Hemodynamic performance of tissue-engineered vascular grafts in Fontan patients

Abstract In the field of congenital heart surgery, tissue-engineered vascular grafts (TEVGs) are a promising alternative to traditionally used synthetic grafts. Our group has pioneered the use of TEVGs as a conduit between the inferior vena cava and the pulmonary arteries in the Fontan operation. Th...

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Autores principales:	Erica L. Schwarz, John M. Kelly, Kevin M. Blum, Kan N. Hor, Andrew R. Yates, Jacob C. Zbinden, Aekaansh Verma, Stephanie E. Lindsey, Abhay B. Ramachandra, Jason M. Szafron, Jay D. Humphrey, Toshiharu Shin’oka, Alison L. Marsden, Christopher K. Breuer
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/f6b80589f56f438bab2b69bc93a66f5a
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spelling	oai:doaj.org-article:f6b80589f56f438bab2b69bc93a66f5a2021-12-02T16:43:45ZHemodynamic performance of tissue-engineered vascular grafts in Fontan patients10.1038/s41536-021-00148-w2057-3995https://doaj.org/article/f6b80589f56f438bab2b69bc93a66f5a2021-07-01T00:00:00Zhttps://doi.org/10.1038/s41536-021-00148-whttps://doaj.org/toc/2057-3995Abstract In the field of congenital heart surgery, tissue-engineered vascular grafts (TEVGs) are a promising alternative to traditionally used synthetic grafts. Our group has pioneered the use of TEVGs as a conduit between the inferior vena cava and the pulmonary arteries in the Fontan operation. The natural history of graft remodeling and its effect on hemodynamic performance has not been well characterized. In this study, we provide a detailed analysis of the first U.S. clinical trial evaluating TEVGs in the treatment of congenital heart disease. We show two distinct phases of graft remodeling: an early phase distinguished by rapid changes in graft geometry and a second phase of sustained growth and decreased graft stiffness. Using clinically informed and patient-specific computational fluid dynamics (CFD) simulations, we demonstrate how changes to TEVG geometry, thickness, and stiffness affect patient hemodynamics. We show that metrics of patient hemodynamics remain within normal ranges despite clinically observed levels of graft narrowing. These insights strengthen the continued clinical evaluation of this technology while supporting recent indications that reversible graft narrowing can be well tolerated, thus suggesting caution before intervening clinically.Erica L. SchwarzJohn M. KellyKevin M. BlumKan N. HorAndrew R. YatesJacob C. ZbindenAekaansh VermaStephanie E. LindseyAbhay B. RamachandraJason M. SzafronJay D. HumphreyToshiharu Shin’okaAlison L. MarsdenChristopher K. BreuerNature PortfolioarticleMedicineRENnpj Regenerative Medicine, Vol 6, Iss 1, Pp 1-17 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Erica L. Schwarz John M. Kelly Kevin M. Blum Kan N. Hor Andrew R. Yates Jacob C. Zbinden Aekaansh Verma Stephanie E. Lindsey Abhay B. Ramachandra Jason M. Szafron Jay D. Humphrey Toshiharu Shin’oka Alison L. Marsden Christopher K. Breuer Hemodynamic performance of tissue-engineered vascular grafts in Fontan patients
description	Abstract In the field of congenital heart surgery, tissue-engineered vascular grafts (TEVGs) are a promising alternative to traditionally used synthetic grafts. Our group has pioneered the use of TEVGs as a conduit between the inferior vena cava and the pulmonary arteries in the Fontan operation. The natural history of graft remodeling and its effect on hemodynamic performance has not been well characterized. In this study, we provide a detailed analysis of the first U.S. clinical trial evaluating TEVGs in the treatment of congenital heart disease. We show two distinct phases of graft remodeling: an early phase distinguished by rapid changes in graft geometry and a second phase of sustained growth and decreased graft stiffness. Using clinically informed and patient-specific computational fluid dynamics (CFD) simulations, we demonstrate how changes to TEVG geometry, thickness, and stiffness affect patient hemodynamics. We show that metrics of patient hemodynamics remain within normal ranges despite clinically observed levels of graft narrowing. These insights strengthen the continued clinical evaluation of this technology while supporting recent indications that reversible graft narrowing can be well tolerated, thus suggesting caution before intervening clinically.
format	article
author	Erica L. Schwarz John M. Kelly Kevin M. Blum Kan N. Hor Andrew R. Yates Jacob C. Zbinden Aekaansh Verma Stephanie E. Lindsey Abhay B. Ramachandra Jason M. Szafron Jay D. Humphrey Toshiharu Shin’oka Alison L. Marsden Christopher K. Breuer
author_facet	Erica L. Schwarz John M. Kelly Kevin M. Blum Kan N. Hor Andrew R. Yates Jacob C. Zbinden Aekaansh Verma Stephanie E. Lindsey Abhay B. Ramachandra Jason M. Szafron Jay D. Humphrey Toshiharu Shin’oka Alison L. Marsden Christopher K. Breuer
author_sort	Erica L. Schwarz
title	Hemodynamic performance of tissue-engineered vascular grafts in Fontan patients
title_short	Hemodynamic performance of tissue-engineered vascular grafts in Fontan patients
title_full	Hemodynamic performance of tissue-engineered vascular grafts in Fontan patients
title_fullStr	Hemodynamic performance of tissue-engineered vascular grafts in Fontan patients
title_full_unstemmed	Hemodynamic performance of tissue-engineered vascular grafts in Fontan patients
title_sort	hemodynamic performance of tissue-engineered vascular grafts in fontan patients
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/f6b80589f56f438bab2b69bc93a66f5a
work_keys_str_mv	AT ericalschwarz hemodynamicperformanceoftissueengineeredvasculargraftsinfontanpatients AT johnmkelly hemodynamicperformanceoftissueengineeredvasculargraftsinfontanpatients AT kevinmblum hemodynamicperformanceoftissueengineeredvasculargraftsinfontanpatients AT kannhor hemodynamicperformanceoftissueengineeredvasculargraftsinfontanpatients AT andrewryates hemodynamicperformanceoftissueengineeredvasculargraftsinfontanpatients AT jacobczbinden hemodynamicperformanceoftissueengineeredvasculargraftsinfontanpatients AT aekaanshverma hemodynamicperformanceoftissueengineeredvasculargraftsinfontanpatients AT stephanieelindsey hemodynamicperformanceoftissueengineeredvasculargraftsinfontanpatients AT abhaybramachandra hemodynamicperformanceoftissueengineeredvasculargraftsinfontanpatients AT jasonmszafron hemodynamicperformanceoftissueengineeredvasculargraftsinfontanpatients AT jaydhumphrey hemodynamicperformanceoftissueengineeredvasculargraftsinfontanpatients AT toshiharushinoka hemodynamicperformanceoftissueengineeredvasculargraftsinfontanpatients AT alisonlmarsden hemodynamicperformanceoftissueengineeredvasculargraftsinfontanpatients AT christopherkbreuer hemodynamicperformanceoftissueengineeredvasculargraftsinfontanpatients
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Hemodynamic performance of tissue-engineered vascular grafts in Fontan patients

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