Is Decellularized Porcine Small Intestine Sub-mucosa Patch Suitable for Aortic Arch Repair?

Abstract

Introduction: We reviewed our experience with decellularized porcine small intestine sub-mucosa (DPSIS) patch, recently introduced for congenital heart defects.Materials and Methods: Between 10/2011 and 04/2016 a DPSIS patch was used in 51 patients, median age 1.1 months (5 days to 14.5 years), for aortic arch reconstruction (45/51 = 88.2%) or aortic coarctation repair (6/51 = 11.8%). All medical records were retrospectively reviewed, with primary endpoints interventional procedure (balloon dilatation) or surgery (DPSIS patch replacement) due to patch-related complications.Results: In a median follow-up time of 1.5 ± 1.1 years (0.6–2.3years) in 13/51 patients (25.5%) a re-intervention, percutaneous interventional procedure (5/51 = 9.8%) or re-operation (8/51 = 15.7%) was required because of obstruction in the correspondence of the DPSIS patch used to enlarge the aortic arch/isthmus, with median max velocity flow at Doppler interrogation of 4.0 ± 0.51 m/s. Two patients required surgery after failed interventional cardiology. The mean interval between DPSIS patch implantation and re-intervention (percutaneous procedure or re-operation) was 6 months (1–17 months). While there were 3 hospital deaths (3/51 = 5.9%) not related to the patch implantation, no early or late mortality occurred for the subsequent procedure required for DPSIS patch interventional cardiology or surgery. The median max velocity flow at Doppler interrogation through the aortic arch/isthmus for the patients who did not require interventional procedure or surgery was 1.7 ± 0.57 m/s.Conclusions: High incidence of re-interventions with DPSIS patch for aortic arch and/or coarctation forced us to use alternative materials (homografts and decellularized gluteraldehyde preserved bovine pericardial matrix).

Wharton’s Jelly–Mesenchymal Stem Cell–Engineered Conduit for Pulmonary Artery Reconstruction in Growing Piglets

“…Multiple investigators have reported failures with SIS over the past 10 years, both in preclinical and clinical scenarios. 25 , 26 , 36 , 37 , 38 , 39 , 40 However, several papers have focused on this biomaterial used as a valve leaflet patch and/or in high pressure districts 37 , 40 ; moreover, histologic changes in preclinical studies were mostly assessed on nonseeded grafts. 23 , 24 , 25 , 27 It could be argued that seeded porcine SIS might not exhibit the same behavior observed in this work when implanted in humans as a result of cross-species immune reaction to the graft.…”

Aortic Arch Reconstruction in Infants Using Autologus Pericardium

“…Важливим фактором, що впливає на віддалені результати є кальцифікація з часом будь-яких біологічних матеріалів, які використовують для пластики дуги аорти, в тому числі й аутоперикарда. Проте дослідження показують нижчу здатність аутоперикарда до кальцифікації, ніж в інших біоматеріалів [6]. Ще одним важливим питанням є аневризмоутворення у віддаленому періоді після використання як біологічних, так і синтетичних матеріалів для пластики аорти.…”

Aneurysmal Degeneration of Extracellular Matrix in Arterial Reconstruction

“…Dobrilovic and colleagues [4] reported early catastrophic patch disruption in 2 patients and pseudoaneurysm in 1 patient who had undergone femoral artery endarterectomy and patchplasty with ECM because of peripheral artery disease. Corno and coworkers [5] reported a 25.5% rate of reintervention in 51 patiens who had undergone aortic arch reconstruction or aortic coarctation repair, and the reason for the reintervention was the obstruction in the ECM patch used to enlarge the aortic arch/isthmus.…”