Francesco Nappi1, Cristiano Spadaccio2, Pierre Fouret3, Nadjib Hammoudi4, Juan Carlos Chachques5, Massimo Chello6, Christophe Acar7. 1. Cardiac Surgery Centre Cardiologique du Nord de Saint-Denis, Paris, France. Electronic address: francesconappi2@gmail.com. 2. Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom. 3. Department of Pathology, Hôpital de la Salpétrière, Paris, France. 4. Department of Cardiology, Hôpital de la Salpétrière, Paris, France. 5. Laboratory of Biosurgical Research, Carpentier Foundation, Pompidou Hospital, University Paris Descartes, Paris, France. 6. Department of Cardiovascular Surgery, University Campus Bio-Medico of Rome, Rome, Italy. 7. Department of Cardiovascular Surgery, Hôpital de la Salpétrière, Paris, France.
Abstract
OBJECTIVES: To circumvent the issue of pulmonary autograft (PA) dilation after the Ross procedure, surgical reinforcement strategies have been suggested in clinical or anecdotal series. However, no preclinical large-animal model of the Ross procedure is available, which is needed to enable full comprehension of the pathologic mechanisms and the effectiveness of reinforcement techniques during growth. Our aim was to develop a large-animal model of the Ross operation, to reproduce the clinical scenario in which this procedure might be applied, and allow for development and testing of various devices and techniques to improve PA performance. In addition, we aimed to test the effectiveness of a bioresorbable mesh for PA reinforcement. METHODS: An experimental model of transposition of the pulmonary trunk as an autograft in the aortic position has been developed and performed under cardiopulmonary bypass in 20 growing lambs, aged 3 months. The experimental design included: a control group that underwent PA transposition; a group in which the PA was reinforced with an external, synthetic, nonresorbable, polypropylene grid; and a group that received various combinations of resorbable meshes. Animals were followed up during growth for 6 months by angiography and echocardiography and eventually killed for pathologic analysis. RESULTS: All animals survived the procedure with no complications. The model was easy and reproducible. Resorbable meshes prevented PA dilation and preserved its progressive growth process, aiding histologic remodelling. CONCLUSIONS: We developed an easy and reproducible model of the Ross procedure, allowing for a reliable simulation of the clinical scenario. Resorbable PA reinforcement may represent an interesting option in this context.
OBJECTIVES: To circumvent the issue of pulmonary autograft (PA) dilation after the Ross procedure, surgical reinforcement strategies have been suggested in clinical or anecdotal series. However, no preclinical large-animal model of the Ross procedure is available, which is needed to enable full comprehension of the pathologic mechanisms and the effectiveness of reinforcement techniques during growth. Our aim was to develop a large-animal model of the Ross operation, to reproduce the clinical scenario in which this procedure might be applied, and allow for development and testing of various devices and techniques to improve PA performance. In addition, we aimed to test the effectiveness of a bioresorbable mesh for PA reinforcement. METHODS: An experimental model of transposition of the pulmonary trunk as an autograft in the aortic position has been developed and performed under cardiopulmonary bypass in 20 growing lambs, aged 3 months. The experimental design included: a control group that underwent PA transposition; a group in which the PA was reinforced with an external, synthetic, nonresorbable, polypropylene grid; and a group that received various combinations of resorbable meshes. Animals were followed up during growth for 6 months by angiography and echocardiography and eventually killed for pathologic analysis. RESULTS: All animals survived the procedure with no complications. The model was easy and reproducible. Resorbable meshes prevented PA dilation and preserved its progressive growth process, aiding histologic remodelling. CONCLUSIONS: We developed an easy and reproducible model of the Ross procedure, allowing for a reliable simulation of the clinical scenario. Resorbable PA reinforcement may represent an interesting option in this context.
Authors: Francesco Nappi; Sanjeet Singh Avtaar Singh; Mario Lusini; Antonio Nenna; Ivancarmine Gambardella; Massimo Chello Journal: Ann Transl Med Date: 2019-09
Authors: Claudia Cattapan; Mila Della Barbera; Arben Dedja; Piero Pavan; Giovanni Di Salvo; Jolanda Sabatino; Martina Avesani; Massimo Padalino; Alvise Guariento; Cristina Basso; Vladimiro Vida Journal: J Clin Med Date: 2022-06-28 Impact factor: 4.964