Oversized Conduits Predict Stenosis in Tissue Engineered Vascular Grafts

Tissue-engineered vascular grafts (TEVGs) offer promising advancements in treating congenital heart disease by enabling the creation of autologous tissue for complex cardiac repairs. Our approach involves implanting biodegradable scaffolds seeded with autologous cells that remodel into functional neovessels. To understand better the factors guiding neovessel formation, we evaluated 50 ovine thoracic TEVGs using angiography at 1 and 6 weeks postimplantation. Nondimensionalization accounted for anatomical differences between animals and identified hemodynamics and surgical sizing as potential driving factors. Regression analysis revealed that narrowing at the inflow anastomosis and graft oversizing correlated significantly with stenosis development. Computational fluid dynamics showed that these factors influenced wall shear stress and flow patterns, contributing to neovessel narrowing. Comparisons with clinical trial data from Fontan conduits supported these findings, emphasizing that matching graft size to the native inflow vessel can reduce stenosis and enhance TEVG performance.