Patch Repair Research Articles (Page 1)

Introduction/Background: Sinus of Valsalva aneurysms are very rare congenital heart disease. Most cases of ruptured sinus of Valsalva aneurysms (RSVA) are associated with other congenital defects. We present a case of Sinus of valsalva aneurysm (SoVA) rupture with underlying supracristal VSD (sVSD). Case Presentation: A 27-year-old male with a past medical history significant for a VSD (diagnosed at childhood but lost to follow up at 18 years of age) who was admitted to the intensive care unit for management of undifferentiated shock, acute renal failure and acute liver failure. Upon initial evaluation, vital signs showed blood pressure of 130/34 mmHg, heart rate 118 bpm, SpO2 100% on 3L NC. An emergent transthoracic echocardiogram with color doppler showed unrestricted left to right flow from the RSoV to RVOT in systole and diastole with concern for ruptured SoV aneurysm. A non-contrast CT scan of the chest also showed a dilated pulmonary trunk with a connection between the SoV and RVOT. Patient underwent primary closure of the VSD, as well as a patch repair of a large fistula between R sinus of Valsalva and RVOT. Patient steadily improved with normalization of renal function and hepatic function. Discussion: Aneurysm of the sinus of Valsalva (SoV) is a rare acquired or congenital anomaly predominantly affecting the right and the noncoronary sinuses, with an estimated prevalence of 0.09% of the population. Most sinus of Valsalva aneurysms arise from the right or the noncoronary sinuses. The most common site of rupture of SOV aneurysm is into the right ventricle followed by right atrium, left ventricle, and the left atrium. Hemodynamically, the flow through VSD produces Venturi effect “windsock effect. This left to right shunt caused by the supracristal VSD weakens the elastic lamina of the aortic sinus creating the SOV aneurysm. Overtime due to continuous negative pressure a SOVA develops on the right aortic root, which can rupture into the right ventricular outflow tract as seen in our case. Conclusion: Sinus of Valsalva aneurysm rupture is a rare but potentially fatal complication and should be considered on the differential in a young individual with underlying sVSD presenting with hemodynamic collapse.

Backround: Aortic pseudoaneurysm (PSA) is a rare but life-threatening vascular complication of cardiac surgeries, trauma, and infective endocarditis (IE). It is associated with a high risk of rupture, fistulation, thrombosis, embolization, and erosion into surrounding structures. Surgical treatment remains the standard treatment for aortic PSAs. However, cases with high surgical risk may need alternative options. Case: A man in his mid-70s with a complex cardiovascular history including coronary artery bypass grafting in 2020, treated aortic valve endocarditis in July 2024, and prior surgical patch repair of an aortic root PSA in September 2024, presented to the emergency department with 3 days of epigastric pain radiating to the back with nausea and mild dyspnea. Initial workup ruled out acute coronary syndrome, and CT angiography (CTA) revealed a focal type B aortic dissection and a persistent aortic root PSA measuring 1.5 x 2.2 cm, reduced from 3.0 x 4.6 cm before the patient’s previous surgery. Transesophageal echocardiography (TEE) showed an orifice adjacent to the right coronary cusp. Given the high surgical risk, the multidisciplinary heart team recommended a transfemoral transcatheter approach. The PSA was successfully excluded using an Amplatzer Duct Occluder II device deployed across the neck of the aneurysm, and a Papyrus-covered stent was deployed in the RCA, ensuring complete sealing. The patient had been preloaded with dual antiplatelet therapy (DAPT). The procedure was completed without complication, and the patient remained hemodynamically stable post-operatively. He was discharged on maintenance DAPT, and his post-procedure CT scan after 2 weeks showed exclusion of PSA. Discussion: Management of aortic PSAs is a challenging scenario with high mortality rates with sole medical therapy. Therefore, surgical intervention remains the mainstay of therapy. However, in the setting of high surgical risk, transcatheter approaches have emerged as a viable alternative option. In our case, a novel dual device transcatheter closure technique using a duct occluder, complemented by a covered stent, proved effective in allowing safe exclusion of the PSA while preserving right coronary flow. However, transcatheter closure is not free of potential complications like residual leaks, device migration, incomplete exclusion of the sac, or damage to surrounding structures such as the coronary ostia, and thus, warrants long-term imaging and follow-up in such cases.

