New Technologies for Surgery of the Congenital Cardiac Defect

David Kalfa,Emile Bacha

doi:10.5041/rmmj.10119

Abstract

The surgical repair of complex congenital heart defects frequently requires additional tissue in various forms, such as patches, conduits, and valves. These devices often require replacement over a patient’s lifetime because of degeneration, calcification, or lack of growth. The main new technologies in congenital cardiac surgery aim at, on the one hand, avoiding such reoperations and, on the other hand, improving long-term outcomes of devices used to repair or replace diseased structural malformations. These technologies are: 1) new patches: CorMatrix® patches made of decellularized porcine small intestinal submucosa extracellular matrix; 2) new devices: the Melody® valve (for percutaneous pulmonary valve implantation) and tissue-engineered valved conduits (either decellularized scaffolds or polymeric scaffolds); and 3) new emerging fields, such as antenatal corrective cardiac surgery or robotically assisted congenital cardiac surgical procedures. These new technologies for structural malformation surgery are still in their infancy but certainly present great promise for the future. But the translation of these emerging technologies to routine health care and public health policy will also largely depend on economic considerations, value judgments, and political factors.

Highlights

Congenital cardiac surgery frequently requires additional tissue such as patches, conduits, and valves
Despite improvements in congenital heart surgery procedural mortality, there remain a substantial number of patients who need multiple reinterventions,[1] because of the lack of growth potential and remodeling of currently used patches (autologous pericardium, preserved xenopericardium, and various prosthetic materials)
This new biomaterial seems to provide an interim bioscaffold that enables the patient’s own cells to repopulate and repair damaged tissues, which is of particular interest in patients with congenital heart diseases, for valve repair, and vascular reconstruction

Summary

INTRODUCTION

Congenital cardiac surgery frequently requires additional tissue such as patches, conduits, and valves. The CorMatrix® ECM displays a lot of potential advantages over other materials currently used in pediatric cardiac surgery, as follows: This new biomaterial seems to provide an interim bioscaffold that enables the patient’s own cells to repopulate and repair damaged tissues, which is of particular interest in patients with congenital heart diseases, for valve repair, and vascular reconstruction. The right ventricle (RV) to main pulmonary artery (PA) conduits that are used to reconstruct the right ventricular outflow tract in congenital heart diseases are prone to develop valvular incompetence and/or obstruction with time These pejorative evolutions are associated with exercise intolerance, arrhythmias, and an increased risk of sudden death[9] and require multiple open-heart surgeries to replace the pulmonary valve. 19% at 5 years, 68% at 10 years, 95%–100% at 15 years, depending on the diameter, age at surgery, and heart defect

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CONCLUSION