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3 . 2022

Structure of neointima in bare metal stents and expanded poly(tetrafluoroethylene) patches in children after two-step surgical treatment of tetralogy of Fallot

Abstract

Background. Neointimal hyperplasia frequently accompanies reconstructive cardiovascular surgery which commonly utilises metal, polymer or xenogeneic biomaterials. If uncontrolled, neointimal hyperplasia results in vascular occlusion ultimately requiring repeated surgery. Therefore, long-term maintenance of primary patency requires prevention of neointimal hyperplasia by means of rapid endothelialisation. Success of this task significantly depends on our understanding of neointimal composition and ultrastructure.

Aim: to investigate ultrastructure of pulmonary artery (PA) at both steps of total surgical repair in low-birth-weight children with tetralogy of Fallot (ToF), where the first and the second step employ bare metal stents and expanded poly(tetrafluoroethylene) patches (ePTFE, Gore-Tex).

Material and methods. Here, we investigated six PA segments in the stents excised from right ventricular outflow tract (RVOT) and pulmonary artery during the total surgical repair in low-birth-weight (<3 kg) children with ToF. Stents functioned from 2.5 to 6 months. PA with ePTFE patches were excised during the repeated replacement of the pulmonary valve because of its failure in 10–13 years after the total surgical repair. Tissue samples were fixed in formalin, postfixed in osmium tetroxide, stained with uranyl acetate, dehydrated in ethanol and acetone and impregnated into epoxy resin. Upon epoxy resin embedding, samples were grinded, polished, counterstained with lead citrate, and visualised by backscattered scanning electron microscopy.

Results. Neointima in stented PA was fully endothelialised and consisted of dense or loose connective tissue which was formed by fibroblasts and smooth muscle cells and enclosed the stent struts. Neointima at the surface of ePTFE patches contained elastic fibers below the endothelial monolayer and a fibroblast layer surrounded by collagen fibers. ePTFE patches suffered from marginal calcification extending to the adjacent tissues.

Conclusion. Neointima in bare metal stents and expanded poly(tetrafluoroethylene) patches have different histoarchitecture but is free from acute inflammation.

Keywords:tetralogy of Fallot; stenting; neointima; bare metal stents; poly(tetrafluoroethylene)

Funding. This study was supported by the Complex Program of Basic Research under the Siberian Branch of the Russian Academy of Sciences within the Basic Research Topic of Research Institute for Complex Issues of Cardiovascular Diseases No. 0419-2021-001 "Novel anti-atherosclerotic therapies and machine learning solutions for automated diagnosis and prognostication of cardiovascular disease". The study is financially supported by the Ministry of Science and Higher Education of the Russian Federation (National Project Science and Universities).
For citation: Mukhamadiyarov R.A., Evtushenko A.V., Tarasov R.S., Khalivopulo I.K., Lyapin A.A., Kutikhin A.G. Structure of neointima in bare metal stents and expanded poly (tetrafluoroethylene) patches in children after two-step surgical treatment of tetralogy of Fallot. Clinical and Experimental Surgery. Petrovsky Journal. 2022; 10 (3): 64–75. DOI: https://doi.org/10.33029/2308-1198-2022-10-3-64-75  (in Russian)

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CHIEF EDITOR
CHIEF EDITOR
Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)

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