reconstruction of the aortic arch is still a challenging part of the Norwood procedure, since recoarctation of the aorta is known to be significantly related to increased morbidity and mortality . Several patch materials such as autologous pericardium, porcine intestinal submucosa, bovine pericardium, and extracellular matrix‐based scaffolds and pulmonary homografts with different geometric designs have been described to achieve the best results in terms of hemodynamics and growth potential . Several advantages and disadvantages of the currently used materials are known and there is no consensus about an ideal patch material for the arch repair in Norwood procedure.…”

Section: Commentmentioning

confidence: 99%

Early results of ring‐reinforced conduit and curved porcine patch in Sano‐Norwood procedure

Yildirim¹,

Bakhshaliyev²,

Kilercik³

et al. 2019

J Card Surg

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Background Patch augmentation of the aortic arch as well as construction of an unobstructed pulmonary blood supply are two important surgical targets in patients with hypoplastic left heart syndrome. In this report, we aimed to present our preliminary results with a combination of two relatively new approaches in Norwood‐Sano procedure. Methods A retrospective analysis was performed in 10 newborns with the diagnosis of hypoplastic left heart syndrome. Our surgical approach incorporated the interposition of a 6.0‐mm ring‐reinforced tube graft with the “dunked technique” between the right ventricle and the pulmonary artery; and reconstruction of the aortic arch using a curved porcine pericardial patch which is specifically designed for the Norwood procedure. Results Mean age and body weight at the time of the Sano‐Norwood operation were 7.3 ± 2.4 days and 3164 ± 406 g, respectively. We encountered 1 (10%) early and 1 (10%) late mortality. All of the patients were discharged without any residual gradients at the aortic arch. Four out of eight patients underwent stage 2 bidirectional cavopulmonary anastomosis at a median age of 5 months (range, 4‐6 months). Pericardial patch augmentation of the left pulmonary artery was deemed mandatory in one of our patients. Conclusions The dunked technique of interposing a ring‐reinforced conduit between the right ventricle and pulmonary artery along with the utilization of a curved porcine pericardial patch specifically designed for aortic arch reconstruction are promising modifications of the Sano‐Norwood procedure in newborns with hypoplastic left heart syndrome.

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Porcine Small Intestinal Submucosa May Be a Suitable Material for Norwood Arch Reconstruction

Cited by 12 publications

References 25 publications

“Less patch more growth?”: comparing two different schools of thought in aortic arch reconstruction techniques during Norwood I

“Less patch more growth?”: comparing two different schools of thought in aortic arch reconstruction techniques during Norwood I

Tissue Engineered Materials in Cardiovascular Surgery: The Surgeon's Perspective

Early results of ring‐reinforced conduit and curved porcine patch in Sano‐Norwood procedure

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