脱細胞同種移植片による大動脈基部置換後の大動脈コンプライアンスと健常対照群との比較

We sought to evaluate compliance and flow of the ascending aorta of patients with decellularized aortic homografts compared to donor age-matched healthy controls.

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. Time-resolved two- and three-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.

13 patients were matched according to the age of their homograft donor (median 42 years, IQR 32-50) to 7 healthy controls (median 40 years, IQR 36-48). Time to postoperative magnetic resonance imaging 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 < 0.001), with no significant difference observed in the distal ascending aorta (22%, IQR 22-33 vs 34%, IQR 22-41, p = 0.438). Maximum blood flow velocity in the proximal ascending aorta was significantly higher in the homograft group compared to healthy controls (168 cm/s, IQR 148-188 vs 115 cm/s, IQR 114-120, p = 0.009).

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 postoperative 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 registred on ClinicalTrials.gov (NCT02527629). For the purposes of this manuscript, healthy individuals were subsequently recruited to serve as the control group.