The fate of the fresh autologous pericardium after right ventricular outflow tract reconstruction

Abstract

Introduction: The autologous pericardium, treated or fresh, is used in reconstructive cardiovascular surgery. We aimed to describe the features of fresh pericardium utilized in right ventricular outflow tract (RVOT) reconstruction, years after the initial surgery. Methods: This cross-sectional study was performed on 72 patients (65.3% male, mean age =18.68 ± 9.63 y) with a history of RVOT reconstruction with the fresh autologous pericardium who underwent reoperation. During the surgery, a 1 × 1 cm sample was cut from the previous pericardial patch, and hematoxylin and eosin (H & E), Masson’s trichrome, and immunohistochemistry (IHC) staining was conducted. All the stained slides were evaluated,and the descriptive results were explained. Results: The mean follow-up duration was 13.48 ± 7.38 years. In preoperative evaluations,53 (73.6%) patients exhibited no RVOT dilatation, 17 (23.6%) showed mild RVOT dilatation,and 2 (2.8%) had RVOT aneurysms. The H & E staining revealed no calcification in 80.55%(58/72), mild calcification in 9.72% (7/72), and moderate calcification in 9.72% (7/72) of the total samples. None of the specimens demonstrated a marked calcification. All the samples were positive for CD31, CD34, smooth muscle alpha-actin, and von Willebrand factor in IHC. In Masson’s trichrome staining, on average, 64.74% (±18.61) of the tissue sections contained collagen fibers. Conclusion: The fresh autologous pericardium, utilized for RVOT reconstruction, showed viability, growth potential, positivity for endothelial cell markers, vascular differentiation,insignificant calcification, and no stenosis at long-term follow-up. We would, therefore, suggest it as a suitable choice for such reconstructive operations. Moreover, its usage during total correction of tetralogy of Fallot could be safe, feasible, and durable.

Patch Materials for Pulmonary Artery Arterioplasty and Right Ventricular Outflow Tract Augmentation: A Review

“…Importantly, the significance of the potential complication of dilatation is not universally agreed upon, and some researchers maintain that the benefits of fresh autologous pericardium outweigh the potential risks [ 23 ]. A recently published study by Tatari et al demonstrated outcomes of fresh autologous pericardium RVOT patches at a mean follow-up interval of 13.48 ± 7.38 years [ 23 ]. Of a 72-patient cohort, 53 (73.6%) showed no RVOT dilatation, 17 (23.6%) showed mild RVOT dilatation, and 2 (2.8%) had RVOT aneurysms [ 23 ].…”

“…A recently published study by Tatari et al demonstrated outcomes of fresh autologous pericardium RVOT patches at a mean follow-up interval of 13.48 ± 7.38 years [ 23 ]. Of a 72-patient cohort, 53 (73.6%) showed no RVOT dilatation, 17 (23.6%) showed mild RVOT dilatation, and 2 (2.8%) had RVOT aneurysms [ 23 ]. In the same study, histologic analysis confirmed the positivity of explanted patches for CD31, CD34, smooth muscle alpha-actin, and von Willebrand factor (VWF) [ 23 ].…”

“…Of a 72-patient cohort, 53 (73.6%) showed no RVOT dilatation, 17 (23.6%) showed mild RVOT dilatation, and 2 (2.8%) had RVOT aneurysms [ 23 ]. In the same study, histologic analysis confirmed the positivity of explanted patches for CD31, CD34, smooth muscle alpha-actin, and von Willebrand factor (VWF) [ 23 ]. In a separate study, Hibino et al showed histologically at three-year post-implant that autologous pericardium used for pulmonary artery arterioplasty differentiates to resemble tissue of the pulmonary artery (Fig.…”

“…3 . Tatari et al evaluated 72 untreated autologous pericardial RVOT patches histologically, finding 7 (9.72%) were mildly calcified and 7 (9.72%) were moderately calcified at a mean follow-up of 13.48 years [ 23 ]. No severe calcification was noted.…”

“…Importantly, fresh autologous pericardium is favored for its ability to grow and differentiate to match its surroundings. Tatari et al present convincing but inconclusive evidence to the superiority of fresh autologous pericardium over glutaraldehyde-fixed pericardium in the setting of RVOT patches [ 23 ]. The findings of growth potential, positive endothelial cell markers, vascular differentiation, and limited calcification all would suggest that fresh autologous pericardium has the potential to remodel and grow with the patient [ 23 ].…”