Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
Eur J Cardiothorac Surg. 2023 Nov 1;64(5). doi: 10.1093/ejcts/ezad366.
Thick-patch pulmonary homograft, autologous pericardium and CardioCel Neo are common patch materials for aortic arch reconstruction. Insufficient data exist on sutured patch strength and limits of use. We evaluated failure strength of these materials to develop a failure prediction model for clinical guidance.
Patch failure strength was evaluated via sutured uniaxial and burst pressure testing. In sutured uniaxial testing, patches were sutured to aortic or Dacron tabs and pulled to failure. In burst pressure testing, patches were sewn into porcine aortas or Dacron grafts and pressurized to failure. Failure membrane tension was calculated. A prediction model of membrane tension versus vessel diameter was generated to guide clinical patch selection.
Combining sutured uniaxial and burst pressure test data, pulmonary homograft failure strength {0.61 [interquartile range (IQR): 0.44, 0.78] N/mm, n = 21} was less than half that of autologous pericardium [2.22 (IQR: 1.65, 2.78) N/mm, n = 15] and CardioCel Neo [1.31 (IQR: 1.20, 1.42) N/mm, n = 20]. Pulmonary homograft burst pressure [245 (IQR: 202, 343) mmHg, n = 7] was significantly lower than autologous pericardium [863 (IQR: 802, 919) mmHg, n = 6] and CardioCel Neo [766 (IQR: 721, 833) mmHg, n = 6]. Our model predicts failure limits for each patch material and outlines safety margins for combinations of aortic diameter and pressure.
Sutured failure strength of thick-patch pulmonary homograft was significantly lower than autologous pericardium and CardioCel Neo. Patient selection (predicted postoperative arch diameter and haemodynamics) and blood pressure management must be considered when choosing patch material for arch reconstruction. In older children and adolescents, autologous or bovine pericardium may be more suitable materials for aortic patch augmentation to minimize the risk of postoperative patch failure.
在主动脉弓重建中，厚补丁肺同种异体移植物、自体心包和 CardioCel Neo 是常用的补丁材料。关于缝合补丁强度和使用限制的数据不足。我们评估了这些材料的失效强度，以建立一个用于临床指导的失效预测模型。
通过缝合的单向和爆裂压力测试评估补丁的失效强度。在缝合的单向测试中，将补丁缝合到主动脉或 Dacron 标签上，并将其拉至失效。在爆裂压力测试中，将补丁缝合到猪主动脉或 Dacron 移植物中，并加压至失效。计算失效膜张力。生成一个膜张力与血管直径的预测模型，以指导临床补丁选择。
结合缝合的单向和爆裂压力测试数据，肺同种异体移植物的失效强度{0.61 [四分位距（IQR）：0.44，0.78] N/mm，n=21}小于自体心包[2.22（IQR：1.65，2.78）N/mm，n=15]和 CardioCel Neo[1.31（IQR：1.20，1.42）N/mm，n=20]的一半。肺同种异体移植物的爆裂压力[245（IQR：202，343）mmHg，n=7]显著低于自体心包[863（IQR：802，919）mmHg，n=6]和 CardioCel Neo[766（IQR：721，833）mmHg，n=6]。我们的模型预测了每种补丁材料的失效极限，并为主动脉直径和压力的组合勾勒出了安全裕度。
厚补丁肺同种异体移植物的缝合失效强度明显低于自体心包和 CardioCel Neo。在选择用于弓重建的补丁材料时，必须考虑患者选择（预测术后弓直径和血液动力学）和血压管理。在年龄较大的儿童和青少年中，自体或牛心包可能是主动脉补丁增强的更合适材料，以最大程度地降低术后补丁失效的风险。
