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3D Printed Patient Specific Tissue Engineered Vascular Graft For Aortic Arch Reconstruction
Umar Siddiqi1, Hiroshi Matsushita, MD1, Katherine Nurminsky1, Paige Mass, BS2, Seda Aslan, MS3, Vincent Cleveland4, Kelvin Nelson, PhD5, Byeol Kim, MS6, Tyler Dunn, BA1, Daniel Rodgers, BS1, Luca Vricella, MD1, Keigo Kawaji, PhD7, Johnson Jed, PhD5, Laura Olivieri, MD4, Alex Krieger, PhD6, Narutoshi Hibino, MD PhD1.
1Section of Cardiac & Thoracic Surgery, Department of Surgery, The University of Chicago Medical Center, Chicago, IL, USA, 2Section of Cardiac & Thoracic Surgery, Department of Surgery, The University of Chicago Medical Center, Washington, DC, USA, 3Section of Cardiac & Thoracic Surgery, Department of Surgery, The University of Chicago Medical Center, Baltimore, MD, USA, 4Department of Cardiology, Children’s National Medical Center, Washington, DC, USA, 5Nanofiber Solutions, Dublin, OH, USA, 6Department of Mechanical Engineering, University of Maryland, Baltimore, MD, USA, 7Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, USA.

Objective(s): Complex vascular reconstruction of the aortic arch remains challenging due to the spectrum of 3D geometrical abnormalities involved. Tissue engineered vascular grafts (TEVG) can be manufactured in shapes to optimize hemodynamics, possess excellent antithrombotic and anti-infective properties, and can accommodate growth. We applied our unique 3D printing technology to create patient-specific TEVG for aortic arch reconstruction.
Methods: Cardiac MRI with 4D flow was acquired for native porcine anatomy (n = 6) and used to design a patient-specific TEVG of the distal aortic arch 4 weeks prior to surgery. An optimal shape of the curved vascular graft with (n=3) or without (n=3) neck vessel branch was designed using a computer-aided design informed by computational flow dynamics analysis. Grafts were manufactured and implanted into the distal aortic arch in the porcine model, and postoperative cardiac MRI data was collected. The graft was explanted after surgery and at 4 weeks for evaluation. Pre- and post-implant hemodynamic data and histology were analyzed.
Results: Postoperative MRI demonstrated no specific dilatation or stenosis of the graft. There was no significant difference in pre/postop hemodynamic variables, including flow (p=0.44), peak wall shear stress (p=0.63), energy loss (p=0.1), and vorticity (p=0.81) at descending aorta. Immunohistochemistry showed endothelization and smooth muscle layer formation without calcification of the graft.
Conclusions: Our patient-specific TEVG demonstrated optimal anatomical fit maintaining ideal hemodynamics and neotissue formation in a porcine model. This study demonstrates the potential of a patient-specific TEVG for aortic arch reconstruction.


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