In Vitro Proof of Concept of a First-Generation Growth-Accommodating Heart Valved Conduit for Pediatric Use.

Autor: Li RL; Department of Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, CHN-274, New York, NY, 10032, USA.; Department of Mechanical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, 220 Mudd Building, 500 W. 120th Street, New York, NY, 10027, USA., Sun M; Department of Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, CHN-274, New York, NY, 10032, USA., Russ JB; Department of Civil Engineering and Engineering Mechanics, Fu Foundation School of Engineering and Applied Science, Columbia University, 610 Mudd Building, 500 W. 120th Street, New York, NY, 10027, USA., Pousse PL; Department of Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, CHN-274, New York, NY, 10032, USA., Kossar AP; Department of Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, CHN-274, New York, NY, 10032, USA., Gibson I; Department of Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, CHN-274, New York, NY, 10032, USA., Paschalides C; Department of Mechanical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, 220 Mudd Building, 500 W. 120th Street, New York, NY, 10027, USA., Herschman AR; Department of Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, CHN-274, New York, NY, 10032, USA.; Department of Mechanical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, 220 Mudd Building, 500 W. 120th Street, New York, NY, 10027, USA., Abyaneh MH; Department of Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, CHN-274, New York, NY, 10032, USA., Ferrari G; Department of Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, CHN-274, New York, NY, 10032, USA., Bacha E; Department of Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, CHN-274, New York, NY, 10032, USA., Waisman H; Department of Civil Engineering and Engineering Mechanics, Fu Foundation School of Engineering and Applied Science, Columbia University, 610 Mudd Building, 500 W. 120th Street, New York, NY, 10027, USA., Vedula V; Department of Mechanical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, 220 Mudd Building, 500 W. 120th Street, New York, NY, 10027, USA., Kysar JW; Department of Mechanical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, 220 Mudd Building, 500 W. 120th Street, New York, NY, 10027, USA.; Department of Otolaryngology-Head and Neck Surgery, Columbia University Medical Center, 3959 Broadway, 5th Floor, New York, NY, 10032, USA., Kalfa D; Department of Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, CHN-274, New York, NY, 10032, USA.
Jazyk: angličtina
Zdroj: Macromolecular bioscience [Macromol Biosci] 2023 Jul; Vol. 23 (7), pp. e2300011. Date of Electronic Publication: 2023 Mar 22.
DOI: 10.1002/mabi.202300011
Abstrakt: Currently available heart valve prostheses have no growth potential, requiring children with heart valve diseases to endure multiple valve replacement surgeries with compounding risks. This study demonstrates the in vitro proof of concept of a biostable polymeric trileaflet valved conduit designed for surgical implantation and subsequent expansion via transcatheter balloon dilation to accommodate the growth of pediatric patients and delay or avoid repeated open-heart surgeries. The valved conduit is formed via dip molding using a polydimethylsiloxane-based polyurethane, a biocompatible material shown here to be capable of permanent stretching under mechanical loading. The valve leaflets are designed with an increased coaptation area to preserve valve competence at expanded diameters. Four 22 mm diameter valved conduits are tested in vitro for hydrodynamics, balloon dilated to new permanent diameters of 23.26 ± 0.38 mm, and then tested again. Upon further dilation, two valved conduits sustain leaflet tears, while the two surviving devices reach final diameters of 24.38 ± 0.19 mm. After each successful dilation, the valved conduits show increased effective orifice areas and decreased transvalvular pressure differentials while maintaining low regurgitation. These results demonstrate concept feasibility and motivate further development of a polymeric balloon-expandable device to replace valves in children and avoid reoperations.
(© 2023 Wiley-VCH GmbH.)
Databáze: MEDLINE
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