Hayashi Hidenori, Contento Jacqueline, Matsushita Hiroshi, Mass Paige, Cleveland Vincent, Aslan Seda, Dave Amartya, Santos Raquel Dos, Zhu Angie, Reid Emmett, Watanabe Tatsuya, Lee Nora, Dunn Tyler, Siddiqi Umar, Nurminsky Katherine, Nguyen Vivian, Kawaji Keigo, Huddle Joey, Pocivavsek Luka, Johnson Jed, Fuge Mark, Loke Yue-Hin, Krieger Axel, Olivieri Laura, Hibino Narutoshi
Division of Cardiac Surgery, Department of Surgery, University of Chicago, Chicago, Ill.
Department of Cardiology, Children's National Hospital, Washington, DC.
JTCVS Open. 2024 Feb 27;18:209-220. doi: 10.1016/j.xjon.2024.02.012. eCollection 2024 Apr.
The complexity of aortic arch reconstruction due to diverse 3-dimensional geometrical abnormalities is a major challenge. This study introduces 3-dimensional printed tissue-engineered vascular grafts, which can fit patient-specific dimensions, optimize hemodynamics, exhibit antithrombotic and anti-infective properties, and accommodate growth.
We procured cardiac magnetic resonance imaging with 4-dimensional flow for native porcine anatomy (n = 10), from which we designed tissue-engineered vascular grafts for the distal aortic arch, 4 weeks before surgery. An optimal shape of the curved vascular graft was designed using computer-aided design informed by computational fluid dynamics analysis. Grafts were manufactured and implanted into the distal aortic arch of porcine models, and postoperative cardiac magnetic resonance imaging data were collected. Pre- and postimplant hemodynamic data and histology were analyzed.
Postoperative magnetic resonance imaging of all pigs with 1:1 ratio of polycaprolactone and poly-L-lactide-co-ε-caprolactone demonstrated no specific dilatation or stenosis of the graft, revealing a positive growth trend in the graft area from the day after surgery to 3 months later, with maintaining a similar shape. The peak wall shear stress of the polycaprolactone/poly-L-lactide-co-ε-caprolactone graft portion did not change significantly between the day after surgery and 3 months later. Immunohistochemistry showed endothelization and smooth muscle layer formation without calcification of the polycaprolactone/poly-L-lactide-co-ε-caprolactone graft.
Our patient-specific polycaprolactone/poly-L-lactide-co-ε-caprolactone tissue-engineered vascular grafts demonstrated optimal anatomical fit maintaining ideal hemodynamics and neotissue formation in a porcine model. This study provides a proof of concept of patient-specific tissue-engineered vascular grafts for aortic arch reconstruction.
由于多种三维几何异常导致的主动脉弓重建复杂性是一项重大挑战。本研究引入了三维打印的组织工程血管移植物，其能够贴合患者特定尺寸，优化血流动力学，展现抗血栓和抗感染特性，并适应生长。
我们获取了10头猪的心脏磁共振成像及四维血流数据以了解其天然解剖结构，术前4周从中设计用于远端主动脉弓的组织工程血管移植物。利用计算流体动力学分析提供信息的计算机辅助设计来设计弯曲血管移植物的最佳形状。制造移植物并将其植入猪模型的远端主动脉弓，收集术后心脏磁共振成像数据。分析植入前后的血流动力学数据和组织学情况。
所有使用聚己内酯与聚-L-丙交酯-共-ε-己内酯比例为1:1的移植物的猪术后磁共振成像显示移植物无特定扩张或狭窄，从术后第二天到3个月后移植物区域呈现正增长趋势，且形状保持相似。聚己内酯/聚-L-丙交酯-共-ε-己内酯移植物部分的峰值壁面剪应力在术后第二天和3个月后之间无显著变化。免疫组织化学显示聚己内酯/聚-L-丙交酯-共-ε-己内酯移植物有内皮化和平滑肌层形成且无钙化。
我们的患者特异性聚己内酯/聚-L-丙交酯-共-ε-己内酯组织工程血管移植物在猪模型中显示出最佳的解剖贴合度，维持了理想的血流动力学和新组织形成。本研究为用于主动脉弓重建的患者特异性组织工程血管移植物提供了概念验证。
