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The Handmade Composite Absorbable Tube For Pulmonary Artery Autograft Avoid Pa Dilatation In The Ross Procedure. Nappi F, Spadaccio C, Olivito S, Chello M, Fouret P, , Jc.chachquèS And C. Acar
Francesco Nappi.
Centre Cardiologique du Nord, Paris, France.

Objectives: The aim of the study was to develop a resorbable reinforcement of PA tailored to give structural support and to guide the process of wall structure modification for the preservation of graft viability. Methods: An experimental model of translocation of the pulmonary trunk as autograft in aortic position has been developed and performed under cardiopulmonary bypass in young lambs, with the PA left without reinforcement, reinforced with standard commercially available mesh, and reinforced with resorbable mesh of polyglactin and polydioxanone. The PA autograft diameter was measured using transoesophageal echography at J0 and at 6 months and compared to the distal aortic diameter. Pathological analysis of the PA autograft was performed at 6 months. Results were compared to those of a control group with no reinforcement (n=4) and to reinforcement with a non-absorbable mesh (n=3). Results: Animal weight was 27+5 kg at J0 and 55+10 kg at 6 months and the reference aortic diameter increased from 14+1 mm at J0 to 19+2 mm at 6 months. With no reinforcement, an instantaneous PA graft distension (26+2mm) was noted followed by an aneurysmal formation at 6 months (39+3mm). Pathological analysis revealed thinning of the vascular wall with one rupture. In all cases, the media presented with multiple disruptions. In the non-absorbable reinforcement group, the graft diameter remained unchanged and equal to the reference aortic diameter (19+1mm at J0 and 20+1 mm at 6 months), however histology showed in places an endoluminal migration of the mesh cutting through the PA autograft wall. Reinforcement with an absorbable material allowed maintaining the PA graft diameter close to the reference value (18+3 mm at J0). At 6 months, mild PA dilation was noted in all 3 groups: polyglactin+ polydioxanone suture: 29+4mm , 4-layer polyglactin: 28+2mm , and knitted polydioxanone : 27+1mm transoesophageal echography revealed resorption of the mesh with no damage to the media. In the polydioxanone group, both the thickness and the ultrastructure of the PA wall resembled those of the aorta. Conclusion: In the paediatric Ross operation, reinforcement with a knitted polydioxanone mesh allowed subsequent growth while limitating pulmonary artery autograft dilatation.

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