title: Compliance mismatch and compressive wall stresses drive anomalous remodelling of pulmonary trunks reinforced with Dacron grafts.
abstract: Synthetic grafts are often satisfactory employed in cardiac and vascular surgery, including expanded poly(ethylene terephthalate) or expanded poly(tetrafluoroethylene). However, accumulating evidences suggest the emergence of worrisome issues concerning the long-term fate of prosthetic grafts as large vessel replacement. Disadvantages related to the use of synthetic grafts can be traced in their inability of mimicking the elasto-mechanical characteristics of the native vascular tissue, local suture overstress leading to several prosthesis-related complications and retrograde deleterious effects on valve competence, cardiac function and perfusion. Motivated by this, in the present work it is analyzed - by means of both elemental biomechanical paradigms and more accurate in silico Finite Element simulations - the physical interaction among aorta, autograft and widely adopted synthetic (Dacron) prostheses utilized in transposition of pulmonary artery, highlighting the crucial role played by somehow unexpected stress fields kindled in the vessel walls and around suture regions, which could be traced as prodromal to the triggering of anomalous remodelling processes and alterations of needed surgical outcomes. Theoretical results are finally compared with histological and surgical data related to a significant experimental animal campaign conducted by performing pulmonary artery transpositions in 30 two-month old growing lambs, followed up during growth for six months. The in vivo observations demonstrate the effectiveness of the proposed biomechanical hypothesis and open the way for possible engineering-guided strategies to support and optimize surgical procedures.
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 Chemical, Materials and Production Engineering of the University of Naples Federico II, Italy.
authors.forename: Angelo Rosario
authors.initials: AR
authors.lastname: Carotenuto
authors.affiliation: Department of Structures for Engineering and Architecture of the University of Naples Federico II, Italy.
authors.forename: Arsenio
authors.initials: A
authors.lastname: Cutolo
authors.affiliation: Department of Pathology, Hôpital de la Salpétriere, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Fouret
authors.affiliation: Department of Cardiovascular Surgery, Hôpital de la Salpétriere, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Acar
authors.affiliation: Laboratory of Biosurgical Research "Carpentier Foundation", Pompidou Hospital, University Paris Descartes, France.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Chachques
authors.affiliation: Department of Structures for Engineering and Architecture and Interdisciplinary Research Center for Biomaterials, University of Napoli Federico II, Italy. Electronic address: fraldi@unina.it.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Fraldi
mesh_terms: D000818:Animals; D001807:Blood Vessel Prosthesis; D003187:Compliance; D011093:Polyethylene Terephthalates / Q000032:analysis*; D011651:Pulmonary Artery / Q000473:pathology*; D012756:Sheep; D013314:Stress, Mechanical; D066253:Vascular Remodeling
chemical_list: D011093:Polyethylene Terephthalates
keywords: Biomechanics; Dacron graft; Pulmonary artery