Patient Specific Tissue Engineered Vascular Graft For Aortic Arch Reconstruction: (Patient specific aortic Tissue Engineered Vascular Graft)

Objective(s) The complexity of aortic arch reconstruction due to diverse three-dimensional (3D) geometrical abnormalities is a major challenge. This study introduces 3D printed tissue-engineered vascular grafts (TEVG), which can fit patient-specific dimensions, optimize hemodynamics, exhibit anti-thrombotic and anti-infective properties, and accommodate growth. Methods We procured cardiac magnetic resonance imaging (MRI) with four-dimensional (4D) flow for native porcine anatomy (n=10), from which we designed TEVG for the distal aortic arch, four weeks before surgery. An optimal shape of the curved vascular graft was designed using computer-aided design informed by computational fluid dynamics analysis. Grafts were manufactured and implanted into the distal aortic arch of porcine models, and post-operative cardiac MRI data was collected. Pre- and post-implant hemodynamic data and histology were analyzed. Results Post-operative MRI of all pigs with 1:1 ratio of polycaprolactone (PCL) and poly-L-lactide-co-ε-caprolactone (PLCL) demonstrated no specific dilatation or stenosis of the graft, revealing a positive growth trend in the graft area from the day after surgery to 3 months later, with maintaining a similar shape. The peak wall shear stress (WSS) of the PCL/PLCL graft portion did not change significantly between the day after surgery and 3 months later. Immunohistochemistry showed endothelization and smooth muscle layer formation without calcification of the PCL/PLCL graft. Conclusions Our patient-specific PCL/PLCL TEVG demonstrated optimal anatomical fit maintaining ideal hemodynamics and neotissue formation in a porcine model. This study provides a proof of concept of patient-specific TEVG for aortic arch reconstruction.