Background: Advancements in congenital heart disease management have led to an increasing adult population with repaired Tetralogy of Fallot (rTOF). Serial imaging of Right Ventricle (RV) size and function have been proposed to guide decisions regarding pulmonary valve replacement (PVR). However, longitudinal data on RV volume changes in this cohort remain sparse. Thus, the optimal timing of surveillance cardiac MRI (CMR) studies in this population remains unknown. Objective: To evaluate serial changes in right ventricular end-diastolic volume index (RVEDVi) in patients with repaired TOF and identify factors contributing to progressive RV dilation over time. Methods: We performed a single-center, retrospective cohort study of 45 patients with rTOF who underwent at least two CMR between 2005 and 2023 at Montefiore Medical Center. All RV volumetric measurements were reassessed by a single observer for consistency. Change in RVEDVi was analyzed, and the associations between RV dilation, pulmonary regurgitation (PR), tricuspid regurgitation (TR), right ventricular ejection fraction (RVEF) and surgical approach were assessed. Results: The cohort included 45 patients (median age at surgery: 13 months, interquartile range [IQR]: 7–49). Of these, 78% had TOF with pulmonary stenosis, and 67% underwent transannular patch repair (Table 1). Serial CMRs revealed considerable variability in RVEDVi, with a general trend toward RV dilation (Figure 1a). Notably, 29% (95% confidence interval [CI] : 17%, 45%) demonstrated a >15% increase in RVEDVi (Figure 1b), with a median time to this change of 29.3 years from surgery (Figure 2) or 5.5 years between two CMR assessments. Of the patients with significant RV dilation, 12 were female. Interestingly, neither the type of surgery, PR fraction, RVEF nor residual outflow obstruction were significantly associated with the degree of RV dilation. Conclusion: Longitudinal CMR analysis of rTOF patients reveals heterogeneous RV remodeling with only 29% of patients showing clinically significant progression of RV dilation over 5.5 years from first CMR assessment. These findings suggest that while RV progression occurs, the majority of patients will have no clinically significant change in RVEDVi over 5.5 years’ time. Robustly assessing change over time, identifying specific risk factors for RV dilation and refining surveillance intervals through multicenter studies could enable more personalized MRI monitoring strategies.

Highly tough and conformal silk-based adhesive patches for sutureless repair of gastrointestinal and peripheral nerve defects.

BackgroundThis study aimed to compare preperitoneal ventral mesh patch with barbed suture in ventral hernia repair, evaluating recurrence rates and complications, and to assess the safety of preperitoneal patch placement.MethodsIn this randomized clinical trial, adult patients undergoing ventral hernia repair at Karlskoga Hospital between 2020 and 2023 were randomized 1 : 1 to either a ventral mesh patch repair group or a non-absorbable barbed suture repair group, blinded to patients and outcome assessors. The primary outcome was recurrence detected at clinical examination and CT verification 1 year after surgery. Pain (measured on a visual analogue scale and using the Ventral Hernia Pain Questionnaire), nausea, and surgical site events (including wound infection, haematoma and seroma) were assessed 4 h, 1 week, 1 month, and 4 years after operation.ResultsOf 256 eligible patients, 209 were screened, and 205 were randomized to ventral mesh patch repair (103) or barbed suture repair (102). The hernia recurrence rate at 1 year was lower in the ventral patch repair group (1.9 versus 5.9%), although this was not statistically significant (P = 0.14). The surgical site infection rate at 1 month was significantly lower in the ventral patch group (0.9 versus 6.9%; P = 0.02). At 1 month, the ventral patch repair group had higher ‘pain right now’ scores on the Ventral Hernia Pain Questionnaire (P = 0.02), although this difference had disappeared by 1 year.ConclusionPreperitoneal ventral hernia patch repair is a safe and effective technique with a recurrence rate not statistically significant from that after barbed suture repair. Although postoperative pain scores at 1 month were higher after ventral patch repair, this difference had disappeared by 1 year.

