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Bobylev D, Horke A, Avsar M, Cvitkovic T, Boethig D, Hazekamp M, Meyns B, Rega F, Dave H, Schmiady M, Ciubotaru A, Cheptanaru E, Vida V, Padalino M, Tsang V, Jashari R, Laufer G, Andreas M, Andreeva A, Tudorache I, Cebotari S, Haverich A, Sarikouch S. Matched comparison of decellularized homografts and bovine jugular vein conduits for pulmonary valve replacement in congenital heart disease. Cell Tissue Bank 2024; 25:55-66. [PMID: 36917328 PMCID: PMC10901942 DOI: 10.1007/s10561-023-10082-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/23/2023] [Indexed: 03/16/2023]
Abstract
For decades, bovine jugular vein conduits (BJV) and classic cryopreserved homografts have been the two most widely used options for pulmonary valve replacement (PVR) in congenital heart disease. More recently, decellularized pulmonary homografts (DPH) have provided an alternative avenue for PVR. Matched comparison of patients who received DPH for PVR with patients who received bovine jugular vein conduits (BJV) considering patient age group, type of heart defect, and previous procedures. 319 DPH patients were matched to 319 BJV patients; the mean age of BJV patients was 15.3 (SD 9.5) years versus 19.1 (12.4) years in DPH patients (p = 0.001). The mean conduit diameter was 24.5 (3.5) mm for DPH and 20.3 (2.5) mm for BJV (p < 0.001). There was no difference in survival rates between the two groups after 10 years (97.0 vs. 98.1%, p = 0.45). The rate of freedom from endocarditis was significantly lower for BJV patients (87.1 vs. 96.5%, p = 0.006). Freedom from explantation was significantly lower for BJV at 10 years (81.7 vs. 95.5%, p = 0.001) as well as freedom from any significant degeneration at 10 years (39.6 vs. 65.4%, p < 0.001). 140 Patients, matched for age, heart defect type, prior procedures, and conduit sizes of 20-22 mm (± 2 mm), were compared separately; mean age BJV 8.7 (4.9) and DPH 9.5 (7.3) years (p = n.s.). DPH showed 20% higher freedom from explantation and degeneration in this subgroup (p = 0.232). Decellularized pulmonary homografts exhibit superior 10-year results to bovine jugular vein conduits in PVR.
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Affiliation(s)
- Dmitry Bobylev
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alexander Horke
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Tomislav Cvitkovic
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dietmar Boethig
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Mark Hazekamp
- Department of Congenital Cardiac Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Bart Meyns
- Department of Cardiac Surgery, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Filip Rega
- Department of Cardiac Surgery, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Hitendu Dave
- Division of Congenital Cardiovascular Surgery, University Children's Hospital, Zurich, Switzerland
| | - Martin Schmiady
- Division of Congenital Cardiovascular Surgery, University Children's Hospital, Zurich, Switzerland
- Cardiac Surgery Center, State Medical and Pharmaceutical University, Chisinau, Moldova
| | - Anatol Ciubotaru
- Cardiac Surgery Center, State Medical and Pharmaceutical University, Chisinau, Moldova
| | - Eduard Cheptanaru
- Cardiac Surgery Center, State Medical and Pharmaceutical University, Chisinau, Moldova
| | - Vladimiro Vida
- Pediatric and Congenital Cardiac Surgery Unit, Azienda Ospedaliera di Padova, University of Padua Medical School, Padua, Italy
| | - Massimo Padalino
- Pediatric and Congenital Cardiac Surgery Unit, Azienda Ospedaliera di Padova, University of Padua Medical School, Padua, Italy
| | - Victor Tsang
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Ramadan Jashari
- European Homograft Bank, Clinique Saint-Jean, Brussels, Belgium
| | - Günther Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Alexandra Andreeva
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Igor Tudorache
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Serghei Cebotari
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Samir Sarikouch
- Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany.
