4 . 2023

11-year efficacy of xenopericardial KemPeriplas-Neo patch for the repair of pulmonary trunk during total surgical repair of tetralogy of Fallot

Abstract

Xenopericardial patches are broadly employed in cardiovascular surgery, yet the mechanisms behind their integration with the pulmonary artery during the total surgical repair in patients with tetralogy of Fallot (ToF) remained unclear to date.

Aim. To assess whether the KemPeriplas vascular patch is well integrated into the pulmonary trunk after the total surgical repair of tetralogy of Fallot in a long term.

Materials and methods. We collected pulmonary trunk of an adolescent (14 years) who underwent the angioplasty using a bovine pericardial patch (KemPeriplas-Neo) during the total surgical repair of ToF at the age of 20 months. Hence, the follow-up period was ≈11 years. Sample was fixed in paraformaldehyde and postfixed with in osmium tetroxide. After uranyl acetate staining and dehydration in ascending ethanol series followed by incubation in acetone, the sample was embedded into epoxy resin. Then, the sample was grinded, polished, and counterstained with lead citrate. The sample was visualised by means of backscattered scanning electron microscopy.

Results. 11 years postimplantation, bovine pericardial patch had no calcification, infection, or inflammation. Generally, the patch retained its integrity. Taken together with the complete endothelialisation and clear subendothelial elastic fibers, it indicated the successful integration of the patch with the pulmonary trunk. However, the patch also contained segments with the fragmented collagen fibers suggestive of a controlled proteolysis and physiological repair of the damaged extracellular matrix.

Conclusion. In >10 years upon the total surgical repair of ToF, bovine pericardial patch KemPeriplas retains its structural integrity and well integrates with the pulmonary trunk, suggesting its applicability in these surgical and pathophysiological scenarios.

Keywords:bovine pericardium; vascular patches; tetralogy of Fallot; pulmonary artery; total surgical repair

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).

Conflict of interest. The authors declare no conflict of interest.

For citation: Mukhamadiyarov R.A., Khalivopulo I.K., Evtushenko A.V., Lyapin A.A., Kutikhin A.G. 11-year efficacy of xenopericardial KemPeriplas-Neo patch for the repair of pulmonary trunk during total surgical repair of tetralogy of Fallot. Clinical and Experimental Surgery. Petrovsky Journal. 2023; 11 (4): 145–54. DOI: https://doi.org/10.33029/2308-1198-2023-11-4-145-154 (in Russian)

References

1. Sevost’yanova V.V., Mironov A.V., Antonova L.V., Tarasov R.S. Vascular patches for arterial reconstruction, challenges and advanced technologies. Kompleksnye problemy serdechno-sosudistykh zabolevaniy [Complex Problems of Cardiovascular Diseases]. 2019; 8 (3): 116–9. DOI: https://doi.org/10.17802/2306-1278-2019-8-3-116-129 (in Russian)

2. Borisov V.G., Zakharov Yu.N., Kazantsev A.N., Shokin Yu.I., Evtushenko A.V., Barbarash L.S., et al. Computer modeling of different shaped patches in classical carotid endarterectomy. Vestnik transplantologii i iskusstvennykh organov [Bulletin of Transplantology and Artificial Organs]. 2021; 23 (4): 132–42. DOI: https://doi.org/10.15825/25/1995-1191-2021-4-132-142 (in Russian)

3. AbuRahma A.F., Darling R.C. 3rd. Literature review of primary versus patching versus eversion as carotid endarterectomy closure. J Vasc Surg. 2021; 74 (2): 666–75. DOI: https://doi.org/10.1016/j.jvs.2021.02.051

4. Léonore F.T., Elsa F., David P.C., Ludovic C., Pascal B., Charles Henri M.A., et al. Short- and long-term outcomes following biological pericardium patches versus prosthetic patches for carotid endarterectomy: a retrospective bicentric study. Ann Vasc Surg. 2021; 72: 66–71. DOI: https://doi.org/10.1016/j.avsg.2020.04.010

