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Reinforcing the pulmonary artery autograft in aortic position with a textile mesh: a histological evaluation

Tijdschriftbijdrage - Tijdschriftartikel

Objectives: The Ross procedure involves replacing a patient’s diseased aortic valve with their own pulmonary valve. The most common failure mode is dilatation of the autograft. Various strategies to reinforce the autograft have been proposed. Personalized external aortic root support (PEARS) has been shown to be effective in stabilizing the aortic root in Marfan patients. In this study, the use of a similar external mesh to support a pulmonary artery autograft was evaluated. Methods: The pulmonary artery was translocated as an interposition autograft in the descending thoracic aortas of ten sheep. The autograft was reinforced with a polyethylene terephthalate mesh (n=7) or left unreinforced (n=3). After six months, a CT-scan was taken and the descending aorta was excised and histologically examined using Hematoxylin-eosin and Elastica van Gieson stains. Results: The autograft/aortic diameter ratio was 1.59 in the unreinforced group, but much less in the reinforced group (1.11) (p<0.05). A fibrotic sheet, variable in thickness and containing fibroblasts, neovessels and foreign body giant cells, was incorporated in the mesh. Histological examination of the reinforced autograft and the adjacent aorta revealed thinning of the vessel wall due to atrophy of the smooth muscle cells (SMC). Potential spaces between the vessel wall and the mesh were filled with edema. Conclusions: Reinforcing an interposition pulmonary autograft in the descending aorta with a macroporous mesh showed promising results in limiting autograft dilatation in this sheep model. Histological evaluation revealed atrophy of the SMC, and consequently thinning of the vessel wall within the mesh support.
Tijdschrift: Interactive Cardiovascular and Thoracic Surgery
ISSN: 1569-9293
Issue: 4
Volume: 27
Pagina's: 566 - 573
Jaar van publicatie:2018
BOF-keylabel:ja
IOF-keylabel:ja
BOF-publication weight:1
CSS-citation score:1
Auteurs:International
Authors from:Higher Education
Toegankelijkheid:Closed