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Current Challenges and Emergent Technologies for Manufacturing Artificial Right Ventricle to Pulmonary Artery (RV-PA) Cardiac Conduits

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Abstract

Despite advances in modern surgery, congenital heart disease remains a medical challenge and major cause of infant mortality. Valved conduits are routinely used to surgically correct blood flow in hearts with congenital malformations by connecting the right ventricle to the pulmonary artery (RV-PA). This review explores the current range of RV-PA conduits and describes their strengths and disadvantages. Homografts and xenografts are currently the primary treatment modalities, however both graft types have limited biocompatibility and durability, and present a disease transmission risk. Structural deterioration of a replaced valve can lead to pulmonary valve stenosis and/or regurgitation. Moreover, as current RV-PA conduits are of a fixed size, multiple subsequent operations are required to upsize a valved conduit over a patient’s lifetime. We assess emerging biomaterials and tissue engineering techniques with a view to replicating the features of native tissues, including matching the durability and elasticity required for normal fluid flow dynamics. The benefits and limitations of incorporating cellular elements within the biomaterial are also discussed. Present review demonstrates that an alignment of medical and engineering disciplines will be ultimately required to produce a biocompatible and high-functioning artificial conduit.

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Abbreviations

BJV:

Bovine jugular vein

CHD:

Congenital heart disease

ECM:

Extra cellular matrix

PCL:

Poly(ɛ-caprolactone)

PHB:

Poly(hydroxybutyrate) or poly(hydroxybutyric acid)

PHBV:

Poly(3-hydroxybutyrate-co-3-hydroxyvalerate)

PLA:

Poly(lactic acid)

PLGA:

Poly(lactic-co-glycolic acid)

PPC:

Poly(propylene carbonate)

PPF:

Poly(propylene fumarate)

RV-PA:

Right ventricle to pulmonary artery

TE:

Tissue engineering

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Authors and Affiliations

  1. The Heart Centre for Children, The Children’s Hospital at Westmead, Westmead, NSW, 2145, Australia

    Iman Manavitehrani, Akshat Saxena & David S. Winlaw

  2. Sydney Medical School, The University of Sydney, Sydney, NSW, 2006, Australia

    Iman Manavitehrani, Aaron Schindeler, Akshat Saxena, David G. Little & David S. Winlaw

  3. School of Chemical and Biomolecular Engineering, The University of Sydney, Sydney, NSW, 2006, Australia

    Pegah Ebrahimi, Sean Daly, Aaron Schindeler, David F. Fletcher & Fariba Dehghani

  4. Orthopaedic Research & Biotechnology Unit, The Children’s Hospital at Westmead, Westmead, NSW, 2145, Australia

    Irene Yang, Aaron Schindeler & David G. Little

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  1. Iman Manavitehrani
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Manavitehrani, I., Ebrahimi, P., Yang, I. et al. Current Challenges and Emergent Technologies for Manufacturing Artificial Right Ventricle to Pulmonary Artery (RV-PA) Cardiac Conduits. Cardiovasc Eng Tech 10, 205–215 (2019). https://doi.org/10.1007/s13239-019-00406-5

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