Poly(glycerol sebacate) (PGS) is promising for engineering flexible cardiac patches for myocardial infarction repair due to its unique elasticity. However, its insulating nature and complex thermal curing process hinder existing 3D printing techniques from producing patches that recapitulate the mechanical, electrical, and anatomical features of native myocardium. Here, a melt-based embedded printing strategy enabling direct, freeform fabrication of thermosetting PGS architectures with in situ thermal curing is proposed. The viscoelastic matrix enables high-fidelity extrusion of PGS prepolymer into microscale filaments while providing temporary support for in situ curing of PGS elastomeric architectures with seamless interface fusion and mechanical stability. This platform further allows direct printing of electro-conductive cardiac patches using carbon nanotube-incorporated PGS that mimic ventricular curvature and mechanical anisotropy. Compared to pure PGS controls, the electro-conductive patches enhance cardiomyocyte maturation in vitro, evidenced by improved sarcomere organization, calcium handling, and electrical synchronization. In vivo, these acellular patches improve mechanical integration with host myocardium, promote vascularization, reduce inflammation, and preserve cardiomyocyte survival, collectively maintaining ejection fraction and attenuating adverse remodeling. This work, therefore, establishes a generalizable manufacturing strategy for printing thermosetting elastomeric constructs with integrated conductivity as acellular, mechanically and electrically functional patches for structural cardiac repair.

This paper investigates the influence of two proprietary redispersible polymers, i.e. Ethylene Vinyl Acetate (EVA) and Styrene Acrylate (SA) - at varying contents of 10%, 15% and 20% by mass of cement - on cracking and crack-determining material properties in non-structural concrete patch repair mortars. Five mortar mixes, one control mix and four polymer-modified mixes, were designed, developed and tested under a controlled laboratory environment. The effects of polymer type and content on macroporosity, the age at cracking and crack widths in restrained shrinkage specimens, compressive strength, direct tensile strength, elastic modulus, drying shrinkage and tensile relaxation were investigated. From the test results, it was observed that polymer type and content influence cracking and crack-determining material properties significantly. An increase in polymer content resulted in a significant reduction in elastic modulus, crack widths, compressive and direct tensile strength. An increase in polymer content also resulted in a significant increase in drying shrinkage, tensile relaxation and the age at cracking. The performance of EVA polymers, with respect to the susceptibility to cracking, was better than that of SA polymers at constant polymer content. Overall, the addition of polymers improved the cracking performance of the non-structural concrete patch repair mortars under investigation significantly, highlighting their potential for use in practice to improve the durability of non-structural concrete patch repairs.

ObjectivesThis study compares outcomes of patch repair vs direct anastomosis in neonatal aortic arch repair with the goal of identifying any long-term differences in restenosis, reoperation, and reintervention rates.MethodsNeonates who underwent aortic arch repair via median sternotomy between 2004 and 2021, using either patch repair or direct anastomosis techniques, were included in this study. Patch materials were glutaraldehyde-treated pericardium and femoral vein homograft. Statistical comparisons included descriptive and bivariable analyses to evaluate patient characteristics, reintervention, reoperation, and restenosis at a 20 mm Hg threshold.ResultsSeventy-five neonates, who underwent neonatal arch repair using patch technique (n = 53) or direct anastomosis (n = 22), were included in the study. No significant differences in reintervention, reoperation, or restenosis were found between surgical approaches at 20 mm Hg threshold (P > .13). Patient characteristics such as younger age (P = .06), shorter height (P = .1), and lower weight (P = .2), at the time of surgery were not significant predictors of restenosis. Cardiopulmonary bypass and circulatory arrest times were shorter with direct anastomosis. Ten-year mortality was 11% (n = 8).ConclusionsThere is no clear advantage of either patch or direct anastomosis for neonatal aortic arch repair regarding early- to mid-term outcomes. Patient-specific factors did not appear to be stronger predictors of restenosis risk than the surgical technique employed.

