Page 43 - Journal of Structural Heart Disease Volume 5, Issue 4

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Meeting Abstracts
Conclusion: Our results with the ODO show that tran- scatheter closure of PDA is safe and effective with good mid-term outcomes. Long shank device should be evalu- ated in large series of patients with large and long PDA
Keywords: Patent Ductus arteriosus. Closure, Occlutech Duct Occluder.
52. SUCCESSFUL IMPLANTATION OF A PULMONARY ARTERY CONDUIT ENGINEERED WITH WHARTON’S JELLY-DERIVED MESENCHYMAL STEM CELLS IN A PRE-CLINICAL PORCINE MODEL OF TETRALOGY OF FALLOT CORRECTION.
Dominga Iacobazzi, Ambra Albertario, Filippo Rapetto, Mohamed Ghorbel, Massimo Caputo
University of Bristol, Bristol, United Kingdom
The material available for pulmonary valve and RVOT reconstruction in paediatric Tetraology of Fallot repair come with the severe limitation of long-term degeneration, causing right ventricular dysfunction, aneurysm forma- tion and arrhythmias, thus necessitating several high-risk reoperations throughout patients’ life. Hence, alternative approaches for the RVOT reconstruction, which meet the requirements of biocompatibility, non-immunogenicity and ready availability of an ideal scaffold, are needed.
By combining the use of autologous Mesenchymal Stem Cells (MSCs) derived from the inner gelatinous portion -Wharton’s Jelly (WJ_MSCs)- of the umbilical cord, and naturally occurring scaffold, we aimed to create WJ_MSCs- engineered pulmonary artery conduit that could poten- tially remodel, repair and grow alongside the children’s growth, eradicating the current limitation of the need for additional surgeries.
WJ_MSCs were phenotypically and functionally character- ised by flow cytometry and their multipotency capacity respectively. We confirmed that the typical MSCs immuno- phenotype and genetic stability is retained throughout passages.
In addition, we have optimized the cell culture and growth onto a naturally occurring extracellular matrix (ECM) scaf- fold (CorMatrix®), where WJ_MSCs exhibit a great capacity to engraft and synthetize their own extracellular matrix, under static and dynamic (bioreactor) culture systems.
The obtained WJ_MSCs engineered conduit has been safely implanted into a new piglet model lately developed by our group, in order to reproduce the clinical scenario of Tetralogy of Fallot/pulmonary atresia surgical correction
in infants, consisting of pulmonary artery and RVOT recon- struction. Preliminary data show that at 6 months follow up, the cellularised conduit was patent with no stenosis, rup- ture, or deformation. Echocardiography revealed a normal blood flow through the main pulmonary artery, and com- parable blood velocity was detected via Doppler before the graft implantation and at the time of explant. Post mortem histological assessment shows a good integration of the conduit, which has been completely repopulated by autologous cells and newly synthetized extracellular matrix component, with no detected sign of calcification.
Our study indicates that the addition of WJ_MSCs to the ECM scaffold can upgrade the material, converting it into a living tissue, with the potential to grow, repair and remodel the youngest hearts. These results might pave the way to new modalities for effective surgical restoration of pulmo- nary artery and RVOT function in TOF patients.
53. PILOT STUDY ON IRON BIOABSORBABLE STENT (IBS) IMPLANTATION IN DUCT-DEPENDENT PULMONARY CIRCULATION
Marhisham Che Mood1, Mazeni Alwi1, Hasri Samion1, Koh Gee Thiong2
1National Heart Institute, Kuala Lumpur, Malaysia. 2Hospital Serdang, Serdang, Malaysia
Palliation with Blalock Taussig shunt (BTS) in complex cyanotic congenital heart disease (CHD) has significant morbidity and mortality. Patent ductus arteriosus (PDA) stenting has advantage in term of morbidity and ICU stay. Branch pulmonary artery (PA) stenosis is common in these patients because of the site of PDA connection. Use of Bare Metal Stent (BMS) in the PDA may aggravate this stenosis and pose challenges at surgical repair.
Objective: Pilot study to investigate the feasibility, safety and efficacy of iron bioabsorbable stent (IBS, Lifetech inc.) implantation in PDA.
Methods: Inclusion criteria- only patients with simple PDA morphology (straight and relatively short), weight > 2.5kg and age < 3 months and no family history of iron dis- orders. Preliminary echocardiography, serum iron study and angiography were performed. Ductal stenting was performed by femoral artery route or transvenous route following balloon dilation. Ease of implant and X-ray vis- ibility was compared to BMS. Aspirin and later clopido- grel were started before discharge. Assessment by clinical examination, echocardiography, CXR and iron studies were performed at 1 month and later 3 monthly follow-ups. End points were death or re-interventions before 9 months.
Hijazi, Z
22nd Annual PICS/AICS Meeting