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Kelleher ST, Regan IE, Cox D, Shaw K, Franklin O, Kenny DP, Walsh KP, McMahon CJ. Aspirin Responsiveness in a Cohort of Pediatric Patients with Right Ventricle to Pulmonary Artery Conduits and Transcatheter Valve Replacement Systems. Pediatr Cardiol 2024:10.1007/s00246-024-03449-1. [PMID: 38489091 DOI: 10.1007/s00246-024-03449-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 02/10/2024] [Indexed: 03/17/2024]
Abstract
The aim of this study was to determine the rate of aspirin responsiveness in a cohort of pediatric patients with in situ xenograft valved right ventricle to pulmonary artery (RV-PA) conduits and/or transcatheter valve replacements (TVR). Aspirin is routinely prescribed to these patients. Optimizing anti-platelet therapy could promote valve longevity and reduce the risk of infective endocarditis in this at-risk group. This was a prospective, observational study. Patients were recruited from both ward and outpatient settings. Patients were eligible if under 18 years and taking aspirin. Non-response to aspirin was defined as > 20% platelet aggregation using light transmission platelet aggregometry (LTA) and < 50% platelet inhibition by thromboelastography with platelet mapping (TEGPM). Participants were invited to provide a confirmatory sample in cases of aspirin resistance and dose adjustments were made. Thirty patients participated. Median age was 9 years (2 months to 18 years). The majority (93%) had complex right ventricular outflow tract pathology. 13 (43%) had an RV-PA conduit and 24 (80%) had a TVR, with valve situated in conduit in 7 (23%) cases. Rate of aspirin non-response on initial testing was 23% (n = 7/30) with median LTA 74.55% (60-76%) and TEG 13.25% (0-44%) in non-responders. Non-responders were more likely to be under 1 year. Two patients required dose increases and one patient non-adherence to dose was identified. Four patients on repeat testing were responsive to aspirin by laboratory tests. The rate of aspirin non-response on laboratory testing in this cohort of patients was 23% and resulted in therapeutic intervention in 10%.
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Affiliation(s)
- Sean T Kelleher
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Irene E Regan
- Department of Coagulation/Haematology, Children's Health Ireland at Crumlin, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
- National Children's Research Centre, Children's Health Ireland, Dublin, Ireland
| | - Dermot Cox
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Kathryn Shaw
- Department of Paediatric Pharmacy, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Orla Franklin
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Damien P Kenny
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Kevin P Walsh
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Colin J McMahon
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland.
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland.
- School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands.
- National Children's Research Centre, Children's Health Ireland, Dublin, Ireland.
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Kubota K, Diller GP, Kempny A, Hoschtitzky A, Imai Y, Kawada M, Shore D, Gatzoulis MA. Surgical pulmonary valve replacement at a tertiary adult congenital heart centre in the current era. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Syedain ZH, Haynie B, Johnson SL, Lahti M, Berry J, Carney JP, Li J, Hill RC, Hansen KC, Thrivikraman G, Bianco R, Tranquillo RT. Pediatric tri-tube valved conduits made from fibroblast-produced extracellular matrix evaluated over 52 weeks in growing lambs. Sci Transl Med 2021; 13:13/585/eabb7225. [PMID: 33731437 DOI: 10.1126/scitranslmed.abb7225] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 12/07/2020] [Accepted: 02/26/2021] [Indexed: 12/18/2022]
Abstract
There is a need for replacement heart valves that can grow with children. We fabricated tubes of fibroblast-derived collagenous matrix that have been shown to regenerate and grow as a pulmonary artery replacement in lambs and implemented a design for a valved conduit consisting of three tubes sewn together. Seven lambs were implanted with tri-tube valved conduits in sequential cohorts and compared to bioprosthetic conduits. Valves implanted into the pulmonary artery of two lambs of the first cohort of four animals functioned with mild regurgitation and systolic pressure drops <10 mmHg up to 52 weeks after implantation, during which the valve diameter increased from 19 mm to a physiologically normal ~25 mm. In a second cohort, the valve design was modified to include an additional tube, creating a sleeve around the tri-tube valve to counteract faster root growth relative to the leaflets. Two valves exhibited trivial-to-mild regurgitation at 52 weeks with similar diameter increases to ~25 mm and systolic pressure drops of <5 mmHg, whereas the third valve showed similar findings until moderate regurgitation was observed at 52 weeks, correlating to hyperincrease in the valve diameter. In all explanted valves, the leaflets contained interstitial cells and an endothelium progressing from the base of the leaflets and remained thin and pliable with sparse, punctate microcalcifications. The tri-tube valves demonstrated reduced calcification and improved hemodynamic function compared to clinically used pediatric bioprosthetic valves tested in the same model. This tri-tube valved conduit has potential for long-term valve growth in children.
