The fate of large-diameter Dacron® vascular grafts in surgical practice: Are we really satisfied?

Spadaccio, Cristiano; Rainer, Alberto; Barbato, Raffaele; Chello, Massimo; Meyns, Bart

doi:10.1016/j.ijcard.2013.07.165

Cited by 34 publications

(28 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Additionally, the autograft engaged in a straight Dacron prosthetic graft would be extremely limited in its possibility of dimensional increase in accord to the somatic growth . Moreover, we previously demonstrated as Dacron grafts and other synthetic polyesters severely impair aortic compliance when used as vascular replacement and elicit a strong inflammatory reaction with significant damage to vessel wall when used a PA reinforcement . From these standpoints, we focused on the improvement of the biomechanical behavior of the reinforced PA using resorbable materials able to integrate within the PA and promote its remodeling while accompanying the physiological process of growth of vascular structures.…”

Section: Discussionmentioning

confidence: 99%

Biomechanics drive histological wall remodeling of neoaortic root: A mathematical model to study the expression levels of ki 67, metalloprotease, and apoptosis transition

Nappi

Fraldi

Spadaccio

et al. 2016

J Biomedical Materials Res

Self Cite

View full text Add to dashboard Cite

The pulmonary artery autograft (PA) is the ideal substitute for aortic valve disease in children and young adult. However, it is harnessed by the issue of long-term dilation and regurgitation, often requiring surgery. PA implanted in aortic position during the growth phase in children undergoes a process of mechanical remodeling. We previously developed a semiresorbable armored prosthesis able to mechanically sustain the neoaorta preventing dilation and to gradually integrate with the PA wall inducing a progressive arterial-like tissue positive remodeling. We also described the mechanisms of growth, remodeling and stress shielding of the reinforced PA through a mathematical model. We sought to demonstrate the biological counterpart and the potential molecular mechanisms underlying this histological and mechanical remodeling. A specific mathematical model was developed to describe mechanical behavior of the PA. Mallory trichrome red staining and immunohistochemistry for MMP-9 were performed to elucidate extracellular matrix remodeling phenomena. Apoptosis and cell proliferation were determined by TUNEL assay and immunohistochemistry for Ki67, respectively. An histological remodeling phenomenon sustained by increased level of MMP-9, augmented cell proliferation and reduced apoptosis in the reinforced PA was demonstrated. The mathematical model predicted the biomechanical behavior subtended by the histological changes of the PA in these settings. Changes in metalloproteinases (MMP-9), cell proliferation and apoptosis are the main actors in the remodeling process occurring after transposition of the PA into systemic regimens. Use of semiresorbable reinforcements might induce a positive remodeling of the PA in the context of Ross operation. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 2785-2793, 2016.

show abstract

Section: Discussionmentioning

confidence: 99%

Biomechanics drive histological wall remodeling of neoaortic root: A mathematical model to study the expression levels of ki 67, metalloprotease, and apoptosis transition

Nappi

Fraldi

Spadaccio

et al. 2016

J Biomedical Materials Res

Self Cite

View full text Add to dashboard Cite

show abstract

“…The concept of “compliance mismatch” between the graft and native aorta has been introduced to explain what emerged as a silent but worrying concern regarding the reflexes that the presence of prosthetic materials can determine on the native cardiovascular structures and consequently on the long-term outcomes of these artificial grafts [ 1 ]. After 50 years since the initial implantation of Dacron grafts and despite their general good performance, dilation or aneurysm, para-anastomotic pseudoaneurysm, and mechanical failure are still considered daunting issues in the follow-up of these patients often requiring additional surgery [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

Old Myths, New Concerns: the Long-Term Effects of Ascending Aorta Replacement with Dacron Grafts. Not All That Glitters Is Gold