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Mavroudis C, Backer CL, Brown JW, Williams WG. The Congenital Heart Surgeons' Society Presidents and Their Contributions. World J Pediatr Congenit Heart Surg 2023; 14:559-571. [PMID: 37737595 DOI: 10.1177/21501351231181331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
The Congenital Heart Surgeons' Society (CHSS) was founded by 16 congenital heart surgeons in 1973, who endeavored to share their clinical advances in an informal setting that would stimulate honest and forthright discussions. As the Society grew, prospective studies were organized from a centralized data center that was established and based first in Birmingham, Alabama, thence to Toronto, and recently in a collaboration between Toronto and the Cleveland Clinic. These studies formed the basis for a myriad of outcomes reports that favorably impacted surgical results. The Kirklin-Ashburn Fellowship was created and endowed by the membership which has been successful in training many congenital heart surgeons. The CHSS was then incorporated into a 501(c) (3) not-for-profit organization with bylaws, officers, and committees in 2002. Increased membership followed. The CHSS has become the face of congenital heart surgery in North America by affiliating with the World Journal for Pediatric and Congenital Heart Surgery, having one designated member on the American Board of Thoracic Surgery, and hosting joint meetings with the European Congenital Heart Surgeons Association. Since 2002, 11 presidents have been elected for two-year terms and have guided the advances that have been achieved by the CHSS. Their contributions and achievements are highlighted in chronological order.
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Affiliation(s)
- Constantine Mavroudis
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Peyton Manning Children's Hospital, Indianapolis, Indiana, USA
| | - Carl L Backer
- Section of Pediatric Cardiothoracic Surgery, UK HealthCare Kentucky Children's Hospital, Lexington, Kentucky, USA
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - John W Brown
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Alifu A, Wang H, Su Y, Chen R. Biventricular repair of double-outlet left ventricle by handmade trileaflet-valved conduit: A case report. Medicine (Baltimore) 2022; 101:e32070. [PMID: 36451474 PMCID: PMC9704874 DOI: 10.1097/md.0000000000032070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
RATIONALE Double-outlet left ventricle (DOLV) is a rare congenital cardiac malformation in which both great arteries arise entirely or predominantly from the left ventricle. An extracardiac conduit is the first surgical option for repairing DOLV, specifically because its placement of the extracardiac conduit can be customized to accommodate all possible anatomical variations. The bovine jugular veins and homograft valves are often used as conduits. There have been no reports on the use of handmade trileaflet-valved conduits for correcting DORV. PATIENT CONCERNS A 1-year old male was admitted for significant heart murmur and cyanosis, according to the results of transthoracic echocardiography, computed tomography angiography, and cardioangiography, and was diagnosed with DOLV and pulmonary stenosis. DIAGNOSIS AND INTERVENTIONS The patient underwent biventricular repair with a handmade trileaflet-valved extracardiac conduit. The postoperative course was uneventful. OUTCOME Three months after the surgery, TTF indicated mild right ventricular outflow obstruction and pulmonary valve regurgitation. LESSONS Correction of the left ventricular double outlet with a handmade trileaflet-valved conduit has been shown to have excellent performance, and long-term outcomes should be followed over time.