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Affiliation(s)
- Zeeshan H Syedain
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | | | - Sandra L Johnson
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | - Matthew Lahti
- Experimental Surgical Services, University of Minnesota, Minneapolis, MN 55455, USA
| | - James Berry
- Experimental Surgical Services, University of Minnesota, Minneapolis, MN 55455, USA
| | - John P Carney
- Experimental Surgical Services, University of Minnesota, Minneapolis, MN 55455, USA
| | - Jirong Li
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | - Ryan C Hill
- Department of Biochemistry and Molecular Genetics, University of Colorado-Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Kirk C Hansen
- Department of Biochemistry and Molecular Genetics, University of Colorado-Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Greeshma Thrivikraman
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | - Richard Bianco
- Experimental Surgical Services, University of Minnesota, Minneapolis, MN 55455, USA
| | - Robert T Tranquillo
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA. .,Department of Chemical Engineering and Materials Science, University of Minnesota, Minneapolis, MN 55455, USA
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Willetts RG, Stickley J, Drury NE, Mehta C, Stumper O, Khan NE, Jones TJ, Barron DJ, Brawn WJ, Botha P. Four right ventricle to pulmonary artery conduit types. J Thorac Cardiovasc Surg 2021; 162:1324-1333.e3. [PMID: 33640135 DOI: 10.1016/j.jtcvs.2020.12.144] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The most durable valved right ventricle to pulmonary artery conduit for the repair of congenital heart defects in patients of different ages, sizes, and anatomic substrate remains uncertain. METHODS We performed a retrospective analysis of 4 common right ventricle to pulmonary artery conduits used in a single institution over 30 years, using univariable and multivariable models of time-to-failure to analyse freedom from conduit dysfunction, reintervention, and replacement. RESULTS Between 1988 and 2018, 959 right ventricle to pulmonary artery conduits were implanted: 333 aortic homografts, 227 pulmonary homografts, 227 composite porcine valve conduits, and 172 bovine jugular vein conduits. Patients weighed 1.6 to 98.3 kg (median 15.3 kg), and median duration of follow-up was 11.4 years, with 505 (52.2%) conduits developing dysfunction, 165 (17.2%) requiring catheter intervention, and 415 (43.2%) being replaced. Greater patient weight, conduit z-score, type and position, as well as catheter intervention were predictors of freedom from replacement. Multivariable analysis demonstrated inferior durability for smaller composite porcine valve conduits, with excellent durability for larger diameter conduits of the same type. Bovine jugular vein conduit longevity was inferior to that of homografts in all but the smallest patients. Freedom from dysfunction at 8 years was 60.7% for aortic homografts, 72% for pulmonary homografts, 51.2% for composite porcine valve conduits, and 41.3% for bovine jugular vein conduits. Judicious oversizing of the conduit improved conduit durability in all patients, but to the greatest extent in patients weighing 5 to 20 kg. CONCLUSIONS Pulmonary and aortic homografts had greater durability than xenograft conduits, particularly in patients weighing 5 to 20 kg. Judicious oversizing was the most significant surgeon-modifiable factor affecting conduit longevity.
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Affiliation(s)
- Robert G Willetts
- Department of Cardiac Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - John Stickley
- Department of Cardiac Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Nigel E Drury
- Department of Cardiac Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Chetan Mehta
- Department of Cardiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Oliver Stumper
- Department of Cardiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Natasha E Khan
- Department of Cardiac Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Timothy J Jones
- Department of Cardiac Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - David J Barron
- Department of Cardiac Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - William J Brawn
- Department of Cardiac Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Phil Botha
- Department of Cardiac Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom.