The use of composite materials is well established in lightweight construction applications, and it is widely used in the aerospace industry. Currently, the focus is shifting from thermoset to thermoplastic composites (CFRTP) due to their advantages in sustainability, resource efficiency, and manufacturing. CFRTP enables out-of-autoclave processing and integral construction methods. The meltability of thermoplastics allows the welding of CFRTP parts. This offers new opportunities for efficient repair strategies. A promising repair process is the laser-based ablation of damaged materials, which ensures a stepwise material removal without compromising surrounding structures. Subsequently, the ablated area is filled by inserting thermoplastic repair patches. In this study, the laser ablation of polyphenylene sulfide-based CFRTP is investigated using a high-power nanosecond pulsed laser. The investigations serve as preparation for the development of a process strategy for three-dimensional ablation on curved surfaces. Continuous curvature leads to a shift in focal position if not adjusted. Real-time focus adjustment is complex and costly. Therefore, the focus position was systematically varied in discrete steps to analyze its influence on ablation volume, surface quality, and taper angle. The focus shift effectively causes a variation in the spot radius and changes the intensity profile. To account for these effects, the results are correlated with the resulting single pulse fluence as well as with the number of overlapping pulses acting on the same surface location. Optical measurement techniques, like laser scanning microscopy, were employed to assess the effect of different focal positions.

Abdominal malignant tumors sometimes involve the inferior vena cava (IVC).1-4 In such cases, radical resection, including IVC resection and reconstruction, is a critical component of curative treatment.3,4 Although patch repair or synthetic tube grafts are used for IVC reconstruction, synthetic grafts may carry risks of infection and thrombosis.5-7 Although tubularized bovine pericardium grafts have shown favorable outcomes, the technical details are not well documented.1,8-11 CASE PRESENTATION: IVC patch reconstruction using bovine pericardial grafts was performed in three cases. In one, the patch extended over more than two-thirds of the circumference, and the reconstruction was carried out in an irregular shape to preserve the branch of the left renal vein. By using a tubularized bovine pericardium graft, a smooth shape enabled easier reconstruction of the branches. A 33-year-old woman presented with an initially unresectable large leiomyosarcoma invading the IVC and hepatic veins. After chemotherapy shrank the tumor, surgical resection, including right nephrectomy, partial hepatectomy, and IVC resection, was performed. A 14 cm tube graft was created in the operating room using bovine pericardium, and this was anastomosed to the IVC. Elevated left renal vein pressure indicated side-to-end anastomosis. Postoperative computed tomography confirmed graft patency, and the patient was discharged uneventfully on postoperative day 10. We present the technical details of IVC resection and reconstruction using a tubularized bovine pericardium graft, along with left renal vein reconstruction.

Although rare, aorto-oesophageal fistula remains one of the most critical diseases in cardiovascular surgery. The lack of prospective studies or large case series leads to an absence of evidence based therapeutic concepts. We conducted a retrospective analysis of patients treated for Aorto-oesophageal fistula between 2014 and 2023. Primary end-points of analysis were 30-day mortality and median survival, subgroup analysis was performed for etiolgoy as well as treatment strategy. Additionally, a systematic search was conducted for all studies researching treatment of the disease including ≥5 patients and published within the last 10 years. In the collective of 10 patients, 4 manifested as primary fistula, while in 6 patients the fistula occurred secondary to previous thoracic endovascular aortic repair. Median duration to manifestation post-TEVAR was 20.1 (34.1) months. Initial treatment consisted of TEVAR or TEVAR-relining in 7 cases, followed by bovine open aortic replacement (n = 1) or partial bovine patch repair (n = 2) when viable. Treatment of the oesophagus consisted of primary suture (n = 1) or oesophagectomy (n = 5) with gastric pull-up or colon interposition. Overall 30-day mortality was 40%, overall median survival was 7.5 (12.8) month. Patients receiving surgical treatment of the oesophagus exhibited longer survival than patients who did not (12.8 (4.7) vs 0.35 (0.4) months). Across the reviewed literature, the strongest effect on survival originates from surgical treatment of the oesophagus. Specific surgical strategies as well as patient characteristics vary widely. We found TEVAR effective in stabilizing the initial Haemorrhage. Short interval oesophagectomy seems to improve survival and should be considered in most patients. Open aortic replacement with bovine pericardium is a viable option. Interventional treatment options alone do not appear to be sufficient.

