Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Takatsuki, Osaka, Japan.
Production Development Section, Fukui Tateami Co., Ltd, Fukui, Japan.
Eur J Cardiothorac Surg. 2018 Aug 1;54(2):318-327. doi: 10.1093/ejcts/ezy045.
Materials used in paediatric cardiac surgery have drawbacks of deterioration, calcification and pseudointimal proliferation resulting in haemodynamic disturbance. The aim of this study was to investigate whether these drawbacks can be overcome by in situ tissue regeneration using a newly developed synthetic hybrid fabric (SHF).
The SHF is an expandable, warp-knitted fabric composed of a combination of biodegradable [poly-l-lactic acid (PLLA)] and non-biodegradable (polyethylene terephthalate) yarns. The fabric is coated with cross-linked gelatin. Mechanical properties of the SHF were compared with those of 2 commercial products: expanded polytetrafluoroethylene sheet and glutaraldehyde-treated bovine pericardium. An oval-shaped defect created in the canine descending aorta or inferior vena cava was filled with the SHF patch. After 2 weeks and 1, 3, 6 and 12 (or 24 in the inferior vena cava) months, the patch was removed for histological examination and evaluation of the remaining PLLA.
The SHF exhibited satisfactory tensile and suture retention strength for surgical implantation similar to or better than the 2 commercial products. Tissue regeneration was induced with multilayered smooth muscle cells and collagen fibres on both sides of the patch, along with a mature endothelial layer and tissue connections containing vasa vasorum across the patch in the aorta and inferior vena cava. Inflammatory reactions were minimal, and no calcium deposition occurred. The molecular weight of PLLA was reduced to half at 12 months after implantation.
The SHF may solve the drawbacks of the existing products. Further studies of the expandability of the SHF patch after degradation of PLLA are warranted.
儿科心脏手术中使用的材料存在恶化、钙化和假内膜增生的缺点，导致血液动力学紊乱。本研究旨在探讨使用新开发的合成混合织物（SHF）是否可以通过原位组织再生来克服这些缺点。
SHF 是一种可扩展的经编织物，由可生物降解的[聚-l-乳酸（PLLA）]和不可生物降解的（聚对苯二甲酸乙二醇酯）纱线组合而成。织物涂有交联明胶。SHF 的机械性能与两种商业产品（膨体聚四氟乙烯片和戊二醛处理的牛心包）进行了比较。在犬降主动脉或下腔静脉上制造出椭圆形缺陷，并用 SHF 补丁填充。在 2 周和 1、3、6 和 12 个月（下腔静脉为 24 个月）后，取出补丁进行组织学检查和剩余 PLLA 的评估。
SHF 表现出令人满意的拉伸和缝合保持强度，适合手术植入，类似于或优于两种商业产品。组织再生在补丁的两侧诱导出多层平滑肌细胞和胶原纤维，以及成熟的内皮层和含有血管腔的组织连接，穿过补丁在主动脉和下腔静脉中。炎症反应轻微，无钙沉积。植入后 12 个月，PLLA 的分子量减少到一半。
SHF 可能解决现有产品的缺点。需要进一步研究 PLLA 降解后 SHF 补丁的可扩展性。