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Affiliation(s)
- Ailixiati Alifu
- Department of Cardiothoracic Surgery, Hainan Women and Children’s Medical Center, Haikou, Hainan Province, China
| | - Haifan Wang
- Department of Cardiothoracic Surgery, Hainan Women and Children’s Medical Center, Haikou, Hainan Province, China
| | - Yuntian Su
- Department of Cardiothoracic Surgery, Hainan Women and Children’s Medical Center, Haikou, Hainan Province, China
| | - Renwei Chen
- Department of Cardiothoracic Surgery, Hainan Women and Children’s Medical Center, Haikou, Hainan Province, China
- * Correspondence: Renwei Chen, Department of Cardiothoracic Surgery, Hainan Women and Children’s Medical Center, Haikou, Hainan Province 570206, China (e-mail: )
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Yuan H, Lu T, Wu Z, Yang Y, Chen J, Wu Q, Wu S, Zhang H, Qian T, Huang C. Decellularized bovine jugular vein and hand-sewn ePTFE valved conduit for right ventricular outflow tract reconstruction in children undergoing Ross procedure. Front Cardiovasc Med 2022; 9:956301. [PMID: 36158834 PMCID: PMC9489926 DOI: 10.3389/fcvm.2022.956301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe Ross procedure is recommended as an optimal aortic valve replacement (AVR) in children and young adults due to several advantages. Nevertheless, multiple reconstructions of the right ventricular outflow tract (RVOT) with new valve conduits have caused some concern regarding the durability of the Ross AVR. Decellularized bovine jugular vein conduit (BJVC) (DP-BJVC) and hand-sewn expanded polytetrafluoroethylene valved conduits (ePTFE VC) are widely employed to reconstruct the RVOT with satisfactory long-term outcomes. However, few studies have compared the safety and efficacy between the two valve conduits. We aimed to evaluate the early outcomes and report our single center experience in the application of these conduits.MethodsTwenty-two pediatric patients (aged < 18 years) who underwent Ross procedures with DP-BJVC and ePTFE VC in our center between 1 June, 2017 and 31 January, 2022 were enrolled. The Kaplan–Meier method was used to evaluate survival, freedom from RVOT reintervention, and freedom from RVOT graft dysfunction. Mixed-effects analysis with the Geisser–Greenhouse correction and Sidak's multiple comparisons test for post-hoc analysis was employed to compare the peak gradient across the conduit at varying follow-ups.ResultsAll patients were followed up in full. The total early survival rate was 90.9%; two patients in the DP-BJVC group died. There was no significant difference in early mortality, cross-clamp time (p = 0.212), in-hospital stay (p = 0.469), and RVOT graft thrombosis or endocarditis between the two groups. There was similarly no significant difference between Kaplan–Meier freedom from RVOT graft dysfunction curve (P = 0.131). The transprosthetic gradient gradually increased over time in both groups and was significantly higher in the DP-BJVC group at follow-up (P < 0.05).ConclusionsBoth conduits show excellent early and midterm outcomes for RVOT reconstruction in the Ross procedure. We suggest that DP-BJVC is more suitable for infants, and ePTFE conduit is more suitable for older children who require larger conduits.
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Affiliation(s)
- Haoyong Yuan
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
- Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Ting Lu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
- Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Zhongshi Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
- Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Yifeng Yang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jinlan Chen
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Qin Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Sijie Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Hong Zhang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Tao Qian
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Can Huang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
- Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
- *Correspondence: Can Huang
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Dong W, Chen D, Jiang Q, Hu R, Qiu L, Zhu H, Zhang W, Zhang H. Ross Procedure in the era of Handmade-Valved Conduits for Right Ventricular Outflow Tract Reconstruction in Children: Short-Term Surgical Outcomes. Front Cardiovasc Med 2022; 9:924253. [PMID: 35770229 PMCID: PMC9234205 DOI: 10.3389/fcvm.2022.924253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveRoss procedure is considered as the “gold standard” for aortic valve replacement, but the conduits used for right ventricular outflow tract (RVOT) reconstruction, such as homografts and bovine jugular vein (BJV) conduits, are of limited availability in China. Handmade expanded polytetrafluoroethylene-valved conduits (HVCs) have been used recently as the alternative for RVOT reconstruction, but their specific experience in Ross procedure is limited in the literature.MethodsThis was a retrospective review of 27 children who underwent Ross procedure in our center from January 2018 to January 2022.ResultsMean age at surgery was 8.0 ± 3.8 years. During the study period, BJV conduits were used for RVOT reconstruction in 6 patients (22%), and HVCs were used in 21 patients (78%). Median conduit size was 20 mm (range, 16–24 mm), and mean conduit Z-score was +0.8 ± 0.9. Median time for cardiopulmonary bypass was 158 min (range, 109–275 min), and mean time for aortic crossclamping was 110 ± 21 min. There was no early mortality. During a median follow-up time of 1.4 years (range, 0.1–3.7 years), 3 patients (11%) with BJV conduits had peak conduit velocity of > 3.5 m/s; 3 patients (11%) with HVCs developed moderate conduit insufficiency; no patients had more than moderate conduit insufficiency. Three patients with BJV conduits had 5 reinterventions, and all received conduit replacement with HVCs.ConclusionHVC is an appealing alternative to BJV conduit for RVOT construction for children undergoing Ross procedure, with favorable short-term outcomes.
