Biofabrication in Congenital Cardiac Surgery: A Plea from the Operating Theatre, Promise from Science

Abstract

Despite significant advances in numerous fields of biofabrication, clinical application of biomaterials combined with bioactive molecules and/or cells largely remains a promise in an individualized patient settings. Three-dimensional (3D) printing and bioprinting evolved as promising techniques used for tissue-engineering, so that several kinds of tissue can now be printed in layers or as defined structures for replacement and/or reconstruction in regenerative medicine and surgery. Besides technological, practical, ethical and legal challenges to solve, there is also a gap between the research labs and the patients’ bedside. Congenital and pediatric cardiac surgery mostly deal with reconstructive patient-scenarios when defects are closed, various segments of the heart are connected, valves are implanted. Currently available biomaterials lack the potential of growth and conduits, valves derange over time surrendering patients to reoperations. Availability of viable, growing biomaterials could cancel reoperations that could entail significant public health benefit and improved quality-of-life. Congenital cardiac surgery is uniquely suited for closing the gap in translational research, rapid application of new techniques, and collaboration between interdisciplinary teams. This article provides a succinct review of the state-of-the art clinical practice and biofabrication strategies used in congenital and pediatric cardiac surgery, and highlights the need and avenues for translational research and collaboration.

Three-Dimensional Virtual and Printed Prototypes in Complex Congenital and Pediatric Cardiac Surgery—A Multidisciplinary Team-Learning Experience

“…Availability of patient-specific, autologous (i.e., non-immunogenic), structurally sound, viable and growing implants could cancel reoperations and could entail improved quality-of-life of the individual patient and relief of a significant public health burden [68]. We believe that clinical/research co-operation in biofabrication and 3D bioprinting-as in our study-holds the promise of realizing these future goals [69,70].…”

Biological Scaffolds for Congenital Heart Disease

“…Acellular scaffolds could be used in their natural structure (i.e., whole hearts [78]), patches (i.e., sections from whole hearts [79]), injectable form (i.e., crosslinked heart-tissuederived ECM gel [80]), 3D bioprinted constructs (i.e., complex, biomimetic 3D bioprinted vascular structures composed of ECM hydrogel sourced from omental tissue [81]) and 3D electrospun scaffolds (i.e., composed of decellularised porcine cardiac tissue blended with poly (ethylene oxide) [16]). Examples of such scaffolds from xenogeneic and allogeneic sources include porcine small intestinal submucosa (SIS), human amniotic membrane (AM), and porcine urinary bladder matrix (UBM), briefly discussed below.…”

“…In addition, CHD patients frequently need multiple open-heart replacements of failing valves and/or conduits, thus being exposed to the risks of additional surgical interventions [16,17]. Not only do complex open-heart surgeries yield high short-term risk for neonates, but, in the paediatric population, additional long-term risks are associated with the inability of the prosthetic material to follow somatic growth, indeed leading to failure and re-operations [16,18,19].…”

A Brief Review on Additive Manufacturing of Polymeric Composites and Nanocomposites

“…As a result, the drive to improve treatment options to address these disadvantages has intensified in recent years. Other research [ 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 ] looked at the effect of the defects on the mechanical efficiency of FRC and subsequently discussed treatment options for removing or minimizing them to improve the functional properties of the fabricated parts. Since FRCs are made up of a polymeric matrix and a short or continuous fiber reinforcement, the analysis will go through the effects of AM parameters such as infill pattern, layer thickness, raster angle, and fiber orientation on both thermoplastic polymers and FRCs printed using FDM technology.…”