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      Hemodynamic performance of tissue-engineered vascular grafts in Fontan patients

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          Abstract

          In the field of congenital heart surgery, tissue-engineered vascular grafts (TEVGs) are a promising alternative to traditionally used synthetic grafts. Our group has pioneered the use of TEVGs as a conduit between the inferior vena cava and the pulmonary arteries in the Fontan operation. The natural history of graft remodeling and its effect on hemodynamic performance has not been well characterized. In this study, we provide a detailed analysis of the first U.S. clinical trial evaluating TEVGs in the treatment of congenital heart disease. We show two distinct phases of graft remodeling: an early phase distinguished by rapid changes in graft geometry and a second phase of sustained growth and decreased graft stiffness. Using clinically informed and patient-specific computational fluid dynamics (CFD) simulations, we demonstrate how changes to TEVG geometry, thickness, and stiffness affect patient hemodynamics. We show that metrics of patient hemodynamics remain within normal ranges despite clinically observed levels of graft narrowing. These insights strengthen the continued clinical evaluation of this technology while supporting recent indications that reversible graft narrowing can be well tolerated, thus suggesting caution before intervening clinically.

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          Most cited references60

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          Tissue engineering: the design and fabrication of living replacement devices for surgical reconstruction and transplantation

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            Evaluation and Management of the Child and Adult With Fontan Circulation: A Scientific Statement From the American Heart Association

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              A CONSTRAINED MIXTURE MODEL FOR GROWTH AND REMODELING OF SOFT TISSUES

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                Author and article information

                Contributors
                schwarze@stanford.edu
                Journal
                NPJ Regen Med
                NPJ Regen Med
                NPJ Regenerative Medicine
                Nature Publishing Group UK (London )
                2057-3995
                22 July 2021
                22 July 2021
                2021
                : 6
                : 38
                Affiliations
                [1 ]GRID grid.168010.e, ISNI 0000000419368956, Department of Bioengineering, , Stanford University, ; Stanford, CA USA
                [2 ]GRID grid.240344.5, ISNI 0000 0004 0392 3476, Center for Regenerative Medicine, , Abigail Wexner Research Institute at Nationwide Children’s Hospital, ; Columbus, OH USA
                [3 ]GRID grid.240344.5, ISNI 0000 0004 0392 3476, The Heart Center, , Nationwide Children’s Hospital, ; Columbus, OH USA
                [4 ]GRID grid.261331.4, ISNI 0000 0001 2285 7943, Department of Biomedical Engineering, , The Ohio State University, ; Columbus, OH USA
                [5 ]GRID grid.261331.4, ISNI 0000 0001 2285 7943, Department of Pediatrics, , The Ohio State University College of Medicine, ; Columbus, OH USA
                [6 ]GRID grid.168010.e, ISNI 0000000419368956, Department of Pediatrics, , Stanford University, ; Stanford, CA USA
                [7 ]GRID grid.47100.32, ISNI 0000000419368710, Department of Biomedical Engineering, , Yale University, ; New Haven, CT USA
                [8 ]GRID grid.240344.5, ISNI 0000 0004 0392 3476, Department of Cardiothoracic Surgery, , Nationwide Children’s Hospital, ; Columbus, OH USA
                [9 ]GRID grid.412332.5, ISNI 0000 0001 1545 0811, Department of Surgery, , The Ohio State University Wexner Medical Center, ; Columbus, OH USA
                [10 ]GRID grid.240344.5, ISNI 0000 0004 0392 3476, Department of Surgery, , Nationwide Children’s Hospital, ; Columbus, OH USA
                Author information
                http://orcid.org/0000-0003-3219-6653
                http://orcid.org/0000-0002-5865-5347
                http://orcid.org/0000-0002-8346-629X
                http://orcid.org/0000-0003-2860-6808
                http://orcid.org/0000-0002-4784-5647
                http://orcid.org/0000-0003-1011-2025
                http://orcid.org/0000-0002-5173-9249
                Article
                148
                10.1038/s41536-021-00148-w
                8298568
                34294733
                aa61d7da-0b67-4e36-93d5-ec90c8ccecbb
                © The Author(s) 2021

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 22 October 2020
                : 11 June 2021
                Funding
                Funded by: FundRef https://doi.org/10.13039/100007520, Nationwide Children’s Hospital (Nationwide Children’s);
                Funded by: Nationwide Children’s Hospital (Nationwide Children’s)
                Funded by: Nationwide Children’s Hospital (Nationwide Children’s)
                Funded by: FundRef https://doi.org/10.13039/100005492, Stanford University (SU);
                Funded by: FundRef https://doi.org/10.13039/100005326, Yale University (Yale);
                Categories
                Article
                Custom metadata
                © The Author(s) 2021

                tissue engineering,circulation,translational research

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