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Published on: May 21, 2017
Aortic Compliance After Root Replacement With Decellularized Homografts Versus in Donor Age-Matched Healthy Controls
Tomislav Cvitkovic1, Alexander Horke1, Dmitry Bobylev1
1Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, 30625, Germany.
Insights
Patients receiving decellularized aortic homografts showed reduced ascending aorta compliance compared to healthy controls. Further follow-up is needed to understand long-term effects of these aortic homografts.
Area of Science:
- Cardiovascular Research
- Biomaterials Science
- Medical Imaging
Background:
- Decellularized aortic homografts are used in cardiovascular surgery.
- Understanding their long-term biomechanical properties is crucial.
Purpose of the Study:
- To evaluate the compliance and blood flow of the ascending aorta in patients with decellularized aortic homografts.
- To compare these parameters with age-matched healthy controls.
Main Methods:
- Retrospective electrocardiography-gated cine balanced steady-state free precession magnetic resonance imaging was used.
- Time-resolved phase-contrast sequences assessed relative area change and pulse wave velocity for compliance.
- Maximum blood flow velocity was also determined.
Main Results:
- Patients with decellularized aortic homografts exhibited significantly lower relative area change in the proximal ascending aorta compared to controls (26% vs 38%, p < 0.001).
- Maximum blood flow velocity was significantly higher in the proximal ascending aorta of homograft patients (168 cm/s vs 115 cm/s, p = 0.009).
- No significant difference in compliance was found in the distal ascending aorta.
Conclusions:
- Decellularized aortic homografts are associated with reduced proximal ascending aorta compliance.
- This may be due to the decellularization process or graft degeneration.
- Long-term follow-up data are essential to understand the in vivo effects of these grafts.
Objectives:
We sought to evaluate compliance and flow of the ascending aorta of patients with decellularized aortic homografts compared to donor age-matched healthy controls.
Methods:
Male patients and donor age-matched male healthy controls were included. Cardiac function was evaluated by retrospectively electrocardiography-gated cine balanced steady-state free precession magnetic resonance imaging (MRI). Time-resolved 2- and 3-dimensional phase-contrast sequences were used to determine relative area change and pulse wave velocity as surrogate parameters for vessel compliance as well as maximum blood flow velocity.
Results:
Thirteen patients were matched according to the age of their homograft donor (median 42 years, interquartile range [IQR] 32-50) to 7 healthy controls (median 40 years, IQR 36-48). Time to post-operative MRI was 3.33 (1.33-4.50) years. Relative area change in the proximal ascending aorta was significantly lower in the homograft group compared to healthy controls (26%, IQR 23-44 vs 38%, IQR 24-44, P < .001), with no significant difference observed in the distal ascending aorta (22%, IQR 22-33 vs 34%, IQR 22-41, P = .438). Maximum blood flow velocity in the proximal ascending aorta was significantly higher in the homograft group compared to healthy controls (168 cm s-1, IQR 148-188 vs 115 cm s-1, IQR 114-120, P = .009).
Conclusions:
Decellularized aortic homograft patients seem to have a reduced compliance of the proximal ascending aorta compared to donor age-matched healthy controls. This may be attributable to the in vitro decellularization process or post-operative graft degeneration. These findings highlight the ultimate need for follow-up data to understand the long-term in vivo effects of decellularized human tissue. This study is a follow-up study of the patients included in the ARISE Study registered on ClinicalTrials.gov (NCT02527629). For the purposes of this manuscript, healthy individuals were subsequently recruited to serve as the control group.
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