Manavitehrani Iman, Ebrahimi Pegah, Yang Irene, Daly Sean, Schindeler Aaron, Saxena Akshat, Little David G, Fletcher David F, Dehghani Fariba, Winlaw David S
The Heart Centre for Children, The Children's Hospital at Westmead, Westmead, NSW, 2145, Australia.
Sydney Medical School, The University of Sydney, Sydney, NSW, 2006, Australia.
Cardiovasc Eng Technol. 2019 Jun;10(2):205-215. doi: 10.1007/s13239-019-00406-5. Epub 2019 Feb 14.
Despite advances in modern surgery, congenital heart disease remains a medical challenge and major cause of infant mortality. Valved conduits are routinely used to surgically correct blood flow in hearts with congenital malformations by connecting the right ventricle to the pulmonary artery (RV-PA). This review explores the current range of RV-PA conduits and describes their strengths and disadvantages. Homografts and xenografts are currently the primary treatment modalities, however both graft types have limited biocompatibility and durability, and present a disease transmission risk. Structural deterioration of a replaced valve can lead to pulmonary valve stenosis and/or regurgitation. Moreover, as current RV-PA conduits are of a fixed size, multiple subsequent operations are required to upsize a valved conduit over a patient's lifetime. We assess emerging biomaterials and tissue engineering techniques with a view to replicating the features of native tissues, including matching the durability and elasticity required for normal fluid flow dynamics. The benefits and limitations of incorporating cellular elements within the biomaterial are also discussed. Present review demonstrates that an alignment of medical and engineering disciplines will be ultimately required to produce a biocompatible and high-functioning artificial conduit.
尽管现代外科手术取得了进展，但先天性心脏病仍然是一项医学挑战，也是婴儿死亡的主要原因。带瓣管道通常用于通过将右心室连接到肺动脉（RV-PA）来手术纠正先天性心脏畸形患者的血流。本综述探讨了目前RV-PA管道的种类，并描述了它们的优缺点。同种异体移植物和异种移植物目前是主要的治疗方式，然而这两种移植物类型的生物相容性和耐久性都有限，并且存在疾病传播风险。置换瓣膜的结构恶化可导致肺动脉瓣狭窄和/或反流。此外，由于目前的RV-PA管道尺寸固定，患者一生中需要多次后续手术来扩大带瓣管道的尺寸。我们评估新兴的生物材料和组织工程技术，以期复制天然组织的特性，包括匹配正常流体流动动力学所需的耐久性和弹性。还讨论了在生物材料中加入细胞成分的益处和局限性。本综述表明，最终需要医学和工程学科相结合，以生产出生物相容性好、功能强大的人工管道。