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Christ T, Paun AC, Grubitzsch H, Holinski S, Falk V, Dushe S. Long-term results after the Ross procedure with the decellularized AutoTissue Matrix P® bioprosthesis used for pulmonary valve replacement. Eur J Cardiothorac Surg 2020; 55:885-892. [PMID: 30508165 DOI: 10.1093/ejcts/ezy377] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/25/2018] [Accepted: 10/04/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Since 1967, the Ross procedure has been performed to treat aortic valve disease using homografts for pulmonary valve replacement. The decellularized Matrix P® prosthesis was developed to overcome (some) limitations of homografts. Until now, the long-term outcome data have been unavailable. METHODS Between 2002 and 2010, the Ross procedures using the Matrix P prosthesis were performed in 492 adult patients (mean age 57.2 ± 10.6 years, range 21-73 years) at our institution. Patient data were prospectively collected and analysed (3617.3 patient-years, mean follow-up 7.7 ± 4.3 years). Completeness of follow-up at 1, 5 and 10 years was 98.4%, 94.5% and 91.0%, respectively. RESULTS Hospital mortality was 3.9% (n = 19). During follow-up, 121 patients died resulting in a survival rate at 5, 10 and 12.5 years of 82.8 ± 1.7%, 70.4 ± 2.3% and 62.4 ± 2.9%, respectively. Echocardiography revealed a high incidence of relevant dysfunction of the Matrix P prosthesis and subsequent right ventricular failure. Primary reoperation/reintervention was necessary for 150 Matrix P and 48 autografts. Freedom from pulmonary valve reoperation at 5, 10 and 12.5 years was 76.2 ± 2.1%, 58.6 ± 2.9% and 53.4 ± 3.4%, respectively. The autograft function and the left ventricular function showed similar results as previously reported with a freedom from autograft reoperation at 5, 10 and 12.5 years of 91.8 ± 1.4%, 86.1 ± 2.0% and 86.1 ± 2.0%, respectively. CONCLUSIONS The Matrix P prosthesis used for the right ventricular outflow tract reconstruction in the Ross procedure showed unfavourable long-term echocardiographic results with a high rate of reoperation/reintervention for structural pulmonary valve failure. As a consequence, long-term survival of this patient cohort was impaired. Based on these findings, the use of the Matrix P prosthesis for pulmonary valve replacement for Ross procedures in adults should not be recommended.
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Affiliation(s)
- Torsten Christ
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alexandru Claudiu Paun
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Herko Grubitzsch
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Holinski
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Simon Dushe
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Zhang HF, Ye M, Yan XG, Chen G, Tao QL, Jia B. Application of a Simplified Hand-Sewn Trileaflet Valved Conduit in Right Ventricular Outflow Tract Reconstruction as an Alternative for Bovine Jugular Vein Graft: Single-Center Experience. Artif Organs 2017; 42:41-48. [PMID: 28971487 DOI: 10.1111/aor.12968] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/11/2017] [Accepted: 04/25/2017] [Indexed: 11/27/2022]
Abstract
The Bovine jugular vein (BJV) graft for right ventricular outflow tract reconstruction (RVOT) is limited applied due to possible graft failure. In this study, we reported the clinical application of simplified hand-sewn trileaflet valved conduit as an alternative for BJV graft. We retrospectively included 68 patients underwent 76 conduits implantation including 22 new simplified hand-sewn trileaflet valved conduits (Group A) and 54 BJV grafts (Group B). For patients in Group A, a hand-sewn trileaflet valved conduit with valves made of autologous pericardium or expanded polytetrafluoroethylene was applied. Baseline, perioperative, and outcomes were analyzed. No early mortality or perioperative complication occurred in Group A, while 2 patients died and 16 patients suffered from conduits failure due to conduits stenosis (n = 11), stenosis plus regurgitation (n = 3), and regurgitation alone (n = 2) in Group B. Freedom from BJV grafts failure within 1, 3, 5, and 7 years was 98.0%, 88.2%, 83.6% and 83.6% in Group A, and 98.0%, 85.8%, 76.8% and 62.1% in Group B. Endocarditis occurred in 9 patients in Group B, but not in Group A. Subsequent analysis showed that endocarditis is the only significant predictor of BJV grafts failure (odds ratio: 6.202, 95% confidence intervals 1.237∼31.108). The novel simplified hand-sewn trileaflet valved conduits seems to be associated with lower incidences of perioperative complication, graft failure, and early-phase mortality, as compared with conventional BJV grafts.