Interventricular septal aneurysm represents a rare cardiac anomaly traditionally associated with ischaemic heart disease or healed congenital ventricular septal defects. In this report, we present the first documented case of robot-assisted surgical repair of an interventricular septal aneurysm. Our 47-year-old male patient presented with symptomatic heart failure secondary to moderate aortic stenosis and severe aortic regurgitation. During pre-operative evaluation, imaging revealed an incidental membranous interventricular septal aneurysm without an associated shunt. The patient underwent successful robot-assisted transthoracic patch repair of the septal aneurysm concurrent with aortic valve replacement. This case demonstrates the feasibility of robot-assisted repair for complex cardiac anomalies, potentially expanding the horizons of minimally invasive cardiac surgery.

Right-sided congenital diaphragmatic hernia: Characterization, utility of prenatal imaging predictors and outcomes.

Open repair of congenital diaphragmatic hernia (CDH) in neonates often requires surgical reconstruction of the abdominal wall. Lateral release (LR) of the abdominal wall fascia, a novel technique avoiding prosthetic patches, offers potential advantages. However, data comparing its outcomes to traditional patch repair are limited.A preliminary prospective cohort study was conducted at the University Medical Center Mannheim from 2021 to 2024, including neonates undergoing CDH surgery with abdominal wall reconstruction via direct closure, LR, or patch repair based on intraoperative surgeon decision. Perioperative, postoperative, and short-term outcome data were analyzed during our standardized follow-up protocols and compared between groups.Among 77 eligible neonates, 11 underwent patch repair and 10 received LR. Baseline characteristics between groups were comparable. The median follow-up was 391 days in the patch group and 215 days in the LR group (p = 0.1971). The LR group had significantly shorter median intubation duration, neonatal intensive care unit stay, and overall length of stay compared with the patch group (32.0 days vs. 43.0 days, p = 0.0445; 33.5 days vs. 66.0 days, p = 0.0309; 68.0 days vs. 97.0 days, p = 0.0435). There were no significant differences in recurrence rates, short-term complications, or motor developmental outcomes.LR appears to be associated with shorter hospital stays and faster recovery, without an increase in perioperative or long-term complications. While these findings suggest potential benefits of LR, they must be interpreted with caution due to the limited sample size. Further randomized, multicenter studies with larger cohorts, including long-term assessment of complications, are needed to confirm its efficacy and refine clinical guidelines.

Long-Term Pulmonary Function Outcomes in Children with Pulmonary Hypoplasia.

