Abstract
Background: A Phase II Clinical Trial reviewed the performance (morbidity and calcification) of the tissue-engineered ADAPT® bovine pericardial scaffold (CardioCel®) in pediatric patients (n = 30) with congenital cardiac defects. In that study, CardioCel® demonstrated no graft-related morbidity and mortality in 25 patients, over 12 months. Five patients died due to non-graft-related events. Echocardiography revealed hemodynamically stable repairs with no calcification of the scaffold. Magnetic resonance imaging (MRI) at 12 months in 10 patients confirmed the absence of calcification. These patients were followed up for further up to 10 years. We present the results of this retrospective review of these patients that were followed for further medium to long-term (median 7.2 years, 25%: 3.6 years 75%: 9.25 years) postoperatively in these patients.Methods: Between April 2008 and September 2009, CardioCel® was implanted in 30 patients with congenital cardiac defects. Efficacy measures included graft-related mortality, morbidity and haemodynamic abnormalities. Calcification was assessed by standard 2D-M mode echocardiography and MRI at 12 months. Medium to long-term assessment included routine clinical assessments and echocardiography.Results: Median age at surgery was 18 months (27 days−13 years). Twenty-five patients (142 patient years) were followed for up to 10 years. The 10-year survival rate is estimated as 86.9% (95% CI 71.4–100.0%) over the entire follow-up period. One patient was lost to follow-up. No graft-related mortality was encountered up to a median follow-up of 7.2 years. Two patients died (pacemaker complications >5 years and arrhythmia >7 years postoperatively). No graft failure, thromboembolic events, infections or device-related reinterventions were recorded. Non-significant residual leaks occurred in 3 patients. Echocardiography demonstrated the absence of calcification in all implants.Conclusion: The tissue-engineered ADAPT® bovine pericardial scaffold demonstrated excellent medium to long-term performance (up to 10 years) when used as a scaffold for repair of congenital cardiac defects in children. Durability, acellularity, biostability and non-calcifying potential of CardioCel® makes it a very attractive tissue for congenital cardiac repair procedures.
Highlights
Since 1977, a variety of bioprosthetic substitutes have been used for pediatric cardiac repairs such as bovine and porcine pericardium fixed with glutaraldehyde, synthetics such as Dacron R, cryopreserved homografts and autologous pericardium, fresh or treated with glutaraldehyde [1, 2]
Calcification of Dacron and xenogeneic substitutes fix with glutaraldehyde after implantation is well-known while fresh pericardium tends to dilate with resulting aneurysm formation in high pressured areas [3, 4] and shrinkage of extended valve leaflet augmentation [5]
Calcification of the implant was not detected on echocardiography in any patient. In this single-center, retrospective study, we have demonstrated medium to long term durability, efficacy and the absence of calcification of the tissue-engineered ADAPT R bovine pericardial scaffold (CardioCel R ) when used to repair a variety of congenital heart defects in pediatric patients followed for up to 10 years
Summary
Since 1977, a variety of bioprosthetic substitutes have been used for pediatric cardiac repairs such as bovine and porcine pericardium fixed with glutaraldehyde, synthetics such as Dacron R , cryopreserved homografts and autologous pericardium, fresh or treated with glutaraldehyde [1, 2].Some of these materials failed due to intimal hyperplasia, calcification, shrinkage with less pliability, resulting in a compliance mismatch with surrounding native tissue [3].Calcification of Dacron and xenogeneic substitutes fix with glutaraldehyde after implantation is well-known while fresh pericardium tends to dilate with resulting aneurysm formation in high pressured areas [3, 4] and shrinkage of extended valve leaflet augmentation [5].Bovine pericardium fixed with glutaraldehyde tends to degenerate when these implants become rigid due to calcium deposits and develop changes in the structural integrity (shape and size) after implantation which eventually causes failure of these grafts. Since 1977, a variety of bioprosthetic substitutes have been used for pediatric cardiac repairs such as bovine and porcine pericardium fixed with glutaraldehyde, synthetics such as Dacron R , cryopreserved homografts and autologous pericardium, fresh or treated with glutaraldehyde [1, 2]. Some of these materials failed due to intimal hyperplasia, calcification, shrinkage with less pliability, resulting in a compliance mismatch with surrounding native tissue [3]. We present the results of this retrospective review of these patients that were followed for further medium to long-term (median 7.2 years, 25%: 3.6 years 75%: 9.25 years) postoperatively in these patients
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