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Affiliation(s)
- Hui-Feng Zhang
- Department of Cardiovascular Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Ming Ye
- Department of Cardiovascular Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Xian-Gang Yan
- Department of Cardiovascular Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Gang Chen
- Department of Cardiovascular Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Qi-Lin Tao
- Department of Cardiovascular Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Bing Jia
- Department of Cardiovascular Surgery, Children's Hospital of Fudan University, Shanghai, China
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Total cavopulmonary connection with a new bioabsorbable vascular graft: First clinical experience. J Thorac Cardiovasc Surg 2017; 153:1542-1550. [DOI: 10.1016/j.jtcvs.2016.11.071] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 11/06/2016] [Accepted: 11/27/2016] [Indexed: 11/24/2022]
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Zhang HF, Chen G, Ye M, Yan XG, Tao QL, Jia B. Mid- to long-term outcomes of bovine jugular vein conduit implantation in Chinese children. J Thorac Dis 2017; 9:1234-1239. [PMID: 28616273 DOI: 10.21037/jtd.2017.05.02] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Bovine jugular vein (BJV) conduits are widely applied for surgical reconstruction of the right ventricular outflow tract (RVOT). However, relevant studies of valve failure rates and the related risk factors are limited in China. The aim of this study was to assess the BJV prognosis after medium- to long-term follow-up. METHODS Fifty-three hospital patients implanted with BJV conduits from January 2002 to December 2013 were recruited. Patient information and follow-up prognosis were reviewed retrospectively. Conduit stenosis and failure as well as endocarditis were diagnosed. RESULTS The total person years was 345.5, and the median follow-up time was 6.3 years. Early mortality occurred in two patients, and there was no late mortality. BJV conduit failure occurred in 15 patients (29.4%) due to severe stenosis (n=10), stenosis plus regurgitation (n=3), and regurgitation alone (n=2). The proportion of patients who were free of BJV conduit failure at 1, 3, 5, and 7 years was 98.0%, 85.8%, 76.8%, and 62.1%, respectively. There were nine cases of endocarditis (17.0%). Multivariate logistic regression analysis showed that endocarditis was a significant risk factor associated with BJV conduit failure (OR: 6.735; 95% CI: 1.348-33.647). CONCLUSIONS The durability of BJV conduits was suboptimal after a mid-term follow-up period. Endocarditis was found to be a significant risk factor that accelerates BJV conduit deterioration.
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Affiliation(s)
- Hui-Feng Zhang
- Cardiovascular Center, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Gang Chen
- Cardiovascular Center, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Ming Ye
- Cardiovascular Center, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Xian-Gang Yan
- Cardiovascular Center, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Qi-Lin Tao
- Cardiovascular Center, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Bing Jia
- Cardiovascular Center, Children's Hospital of Fudan University, Shanghai 201102, China
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¿Funcionan igual las prótesis pulmonares porcinas en menores de edad que en adultos? Una llamada a la prudencia. CIRUGIA CARDIOVASCULAR 2017. [DOI: 10.1016/j.circv.2016.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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10
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Prótesis pulmonar porcina versus yugular bovina para reparar el tracto de salida del ventrículo derecho en menores con cardiopatía congénita. CIRUGIA CARDIOVASCULAR 2017. [DOI: 10.1016/j.circv.2016.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Buchholz C, Mayr A, Purbojo A, Glöckler M, Toka O, Cesnjevar RA, Rüffer A. Performance of stented biological valves for right ventricular outflow tract reconstruction. Interact Cardiovasc Thorac Surg 2016; 23:933-939. [DOI: 10.1093/icvts/ivw264] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/06/2016] [Accepted: 06/22/2016] [Indexed: 11/14/2022] Open
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Cleuziou J, Vitanova K, Kasnar-Samprec J, Hörer J, Lange R, Schreiber C. Durability of down-sized homografts for the reconstruction of the right ventricular outflow tract. Eur J Cardiothorac Surg 2015; 49:1421-5. [PMID: 26613670 DOI: 10.1093/ejcts/ezv418] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 10/08/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Small-sized homografts are rare but may be required for the reconstruction of the right ventricular outflow tract (RVOT). Down-sizing adult-sized homografts can be an option to overcome the shortage of availability. METHODS Since 1994, we have been down-sizing adult-sized homografts by excising one cusp. The aim of the study was to analyse the durability of down-sized homografts and compare it with small-sized homografts in a paediatric population. All patients below a body weight of 14 kg were included in the study. The end-point of the study was homograft failure. RESULTS A total of 152 patients met the inclusion criteria of the study, of which 82 patients (54%) received a down-sized homograft. The median age was 17.1 (0.3-64.8) months and the mean weight 8.4 ± 3.4 kg. Fifty-eight patients (38%) were under 1 year and 10 (6.5%) under 1 month of age at the time of homograft implantation. The mean homograft size of the whole study population was 14.7 ± 2.5 mm and the mean z-score was 1.6 ± 0.9. The median follow-up time was 10 (0.03-19.7) years. Early mortality after homograft implantation was 5% (n = 8), 4 of these patients had received a down-sized homograft. The study population comprised early survivors, that is, 144 patients. During follow-up, a total of 46 homografts failed, 23 in each group, after a mean time of 5.7 ± 4.2 years. Freedom from homograft failure was 94.6 ± 2.6, 87.2 ± 4 and 68.6 ± 6.6% for down-sized homografts and 95.2 ± 2.7, 78.7 ± 5.5 and 61 ± 7% for small-sized homografts at 1, 5 and 10 years, respectively (P = 0.3). Risk factors for homograft failure in the multivariable analysis were a homograft z-score of <1 and age below 1 year at the time of implantation (P = 0.02). CONCLUSION Down-sized homografts demonstrated a durability similar to that of small-sized homografts. Therefore, down-sizing adult-sized homografts by creating a bicuspid valve to fit into the corresponding RVOT in children with congenital heart defects is an excellent method to overcome the shortage of small-sized homografts.