5. Orrapin S., Benyakorn T., Howard D.P., Siribumrungwong B., Rerkasem K. Patches of different types for carotid patch angioplasty. Cochrane Database Syst Rev. 2021; 2 (2): CD000071. DOI: https://doi.org/10.1002/14651858.CD000071.pub4

6. Danial P., Moiroux-Sahraoui A., Debauchez M., Monin J.L., Berrebi A., Shraer N., et al. Aortic valve repair using pericardial patch standardized with external ring annuloplasty. Eur J Cardiothorac Surg. 2022; 62 (4): ezac072. DOI: https://doi.org/10.1093/ejcts/ezac072

7. Elassal A.A., Al-Radi O.O., Zaher Z.F., Dohain A.M., Abdelmohsen G.A., Mohamed R.S., et al. Equine pericardium: a versatile alternative reconstructive material in congenital cardiac surgery. J Cardiothorac Surg. 2021; 16 (1): 110. DOI: https://doi.org/10.1186/s13019-021-01494-y

8. Zaidi M., Premkumar G., Naqvi R., Khashkhusha A., Aslam Z., Ali A., et al. Aortic valve surgery: management and outcomes in the paediatric population. Eur J Pediatr. 2021; 180 (10): 3129–39. DOI: https://doi.org/10.1007/s00431-021-04092-1

9. Nokhrin A.V., Tarasov R.S., Mukhamadiyarov R.A., Shishkova D.K., Kutikhin A.G., Dzyuman A.N., et al. Two-stage approach for surgical treatment of tetralogy of Fallot in underweight children: clinical and morphological outcomes. J Card Surg. 2019; 34 (5): 293–9. DOI: https://doi.org/10.1111/jocs.14031

10. Mukhamadiyarov R.A., Lyapin A.A., Kutikhin A.G. Ultrastructure of stented right ventricular outflow tract in low-birth-weight infants before surgical correction of tetralogy of Fallot. Clinical and Experimental Surgery. Petrovsky Journal. 2021; 9 (2): 46–58. (In Russ.) DOI: https://doi.org/10.33029/2308-1198-2021-9-2-46-58 (in Russian)

11. Mukhamadiyarov R.A., Bogdanov L.A., Glushkova T.V., Shishkova D.K., Kostyunin A.E., Koshelev V.A., et al. EMbedding and backscattered scanning electron microscopy: a detailed protocol for the whole-specimen, high-resolution analysis of cardiovascular tissues. Front Cardiovasc Med. 2021; 8: 739549. DOI: https://doi.org/10.3389/fcvm.2021.739549

12. Mukhamadiyarov R.A., Kutikhin A.G. Histology and histopathology of blood vessels: backscattered scanning electron microscopy approach. Fundamental’naya i klinicheskaya meditsina [Fundamental and Clinical Medicine]. 2019; 4 (1): 6–14. DOI: https://doi.org/10.23946/2500-0764-2019-4-1-6-14 (in Russian)

13. Boukens B.J.D., Basso C., Migliore F., Rizzo S., Thiene G. Embryology, anatomy, and pathology of ventricular outflow tracts related to cardiac mapping and arrhythmias. In: M. Shenasa, G. Hindricks, D.J. Callans, J.M. Miller, M.E. Josephson (eds). Cardiac Mapping. 5th ed. John Wiley & Sons, 2019: 7–28. ISBN 9781119152590. DOI: https://doi.org/10.1002/9781119152637.ch2

14. Albertario A., Swim M.M., Ahmed E.M., Iacobazzi D., Yeong M., Madeddu P., et al. Successful reconstruction of the right ventricular outflow tract by implantation of thymus stem cell engineered graft in growing swine. JACC Basic Transl Sci. 2019; 4 (3): 364–84. DOI: https://doi.org/10.1016/j.jacbts.2019.02.001

15. Kostyunin A.E., Glushkova T.V., Shishkova D.K., Markova V.E., Ovcharenko E.A. Screening analysis of proteolytic enzymes and their inhibitors in the leaflets of epoxy-treated bioprosthetic heart valves explanted due to dysfunction. Biomeditsinskaya khimiya [Biomedical Chemistry]. 2022; 68 (1): 68–75. DOI: https://doi.org/10.18097/PBMC20226801068 (in Russian)