Expandable Valves, Annuloplasty Rings, Shunts, and Bands for Growing Children

Feins, Eric N.; Emani, Sitaram M.

doi:10.1053/j.pcsu.2020.02.002

Cited by 15 publications

(9 citation statements)

References 38 publications

(36 reference statements)

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“…In general, clinical outcomes of RVOT reconstruction identify a younger age at implantation as a significant risk factor in early PPVR failure and reoperation 19 . In addition to the amplified consequences of biofouling in this age group, this observation may be explained by patient outgrowth of the device 12,14,18,26,27,196 . Clinically, this is described as prosthetic‐patient mismatch (PPM), 197 which is generally indicated when the ratio of the valve's effective orifice area (EOA, a measure of the cross‐sectional area open to blood flow during systole) to the patient's body surface area decreases below 0.85 cm 2 /m 2 198,199 .…”

Section: Somatic Outgrowthmentioning

confidence: 99%

“…Additionally, many other valvular heart diseases burden the pediatric and adult populations10,256 and progress toward satisfactory PPVRs could provide a platform to launch innovations in other HVRs. Furthermore, the successful development of antifouling biomaterials could find application in extending the lifespan of various cardiovascular devices such as vascular catheters, stents, ventricular assist devices or extracorporeal membrane oxygenation units,63 while an improved understanding of growth accommodating designs could benefit many other pediatric implants 196,220. Thus, next-generation PPVRs would meet an urgent clinical challenge in the treatment of CHDs, while establishing precedent for the invention of better pediatric and cardiovascular medical technologies.AUTHOR CONTRIBUTIONSMatthew Alexander Crago: Conceptualization (lead); data curation (lead); investigation (lead); visualization (lead); writingoriginal draft (lead).…”

mentioning

confidence: 99%

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Pediatric pulmonary valve replacements: Clinical challenges and emerging technologies

Crago

Winlaw

Farajikhah

et al. 2023

Bioengineering & Transla Med

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Congenital heart diseases (CHDs) frequently impact the right ventricular outflow tract, resulting in a significant incidence of pulmonary valve replacement in the pediatric population. While contemporary pediatric pulmonary valve replacements (PPVRs) allow satisfactory patient survival, their biocompatibility and durability remain suboptimal and repeat operations are commonplace, especially for very young patients. This places enormous physical, financial, and psychological burdens on patients and their parents, highlighting an urgent clinical need for better PPVRs. An important reason for the clinical failure of PPVRs is biofouling, which instigates various adverse biological responses such as thrombosis and infection, promoting research into various antifouling chemistries that may find utility in PPVR materials. Another significant contributor is the inevitability of somatic growth in pediatric patients, causing structural discrepancies between the patient and PPVR, stimulating the development of various growthaccommodating heart valve prototypes. This review offers an interdisciplinary perspective on these challenges by exploring clinical experiences, physiological understandings, and bioengineering technologies that may contribute to device development. It thus aims to provide an insight into the design requirements of next-generation PPVRs to advance clinical outcomes and promote patient quality of life.

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Section: Somatic Outgrowthmentioning

confidence: 99%

mentioning

confidence: 99%

Pediatric pulmonary valve replacements: Clinical challenges and emerging technologies

Crago

Winlaw

Farajikhah

et al. 2023

Bioengineering & Transla Med

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“…The status quo for growing heart valve implants is based on tissue engineering. [4][5][6][7][8] However, all tissue engineered heart valves have failed clinical translation. [6][7][8][9] Partial heart transplantation is a new approach to deliver growing heart valve implants.…”

Section: Introductionmentioning

confidence: 99%

“…The status quo for growing heart valve implants is based on tissue engineering 4‐8 . However, all tissue engineered heart valves have failed clinical translation 6‐9 .…”

Section: Introductionmentioning

confidence: 99%

Partial heart xenotransplantation: A research protocol in non‐human primates

et al. 2023

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Partial heart transplantation is a new type of transplant that delivers growing heart valve replacements for babies. Partial heart transplantation differs from orthotopic heart transplantation because only the part of the heart containing the heart valve is transplanted. It also differs from homograft valve replacement because viability of the graft is preserved by tissue matching, minimizing donor ischemia times, and recipient immunosuppression. This preserves partial heart transplant viability and allows the grafts to fulfill biological functions such as growth and self‐repair. These advantages over conventional heart valve prostheses are balanced by similar disadvantages as other organ transplants, most importantly limitations in donor graft availability. Prodigious progress in xenotransplantation promises to solve this problem by providing an unlimited source of donor grafts. In order to study partial heart xenotransplantation, a suitable large animal model is important. Here we describe our research protocol for partial heart xenotransplantation in nonhuman primates.

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“…Conventional approaches to deliver growing heart valve replacement are based on tissue engineering or mechanical engineering but these approaches have failed in clinical translation (5)(6)(7)(8)(9). This is a critical barrier to progress in the field.…”

Section: Introductionmentioning

confidence: 99%

Cellular Viability of Partial Heart Transplant Grafts in Cold Storage

et al. 2021

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Congenital heart defects are the most common types of birth defects in humans. Children with congenital heart defects frequently require heart valve replacement with an implant. Unfortunately, conventional heart valve implants do not grow. Therefore, these children are committed to serial re-operations for successively larger implant exchanges. Partial heart transplantation is a new and innovative approach to deliver growing heart valve implants. However, the transplant biology of partial heart transplant grafts remains unexplored. This is a critical barrier for clinical translation. Therefore, we investigated the cellular viability of partial heart transplants in cold storage. Histology and immunohistochemistry revealed no morphological differences in heart valves after 6, 24, or 48 h of cold storage. Moreover, immunohistochemistry showed that the marker for apoptosis activated caspase 3 and the marker for cell division Ki67 remained unchanged after 48 h of cold storage. Finally, quantification of fluorescing resorufin showed no statistically significant decrease in cellular metabolic activity in heart valves after 48 h of cold storage. We conclude that partial heart transplants remain viable after 48 h of cold storage. These findings represent the first step toward translating partial heart transplantation from the bench to the bedside because they have direct clinical implications for the procurement logistics of this new type of transplant.

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Expandable Valves, Annuloplasty Rings, Shunts, and Bands for Growing Children

Cited by 15 publications

References 38 publications

Pediatric pulmonary valve replacements: Clinical challenges and emerging technologies

Pediatric pulmonary valve replacements: Clinical challenges and emerging technologies

Partial heart xenotransplantation: A research protocol in non‐human primates

Cellular Viability of Partial Heart Transplant Grafts in Cold Storage

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