Use of bioresorbable scaffold for neopulmonary artery in simple transposition of great arteries: Tissue engineering moves steps in pediatric cardiac surgery.
BACKGROUND
Supravalvular pulmonary stenosis (SPS) remains a worrisome complication in the long term of simple transposition of the great arteries. Issues of scar formation and inability to grow are considered at the base of this phenomenon. We pioneered the use of a tissue engineering approach to guide the maturation and the growth of pulmonary autograft in the Ross procedure with encouraging results. We therefore sought to investigate the use of a similar approach in the reconstruction of neopulmonary trunk (NPT) with the aim to recreate a vascular conduit that retains the structural architecture and the same biological potential of native pulmonary artery and prevents long-term SPS.


METHODS
A model of NPT reconstruction in growing lambs was used. NPT was constructed with autologous pericardium and reinforced with a four-layered knitted polydioxanone mesh (PDS n=10) or left unreinforced (control n=10). Animals were left growing for 6 months and angiographic and transesophageal echocardiographic measurements were performed at day 1 and at the end of the study together with histological analysis.


RESULTS
Control group developed SPS while PDS reinforcement allowed a progressive increase in diameter with an optimal size to match the pulmonary artery of healthy growing controls. Histological analysis showed in the control group disruption of endothelial lining with fibrosis, while demonstrated in the PDS group a trilaminar vessel-like structure.


CONCLUSIONS
The bioresorbable reinforcement induced the formation over time of a neopulmonary conduit able to both face the hemodynamic load of the pulmonary system and guarantee a harmonious increase in size during the somatic growth.
Cardiac Surgery Centre Cardiologique du Nord de Saint-Denis, Paris, France. Electronic address: francesconappi2@gmail.com.
Francesco
F
Nappi
Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom.
Cristiano
C
Spadaccio
Department of Structures & Interdisciplinary Research Center of Biomaterials University of Naples "Federico II", Naples, Italy.
Massimiliano
M
Fraldi
Department of Cardiovascular Surgery, Hôpital de la Salpétrière, Paris, France.
Cristophe
C
Acar
D020341:Absorbable Implants; D000818:Animals; D001807:Blood Vessel Prosthesis; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000639:trends; D002648:Child; D004195:Disease Models, Animal; D006801:Humans; D011474:Prosthesis Design; D011651:Pulmonary Artery / Q000601:surgery*; D012756:Sheep; D023822:Tissue Engineering / Q000639:trends*; D054457:Tissue Scaffolds; D014188:Transposition of Great Vessels / Q000601:surgery*
Autologous pericardium; Bioresorbable materials; Neopulmunary trunk; Tissue engineering; Transposition of great vessels