Use of bioresorbable scaffold for neopulmonary artery in simple transposition of great arteries: Tissue engineering moves steps in pediatric cardiac surgery

Nappi, Francesco; Spadaccio, Cristiano; Fraldi, Massimiliano; Acar, Cristophe

doi:10.1016/j.ijcard.2015.08.124

Cited by 8 publications

(4 citation statements)

References 20 publications

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“…However, all these reinforcements are significantly stiffer than the native aorta and do not provide sufficient vascular compliance. Therefore, Nappi et al proposed a resorbable reinforcement to strengthen the pulmonary autograft, which they evaluated in an ovine model [14,15,16,17,18].…”

Section: Introductionmentioning

confidence: 99%

Biomechanical evaluation of a personalized external aortic root support applied in the Ross procedure

Vastmans

Fehervary

Verbrugghe

et al. 2018

Journal of the Mechanical Behavior of Biomedical Materials

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A commonly heard concern in the Ross procedure, where a diseased aortic valve is replaced by the patient's own pulmonary valve, is the possibility of pulmonary autograft dilatation. We performed a biomechanical investigation of the use of a personalized external aortic root support or exostent as a possibility for supporting the autograft. In ten sheep a short length of pulmonary artery was interposed in the descending aorta, serving as a simplified version of the Ross procedure. In seven of these cases, the autograft was supported by an external mesh or so-called exostent. Three sheep served as control, of which one was excluded from the mechanical testing. The sheep were sacrificed six months after the procedure. Samples of the relevant tissues were obtained for subsequent mechanical testing: normal aorta, normal pulmonary artery, aorta with exostent, pulmonary artery with exostent, and pulmonary artery in aortic position for six months. After mechanical testing, the material parameters of the Gasser-Ogden-Holzapfel model were determined for the different tissue types. Stress-strain curves of the different tissue types show significantly different mechanical behavior. At baseline, stress-strain curves of the pulmonary artery are lower than aortic stress-strain curves, but at the strain levels at which the collagen fibers are recruited, the pulmonary artery behaves stiffer than the aorta. After being in aortic position for six months, the pulmonary artery tends towards aorta-like behavior, indicating that growth and remodeling processes have taken place. When adding an exostent around the pulmonary autograft, the mechanical behavior of the composite artery (exostent + artery) differs from the artery alone, the non-linearity being more evident in the former.

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Section: Introductionmentioning

confidence: 99%

Biomechanical evaluation of a personalized external aortic root support applied in the Ross procedure

Vastmans

Fehervary

Verbrugghe

et al. 2018

Journal of the Mechanical Behavior of Biomedical Materials

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“…This composite prosthesis prevented pulmonary autograft dilation while reabsorption of its PDS layer promoted a connective remodeling of the pulmonary autograft wall resulting in a neo-vessel formation, with increased elastin content and therefore potentially improved biomechanical properties. Moreover, application of a bio-resorbable reinforcement is able to modify the behavior of the curve of distensible materials, such as vessels wall, obtaining an increase of their elastic properties (41)(42)(43)46,49). Pre-clinical and clinical evaluations of the biomechanical properties of these reinforced pulmonary autografts might shed new light on the current debate about the long-term fate of the pulmonary autograft after Ross procedure, in order to improve the outcomes of the treated young patients.…”

Section: Future Directionsmentioning

confidence: 99%

“…Histologic analysis proved that loss and fragmentation of medial elastin fibers and increased adventitial collagen deposition occur after implantation (36)(37)(38). Since late autograft dysfunction remains a daunting issue in the Ross operation, our group and others tried to characterize the biomechanical aspects of pulmonary autograft failure (39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49) to understand in details the long-term effects and develop future frontiers in both surgical and basic researches.…”

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confidence: 99%

Pulmonary autograft in aortic position: is everything known?

et al. 2017

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“…Accumulating evidence suggest that patients with bicuspid aortic valve and aortic regurgitation have a higher risk of increased pulmonary autograft root diameter thus, a higher risk of failure with shortened durability. Mechanical phenomena related to the dilatation of pulmonary autograft under systemic pressure have recently been studied highlighting the biomechanics of PA (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Mookhoek et al (8) evidenced that the failed PA had a nonlinear response to mechanical loading, typical of healthy human arterial tissue, as nonlinear stress-strain response was present in both failed PA and normal PAR.…”

mentioning

confidence: 99%