Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA.
Experimental Surgical Services, University of Minnesota, Minneapolis, MN 55455, USA.
Sci Transl Med. 2021 Mar 17;13(585). doi: 10.1126/scitranslmed.abb7225.
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.
需要能够随着儿童生长的替代心脏瓣膜。我们制造了由成纤维细胞衍生的胶原基质制成的管状结构,这些管状结构已被证明可以在羔羊中再生和生长,作为肺动脉替代物,并设计了一种由三个缝合在一起的管组成的带瓣导管。将三管带瓣导管植入 7 只羔羊,与生物瓣导管进行比较。在第一批 4 只动物的前两个队列中,将瓣膜植入肺动脉的两只羔羊的瓣膜功能轻度反流,收缩压下降<10mmHg,直至植入后 52 周,在此期间,瓣膜直径从 19mm 增加到生理正常的25mm。在第二队列中,瓣膜设计进行了修改,增加了一个额外的管,在三管瓣膜周围形成一个套管,以抵消相对于瓣叶更快的根部生长。两个瓣膜在 52 周时表现出微量至轻度反流,直径增加至25mm,收缩压下降<5mmHg,而第三个瓣膜在 52 周时表现出类似的发现,直到观察到中度反流,与瓣膜直径的过度增加相关。在所有取出的瓣膜中,瓣叶含有间质细胞和内皮细胞,从瓣叶底部开始,并保持薄而柔韧,微钙化稀疏且呈点状。与在同一模型中测试的临床使用的儿科生物瓣相比,三管瓣膜显示出减少的钙化和改善的血液动力学功能。这种三管带瓣导管在儿童中具有长期瓣膜生长的潜力。
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