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Don’t Oversize Your Tissue-Engineered Vascular Grafts: Insights for the Translation of New Surgical Technologies

Don’t Oversize Your Tissue-Engineered Vascular Grafts: Insights for the Translation of New Surgical Technologies 1024 683 Abbie Miller

Study shows that adoption of a tissue engineered vascular graft technology currently in clinical trials would require a shift in surgical approach.

Tissue engineered vascular grafts (TEVGs) are designed to overcome two important problems associated with synthetic conduits used in surgeries for children with congenital heart disease (CHD): the lack of growth potential and the risk of somatic overgrowth.

So far, TEVGs show promise in preclinical and early clinical trials.

“Our approach involves implanting biodegradable scaffolds seeded with autologous cells that remodel into functional neovessels,” says Christopher Breuer, MD, pediatric surgeon and director of the Center for Regenerative Medicine at in the Abigail Wexner Research Institute at Nationwide Children’s Hospital.

In previous research, we’ve shown that stenosis in TEVGs is an inflammation-driven process mediated by mechanical factors. It is partially reversible and can be modulated.

After developing a second-generation TEVG and initiating a second clinical trial to evaluate performance, Dr. Breuer and team hypothesized that surgical factors contribute to stenosis formation. To evaluate this hypothesis, the researchers implanted and evaluated 50 ovine TEVGs, collecting angiography at 1 and 6 weeks postimplantation. The results of this study are published in JACC: Basic to Translational Science.

Results indicated that hemodynamics and surgical sizing of the graft were potential driving factors. Regression analysis showed that narrowing at the inflow anastomosis and graft oversizing were significantly correlated with stenosis development. Computational fluid dynamics simulations showed that these factors influenced wall shear stress and flow patterns, contributing to neovessel narrowing. Additionally, clinical trial data supported these findings, emphasizing the importance of matching graft size to the native inflow vessel when using TEVGs.

“This current study demonstrates that, within TEVGs, graft oversizing as well as greater narrowing of the inflow anastomosis at the time of surgery worsen the degree of stenosis,” says Dr. Breuer. “Considering that the current clinical practice is for surgeons to oversize the graft – for good reason, with synthetic grafts you need to give extra room for the child to grow to reduce reoperations – we need to be prepared to incorporate education and behavior change support as we advance the translation and implementation of TEVGs.”

 

Figure 1: Experimental images showing stenosis in TEVG in relationship to inflow anastomosis and graft size. 

Reference:

Blum KM, Turner ME, Schwarz EL, Best CA, Kelly JM, Yates AR, Hor KN, Matsuzaki Y, Drews JD, Zakko J, Shah K, Shinoka T, Humphrey JD, Marsden AL, Breuer CK. Oversized Conduits Predict Stenosis in Tissue Engineered Vascular Grafts. JACC Basic Transl Sci. 2025 Apr 16:101248.

Image credits: Adobe Stock (header); Nationwide Children’s (Figure 1 courtesy of Breuer Lab)

About the author

Abbie (Roth) Miller, MWC, is a passionate communicator of science. As the manager, medical and science content, at Nationwide Children’s Hospital, she shares stories about innovative research and discovery with audiences ranging from parents to preeminent researchers and leaders. Before coming to Nationwide Children’s, Abbie used her communication skills to engage audiences with a wide variety of science topics. She is a Medical Writer Certified®, credentialed by the American Medical Writers Association.

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