title: Old Myths, New Concerns: the Long-Term Effects of Ascending Aorta Replacement with Dacron Grafts. Not All That Glitters Is Gold.
abstract: Synthetic grafts are widely used in cardiac and vascular surgery since the mid-1970s. Despite their general good performance, inability of mimicking the elastomechanical characteristics of the native arterial tissue, and the consequent lack of adequate compliance, leads to a cascade of hemodynamic and biological alterations deeply affecting cardiovascular homeostasis. Those concerns have been reconsidered in more contemporaneous surgical and experimental reports which also triggered some research efforts in the tissue engineering field towards the realization of biomimetic arterial surrogates. The present review focuses on the significance of the "compliance mismatch" phenomenon occurring after aortic root or ascending aorta replacement with prosthetic grafts and discusses the clinical reflexes of this state of tissue incompatibility, as the loss of the native elastomechanical properties of the aorta can translate into detrimental effects on the normal efficiency of the aortic root complex with impact in the long-term results of patients undergoing aortic replacement.
authors.affiliation: Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Agamemnon Street Clydebank, Glasgow, G81 4DY, UK. cristiano.spadaccio@gjnh.scot.nhs.uk.|College of Medical, Veterinary and Life Sciences, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK. cristiano.spadaccio@gjnh.scot.nhs.uk.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Spadaccio
authors.affiliation: Cardiac Surgery Centre Cardiologique du Nord de Saint-Denis, Paris, France.
authors.forename: Francesco
authors.initials: F
authors.lastname: Nappi
authors.affiliation: Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Agamemnon Street Clydebank, Glasgow, G81 4DY, UK.|College of Medical, Veterinary and Life Sciences, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
authors.forename: Nawwar
authors.initials: N
authors.lastname: Al-Attar
authors.affiliation: Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Agamemnon Street Clydebank, Glasgow, G81 4DY, UK.
authors.forename: Fraser W
authors.initials: FW
authors.lastname: Sutherland
authors.affiliation: Department of Cardiothoracic Surgery, Hôpital Pitié-Salpétrière, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Acar
authors.affiliation: Department of Cardiovascular Sciences|, University Campus Bio-Medico of Rome, Roma, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Nenna
authors.affiliation: CIR-Laboratory of Tissue Engineering, Università Campus Bio-Medico di Roma, Roma, Italy.
authors.forename: Marcella
authors.initials: M
authors.lastname: Trombetta
authors.affiliation: Department of Cardiovascular Sciences|, University Campus Bio-Medico of Rome, Roma, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Chello
authors.affiliation: CIR-Laboratory of Tissue Engineering, Università Campus Bio-Medico di Roma, Roma, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Rainer
mesh_terms: D001011:Aorta / Q000503:physiopathology / Q000601:surgery*; D001696:Biomechanical Phenomena; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006439:Hemodynamics; D006801:Humans; D011093:Polyethylene Terephthalates; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012307:Risk Factors; D013997:Time Factors; D023822:Tissue Engineering; D016896:Treatment Outcome
chemical_list: D011093:Polyethylene Terephthalates
keywords: Aortic compliance; Aortic replacement; Aortic root; Aortic surgery; Complications; Dacron; Hemodynamics; Windkessel