A handsewn pericardial valved pulmonary conduit: pulsatile flow loop in vitro and acute porcine in vivo evaluation

Lisa Carlson Hanse*, Marcell Juan Tjørnild, Zarmiga Karunanithi, Johannes Høgfeldt Jedrzejczyk, Lejla Islamagič, Nynne Emilie Hummelshøj, Malene Enevoldsen, Peter Johansen, Mette Høj Lauridsen, Vibeke Elisabeth Hjortdal

*Corresponding author for this work

Abstract

OBJECTIVES: Right ventricle to pulmonary artery anatomic discontinuity is common in complex congenital heart malformations. Handsewn conduits are a practised method of repair. In a proof-of-concept study, we evaluated pulmonary valve replacement with a handsewn pericardial valved pulmonary conduit in vitro and in vivo.

METHODS: A pulsatile flow-loop model (in vitro) and an acute 60-kg porcine model (in vivo) were used. With echocardiography and pressure catheters, baseline geometry and fluid dynamics were measured. The pulmonary valve was replaced with a handsewn glutaraldehyde-treated pericardial valved pulmonary conduit corresponding to a 21-mm prosthetic valve, after which geometric measurements and fluid dynamics were reassessed.

RESULTS: In vitro, 15 pulmonary trunks at 4 l/min and 13 trunks at 7 l/min, and in vivo, 11 animals were investigated. The valved pulmonary conduit was straightforward to produce at the operating table and easy to suture in place. All valves were clinically sufficient in vitro and in vivo. The mean transvalvular pressure gradient in the native valve and the conduit was 8 mmHg [standard deviation (SD): 2] and 7 mmHg (SD: 2) at 4 l/min in vitro, 19 mmHg (SD: 3) and 17 mmHg (SD: 4) at 7 l/min in vitro and 3 mmHg (SD: 2) and 6 mmHg (SD: 3) in vivo.

CONCLUSIONS: Our proof-of-concept demonstrates no early evidence of structural damage to the conduit, and the fluid dynamic data were acceptable. The handsewn conduit can be produced at the operating table.

Original languageEnglish
Article numberezad143
JournalEuropean journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
Volume63
Issue number4
ISSN1010-7940
DOIs
Publication statusPublished - 3 Apr 2023

Keywords

  • Animals
  • Bioprosthesis
  • Heart Defects, Congenital/surgery
  • Heart Valve Prosthesis
  • Heart Ventricles/diagnostic imaging
  • Pulmonary Artery/diagnostic imaging
  • Pulmonary Valve/diagnostic imaging
  • Pulsatile Flow
  • Swine

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