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Huyan Y, Chang Y, Song J. Application of Homograft Valved Conduit in Cardiac Surgery. Front Cardiovasc Med 2021; 8:740871. [PMID: 34712711 PMCID: PMC8545902 DOI: 10.3389/fcvm.2021.740871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Valved conduits often correct the blood flow of congenital heart disease by connecting the right ventricle to the pulmonary artery (RV-PA). The homograft valved conduit was invented in the 1960s, but its wide application is limited due to the lack of effective sterilization and preservation methods. Modern cryopreservation prolongs the preservation time of homograft valved conduit, which makes it become the most important treatment at present, and is widely used in Ross and other operations. However, homograft valved conduit has limited biocompatibility and durability and lacks any additional growth capacity. Therefore, decellularized valved conduit has been proposed as an effective improved method, which can reduce immune response and calcification, and has potential growth ability. In addition, as a possible substitute, commercial xenograft valved conduit has certain advantages in clinical application, and tissue engineering artificial valved conduit needs to be further studied.
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Affiliation(s)
- Yige Huyan
- The Cardiomyopathy Research Group at Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Chang
- The Cardiomyopathy Research Group at Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiangping Song
- The Cardiomyopathy Research Group at Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Qian T, Yuan H, Chen C, Liu Y, Lu T, Huang C, Wu Z. Conduits for Right Ventricular Outflow Tract Reconstruction in Infants and Young Children. Front Surg 2021; 8:719840. [PMID: 34631780 PMCID: PMC8492946 DOI: 10.3389/fsurg.2021.719840] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/11/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose of Review: Right ventricular outflow tract (RVOT) reconstruction remains a challenge due to the lack of an ideal conduit. Data and experience are accumulating with each passing day. Therefore, it is necessary to review this topic from time to time. This is a 2021 update review focused on the history, evolution, and current situation of small-sized conduits (≤ 16 mm) for RVOT reconstruction in infants and young children. Recent Findings: Currently, the available small-sized (≤16 mm) conduits can meet most clinical needs. Homograft is still a reliable choice for infants and young children validated by a half-century clinical experience. As an alternative material, bovine jugular vein conduit (BJVC) has at least comparable durability with that of homograft. The performance of expanded polytetrafluoroethylene (ePTFE) is amazing in RVOT position according to limited published data. The past century has witnessed much progress in the materials for RVOT reconstruction. However, lack of growth potential is the dilemma for small-sized conduits. Tissue-engineering based on cell-free scaffolds is the most promising technology to obtain the ideal conduit. Summary: No conduit has proved to have lifelong durability in RVOT position. We are far from the ideal, but we are not in a state of emergency. In-depth clinical research as well as innovation in material science are needed to help improve the durability of the conduits used in infants and young children.
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Affiliation(s)
- Tao Qian
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Haoyong Yuan
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Chunyang Chen
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Yuhong Liu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Ting Lu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Can Huang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Zhongshi Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
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Zhuravleva IY, Karpova EV, Dokuchaeva AA, Kuznetsova EV, Vladimirov SV, Ksenofontov AL, Nichay NR. Bovine jugular vein conduit: What affects its elastomechanical properties and thermostability? J Biomed Mater Res A 2021; 110:394-408. [PMID: 34390309 DOI: 10.1002/jbm.a.37296] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/23/2021] [Accepted: 08/03/2021] [Indexed: 12/12/2022]
Abstract
The aim of this study was to compare the mechanical properties and thermal stability of the venous wall depending on the treatment method used, and, accordingly, on those structural changes in the tissue that this treatment causes. Bovine jugular vein walls (BJVWs) cross-linked with glutaraldehyde (GA), ethylene glycol diglycidyl ether (DE), and Contegra commercial conduit were evaluated using uniaxial stretching [with and without pre-conditioning (PreC)], differential scanning calorimetry, amino acid analysis, and attenuated total reflection infrared spectroscopy. Fresh BJVW was used as a control. It was shown that failure stress in non-PreC GA-treated and DE-treated materials was lower than that in fresh and Contegra counterparts. Contegra samples were the stiffest among the tested materials. Cyclic preloading leads to distortion of the mechanical behavior of this material, which is heterogeneous in composition and structure. The denaturation temperatures (Td ) of all cross-linked BJVWs were higher than the Td of the fresh vein. The microstructures of the tested BJVWs did not exhibit any differences, but the cross-linking density and hydration of the DE-vein were the highest. GA-cross-linking or DE-cross-linking and isopropanol exposure (Contegra) changed the protein secondary structures of the tested materials in different ways. We hypothesized that the protein secondary structure and hydration degree are the main causes of differences in the mechanical properties and thermal stability of BJVW.