Engineered cardiac tissue (ECT) has emerged as a transformative platform for modelling cardiac diseases, drug screening, and regenerative therapies. Among the various strategies for ECT construction, cardiomyocytes derived from human induced pluripotent stem cells (iPSC-CMs) have gained prominence due to their capacity to overcome critical limitations of primary cardiomyocyte sources, such as species-specific differences, limited tissue availability, and ethical concerns. In this review, we present a comprehensive overview of recent advancements in the use of iPSC-CMs for ECT development. We begin by outlining current methodologies for differentiating iPSC into cardiomyocytes, followed by an evaluation of key tissue engineering approaches, including scaffold-based, scaffold-free, and biofabrication techniques, that are used to assemble functional cardiac constructs in vitro. Special attention is given to the comparative advantages and challenges of these platforms. We highlight emerging applications of iPSC-CM-based ECTs, focusing on heart-on-a-chip systems for disease modelling and high-throughput drug testing, as well as cardiac patches for myocardial repair. Finally, we highlight major challenges, such as iPSC-CM immaturity, poor vascularization, and limited electromechanical integration, and discuss emerging bioengineering strategies to overcome these barriers and advance the clinical translation of engineered cardiac tissues. STATEMENT OF SIGNIFICANCE: ECT is an increasingly sophisticated platform with significant potential for cardiac disease modelling, drug screening, and regenerative therapy. This review provides a comprehensive analysis of the emerging role of human iPSC-CMs in ECT development, with emphasis on advanced differentiation protocols, biomaterial-guided tissue assembly, and cutting-edge biofabrication strategies. By critically evaluating scaffold-based, scaffold-free, and bioprinting approaches, we offer an integrated perspective on the fabrication of functional cardiac constructs. In addition, we discuss translational applications-including heart-on-a-chip systems and myocardial patches-and examine key challenges such as iPSC-CM immaturity, limited vascularization, and suboptimal electromechanical coupling. This review presents a timely synthesis at the intersection of stem cell biology, biomaterials science, and tissue engineering, intended to guide the design of next-generation therapeutic cardiac tissues.

Shear bond strength of patch repair using hybrid alkali-activated binders exposed to H2SO4 and MgSO4 solutions

Postinfarction Ventricular Septal Rupture With Thin Membrane Preventing Cardiopulmonary Collapse.

Introduction: Partial anomalous pulmonary venous return (PAPVR) is a congenital heart defect frequently associated with a sinus venosus atrial septal defect (ASD). Surgical repair varies depending on the anatomical position of the anomalous pulmonary veins. This study aims to compare the outcomes of three surgical techniques - single patch, two-patch technique, and Warden procedure- used in the repair of PAPVR with sinus venosus ASD. Methods: A retrospective study was conducted, analyzing the outcomes of 87 patients who underwent surgical repair for PAPVR between January 2011 and August 2024. Patients were divided into three groups based on the surgical technique used: 44 underwent the Warden procedure, 33 were treated with the single-patch technique, and 10 received the two-patch technique. Results: No mortality was observed across all techniques. The median age at operation was 5.4 years (1.4–10.4 years), and the median hospital stay was 3.0 days (IQR 3.0–4.0). Logistic regression analysis revealed a higher likelihood of immediate postoperative complications with the Warden technique (OR: 5.00, 95% CI [1.30–19.25], p = 0.0193). No patients required a pacemaker implantation. Four patients who had a single (2) and double patch (2) technique needed a reintervention on the systemic or pulmonary venous pathway, while no patient who had a Warden procedure needed a reintervention of the venous pathways. Conclusion: Despite a higher risk of early complications, the Warden procedure seems to preserve patients from reinterventions on the systemic or pulmonary venous pathway.

This work is focused on the design and theoretical evaluation of a new structural health monitoring scheme for composite patch repair systems that is equipped with diagnostic and prognostic capabilities and considers uncertainty. The system processes strain readings from a limited number of strategically placed sensors and returns information on the crack and debonding detection along with the repair’s remaining useful life. The problem of optimal sensor placement is approached with genetic algorithms that aim to maximize the accuracy and robustness of a trained neural network which is used as the mapping function between strains and diagnostic parameters. The later are considered as regressors in a surrogate model with the response being the stress intensity factor (SIF) of the repaired crack. The SIF range is required in a crack growth predictive model for estimating the remaining useful life of the repaired system. The SHM scheme is demonstrated in a fabricated yet realistic case study. Finite element simulations were performed to explore the problem mechanics, for training the data-driven model and finally for showcasing the online operation of the SHM system.