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Affiliation(s)
- Julie Cleuziou
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany
| | - Keti Vitanova
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany
| | - Jelena Kasnar-Samprec
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany
| | - Jürgen Hörer
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany
| | - Christian Schreiber
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany
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Dunne B, Xiao A, Litton E, Andrews D. Mechanical Prostheses for Right Ventricular Outflow Tract Reconstruction: A Systematic Review and Meta-Analysis. Ann Thorac Surg 2015; 99:1841-7. [DOI: 10.1016/j.athoracsur.2014.11.058] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 11/17/2014] [Accepted: 11/24/2014] [Indexed: 11/30/2022]
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14
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Xu Z, Tan Y, Wan J, Wu H, Gong D, Shi Q, Zhou Z, Xu X, Li W. Mosaic tissue-engineered porcine pulmonary artery valved conduit: long-term follow-up after implantation in an ovine model. Interact Cardiovasc Thorac Surg 2014:ivu350. [PMID: 25332185 DOI: 10.1093/icvts/ivu350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To determine the effects of implanting a novel mosaic tissue-engineered porcine pulmonary artery valved conduit into the right ventricular outflow tract of sheep at a long-term follow-up. METHODS The designed mosaic tissue-engineered porcine pulmonary artery valved conduits were implanted between the right ventricular outflow tract and distal pulmonary artery in sheep using the off-pump method. The sheep weight, conduit diameter, pulmonary valve annular diameter, left ventricular end-diastolic diameter, calcification and regurgitation of the pulmonary valve were measured preoperatively and at 6 and 12 months postoperatively. Macroscopic observation, ultrastructural analysis, endothelialization and detection of calcium content were performed after sacrificing the sheep at 12 months after surgery. RESULTS The average sheep weight at 12 months after surgery was significantly higher than that preoperatively (P <0.05), indicating that the sheep continued to grow well. The transplanted conduit showed unobstructed blood flow, soft walls and a smooth inner wall, but no ectasia or stenosis. The valve of the conduit was partially stiff, able to open and close and mild-to-medium regurgitation was present. The conduit diameter, pulmonary valve annular diameter and the left ventricular end-diastolic diameter were each significantly increased (P <0.05). Haematoxylin-eosin staining and scanning electron microscopy revealed regularly arranged cells with slight inflammatory cell infiltration and a clear, fibrous texture. Immunohistochemical staining indicated that endothelial cell marker CD31-positive cells had formed a continuous film-like structure on the inner wall of the conduit. Scattered smooth muscle actin-positive cells were found in the middle layer of the conduit. CONCLUSIONS The mosaic tissue-engineered porcine pulmonary artery valved conduit demonstrated good biocompatibility, did not cause an immune rejection response, contributed to endothelial coverage and has the potential to adapt to the needs of the growth and development of the body.
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Affiliation(s)
- Zhiwei Xu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China Department of Cardiac Surgery, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Yan Tan
- Department of Intensive Care Unit, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Juyi Wan
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hao Wu
- Department of Cardiac Surgery, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Da Gong
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qiuxia Shi
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zifan Zhou
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiufang Xu
- Department of Molecular Biology, Institute of Heart, Lung and Blood Vessel, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wenbin Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Dunn DA, Hodge AJ, Lipke EA. Biomimetic materials design for cardiac tissue regeneration. WILEY INTERDISCIPLINARY REVIEWS-NANOMEDICINE AND NANOBIOTECHNOLOGY 2013; 6:15-39. [DOI: 10.1002/wnan.1241] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 07/10/2013] [Accepted: 07/29/2013] [Indexed: 01/12/2023]
Affiliation(s)
- David A. Dunn
- Department of Chemical Engineering, Auburn University, Auburn, AL, USA
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