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Affiliation(s)
- Irina Yu Zhuravleva
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, Novosibirsk, Russian Federation
| | - Elena V Karpova
- N.N. Vorozhtsov Novosibirsk Institute of Organic Chemistry SB RAS, Novosibirsk, Russian Federation
| | - Anna A Dokuchaeva
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, Novosibirsk, Russian Federation
| | - Elena V Kuznetsova
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, Novosibirsk, Russian Federation
| | - Sergei V Vladimirov
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, Novosibirsk, Russian Federation
| | - Alexander L Ksenofontov
- A. Belozersky Research Institute of Physico-Chemical Biology MSU, Moscow, Russian Federation
| | - Natalia R Nichay
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, Novosibirsk, Russian Federation
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Qian T, Wu ZS, Hu JG, Yang YF, Wu Q, Lu T, Huang C, Li J. Midterm Outcomes of Crosslinked Acellular Bovine Jugular Vein Conduit for Right Ventricular Outflow Tract Reconstruction. Front Pediatr 2021; 9:725030. [PMID: 34485205 PMCID: PMC8416030 DOI: 10.3389/fped.2021.725030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/23/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Conduits for reconstructing right ventricular outflow tract (RVOT) in children with congenital heart disease have evolved for better durability over the past decades, but conduits failure remains common. We designed decellularized and photooxidatively crosslinked bovine jugular vein conduit (DP-BJVC) and now aim to evaluate the midterm results of DP-BJVC for RVOT reconstruction. Methods: Ninety patients (median age: 4.2 years) undergoing RVOT reconstruction using DP-BJVC were prospectively followed for median of 4.7 years (range: 0.2-16.1 years). Kaplan-Meier analysis was used to examine the survival, freedom from conduit explantation and catheter-based reintervention. Risk factors were analyzed with Cox regression analysis. Results: Follow-up was completed in 92% of patients. There were five (5.6%) early deaths. The 10-year survival rate was 85.2%, with palliative procedure at DP-BJVC implantation as the risk factor. The 10-year freedom from conduit explantation and reintervention were 84.4 and 67.3% respectively, with previous cardiac operation as the only risk factor for explantation. Complications during the follow-up included conduit stenosis (peak gradient ≥50 mmHg) in 12 (12.9%), severe regurgitation in 2 (2.4%), and infective endocarditis in 2 (2.4%). The annual increase in gradient was highest in the first year (P = 0.003), but not appreciably afterwards. The echo-measured annulus diameter trends to increase by an average of 0.37 mm per year. Calcification appeared mild in the failed conduits. Conclusions: DP-BJVC provides satisfactory durability and functionality for RVOT reconstruction for children, with low morbidity of stenosis and endocarditis, as well as increase in diameter mildly with age in midterm follow-ups.
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Affiliation(s)
- Tao Qian
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Zhong-Shi Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Jian-Guo Hu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yi-Feng Yang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qin Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ting Lu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Can Huang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Jia Li
- Clinical Physiology Laboratory, Guangzhou Women and Children's Medical Center, Institute of Pediatrics, Guangzhou Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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