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Contact

Fabien Kawecki

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Contact

Linkedin biotis-bordeaux

Secretary Email

33 (0)5 57 57 14 88

Bioingénierie Tissulaire (BioTis)       

Physical Address:

Batiment BBS (Bordeaux Biologie Santé), 5e étage

2, rue du Dr Hoffmann Martinot,

33000, Bordeaux, France

Mailing Address:

Université de Bordeaux, Campus Carreire

146, rue Léo Saignat, Case 84,

33076, Bordeaux Cedex, France

Surgical Correction of Tetralogy of Fallot Using Cell-Assembled Extracellular Matrix

Abstract

Reference

Project Leader

Tetralogy of Fallot (ToF) is a common cyanotic congenital heart defect requiring surgical enlargement of the right ventricular outflow tract (RVOT), often through transannular patching that induces pulmonary valve (PV) regurgitation and long-term right ventricular dysfunction [1]. Monocusp valves are frequently added to mitigate regurgitation, but their performance is highly variable due to limitations in material biocompatibility, leaflet design, and immune-related failure [2-5].Existing evaluation methods—animal models, simplified mock circulatory systems, and static computational models—are insufficient to fully assess monocusp dynamics and optimize design [6-8].

To overcome these limitations, we developed an integrated evaluation platform combining a soft biorobotic heart, a dynamic computational RVOT model, and in vivo validation [9]. We further explored Cell-Assembled extracellular Matrix (CAM) as a fully biological monocusp material to reduce complications associated with synthetic or xenogenic grafts. Using this multiscale experimental and computational framework, we assessed and optimized CAM-based monocusp valves, providing new insights into RVOT flow patterns and offering improved tools for advancing surgical repair strategies in congenital heart disease.

▷C. Apitz, G. D. Webb, A. N. Redington, Tetralogy of Fallot. Lancet 374, 1462–1471 (2009).

▷A. Frigiola, A. Redington, S. Cullen, M. Vogel, Pulmonary regurgitation is an important determinant of right ventricular contractile dysfunction in patients with surgically repaired Tetralogy of Fallot. Circulation 110, II153–II157 (2004).

▷D. S. Nath, D. P. Nussbaum, C. Yurko, O. M. Ragab, A. J. Shin, S. R. Kumar, V. A. Starnes, W. J. Wells, Pulmonary homograft monocusp reconstruction of the right ventricular outflow tract: Outcomes to the intermediate term. Ann. Thorac. Surg. 90, 42–49 (2010).

▷S. R. Gundry, Pericardial and synthetic monocusp valves: Indication and results. Semin. Thorac. Cardiovasc. Surg. Pediatr. Card. Surg. Annu. 2, 77–82 (1999).

▷C. Mather, P. Treuting, Onchocerca armillata contamination of a bovine pericardial xenograft in a human patient with repaired Tetralogy of Fallot. Cardiovasc. Pathol. 21, e35–e38 (2012).

▷S. B. Kizilski, X. Zhang, N. E. Kneier, M. D. Chaillo Lizarraga, N. E. Schulz, P. E. Hammer, D. M. Hoganson, An in vitro circulatory loop model of the pediatric right ventricular outfltow trac as a platform for valve evaluation. Eng. Technol. 14, 217–229 (2023).

▷N. Milani-­Nejad, P. M. Janssen, Small and large animal models in cardiac contraction research: Advantages and disadvantages. Pharmacol. Ther. 141, 235–249 (2014).

▷S. Mosbahi, E. Mickaily-­Huber, D. Charbonnier, R. Hullin, M. Burki, E. Ferrari, L. K. von Segesser, D. A. Berdajs, Computational fluid dynamics of the right ventricular outflow tract and of the pulmonary artery: A bench model of flow dynamics. Interact. Cardiovasc. Thorac. Surg. 19, 611–616 (2014).

▷Singh M, Roubertie R, Ozturk C, Borchiellini P, Rames A, Bonnemain J, Dutra Gollob S, Wang SX, Naulin J, El Hamrani D, Dugot-Senant N, Gosselin I, Grenet C, L’Heureux N, Roche ET, and Kawecki F. Hemodynamic evaluation of biomaterial-based surgery for Tetralogy of Fallot using a biorobotic heart, in silico, and ovine models, Science Translational Medicine 16 (2024) 1-17