Spadaccio

Nappi

Al‐Attar

et al. 2016

J. of Cardiovasc. Trans. Res.

Self Cite

View full text Add to dashboard Cite

Synthetic grafts are widely used in cardiac and vascular surgery since the mid-1970s. Despite their general good performance, inability of mimicking the elastomechanical characteristics of the native arterial tissue, and the consequent lack of adequate compliance, leads to a cascade of hemodynamic and biological alterations deeply affecting cardiovascular homeostasis. Those concerns have been reconsidered in more contemporaneous surgical and experimental reports which also triggered some research efforts in the tissue engineering field towards the realization of biomimetic arterial surrogates. The present review focuses on the significance of the “compliance mismatch” phenomenon occurring after aortic root or ascending aorta replacement with prosthetic grafts and discusses the clinical reflexes of this state of tissue incompatibility, as the loss of the native elastomechanical properties of the aorta can translate into detrimental effects on the normal efficiency of the aortic root complex with impact in the long-term results of patients undergoing aortic replacement.

show abstract

“…Nevertheless, up to 30% of the patients who require arterial bypass surgery do not possess suitable or sufficient autologous blood vessels, necessitating the use of synthetic grafts . Polyethylene‐terephthalate (PET) and expanded polyetetrafluoroethylene (ePTFE) are currently used for prosthetic vascular grafts (ePTFE) providing satisfactory results when used to replace or by‐pass large diameter blood vessels . However, the performances of those biomaterials in small‐diameter vascular grafts are poor when compared with autologous vein grafts concerning the patency rate .…”

Section: Introductionmentioning

confidence: 99%

“…2 Polyethylene-terephthalate (PET) and expanded polyetetrafluoroethylene (ePTFE) are currently used for prosthetic vascular grafts (ePTFE) providing satisfactory results when used to replace or by-pass large diameter blood vessels. 3 However, the performances of those biomaterials in small-diameter vascular grafts are poor when compared with autologous vein grafts concerning the patency rate. 4 When used for femur-popliteal bypass grafting, PET and ePTFE presented a patency rate of 36% and 47% functional after 2 years, respectively.…”

Section: Introductionmentioning

confidence: 99%

In vitroandin vivoevaluation of blood coagulation activation of polyvinyl alcohol hydrogel plus dextran-based vascular grafts

Alexandre

Costa

Coimbra

et al. 2014

J. Biomed. Mater. Res.

View full text Add to dashboard Cite

Polyvinyl alcohol hydrogel (PVA) is a water-soluble synthetic polymer that is commonly used in biomedical applications including vascular grafting. It was argued that the copolymerization of PVA with dextran (Dx) can result in improvement of blood-biomaterial interactions. The focus of this experimental study was to assess that interaction through an in vivo and in vitro evaluation of the coagulation system activation. The thrombogenicity of the copolymer was determined by quantification of platelet adhesion through the lactate dehydrogenase assay, determination of whole blood clotting time, and by quantification of platelet activation by flow cytometry. The thrombin-antithrombin complex blood levels were also determined. The obtained results for the in vitro assays suggested a non-thrombogenic profile for PVA/Dx. Additionally in vivo coagulation and hematological parameters were determined in an animal model after PVA/Dx vascular graft implantation. For coagulation homeostasis assessment, the intrinsic and extrinsic pathway's activation was determined by measuring prothrombin time (PT) and activated partial thromboplastin time (aPTT). Other markers of coagulation and inflammation activation including d-dimers, interleukin-6, and C-reactive protein were also assessed. The PVA/Dx copolymer tended to inhibit platelet adhesion/activation process and the contact activation process for coagulation. These results were also confirmed with the in vivo experiments where the measurements for APTT, interleukin-6, and C-reactive protein parameters were normal considering the species normal range of values. The response to those events is an indicator of the in vitro and in vivo hemocompatibility of PVA/Dx and it allows us to select this biomaterial for further preclinical trials in vascular reconstruction.

show abstract

The fate of large-diameter Dacron® vascular grafts in surgical practice: Are we really satisfied?

Cited by 34 publications

References 6 publications

Biomechanics drive histological wall remodeling of neoaortic root: A mathematical model to study the expression levels of ki 67, metalloprotease, and apoptosis transition

Biomechanics drive histological wall remodeling of neoaortic root: A mathematical model to study the expression levels of ki 67, metalloprotease, and apoptosis transition

Old Myths, New Concerns: the Long-Term Effects of Ascending Aorta Replacement with Dacron Grafts. Not All That Glitters Is Gold

In vitroandin vivoevaluation of blood coagulation activation of polyvinyl alcohol hydrogel plus dextran-based vascular grafts

Contact Info

Product

Resources

About