期刊论文详细信息
Frontiers in Cardiovascular Medicine
Understanding Pulmonary Autograft Remodeling After the Ross Procedure: Stick to the Facts
article
Lucas Van Hoof1  Peter Verbrugghe1  Elizabeth A. V. Jones2  Jay D. Humphrey3  Stefan Janssens4  Nele Famaey5  Filip Rega1 
[1] Department of Cardiac Surgery, University Hospitals Leuven;Center for Molecular and Vascular Biology;Department of Biomedical Engineering, Yale University;Department of Cardiology, University Hospitals Leuven;Biomechanics Section
关键词: Ross procedure;    pulmonary autograft;    mechanobiology;    remodeling;    extracellular matrix;    external support;   
DOI  :  10.3389/fcvm.2022.829120
学科分类:地球科学(综合)
来源: Frontiers
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【 摘 要 】

The Ross, or pulmonary autograft, procedure presents a fascinating mechanobiological scenario. Due to the common embryological origin of the aortic and pulmonary root, the conotruncus, several authors have hypothesized that a pulmonary autograft has the innate potential to remodel into an aortic phenotype once exposed to systemic conditions. Most of our understanding of pulmonary autograft mechanobiology stems from the remodeling observed in the arterial wall, rather than the valve, simply because there have been many opportunities to study the walls of dilated autografts explanted at reoperation. While previous histological studies provided important clues on autograft adaptation, a comprehensive understanding of its determinants and underlying mechanisms is needed so that the Ross procedure can become a widely accepted aortic valve substitute in select patients. It is clear that protecting the autograft during the early adaptation phase is crucial to avoid initiating a sequence of pathological remodeling. External support in the freestanding Ross procedure should aim to prevent dilatation while simultaneously promoting remodeling, rather than preventing dilatation at the cost of vascular atrophy. To define the optimal mechanical properties and geometry for external support, the ideal conditions for autograft remodeling and the timeline of mechanical adaptation must be determined. We aimed to rigorously review pulmonary autograft remodeling after the Ross procedure. Starting from the developmental, microstructural and biomechanical differences between the pulmonary artery and aorta, we review autograft mechanobiology in relation to distinct clinical failure mechanisms while aiming to identify unmet clinical needs, gaps in current knowledge and areas for further research. By correlating clinical and experimental observations of autograft remodeling with established principles in cardiovascular mechanobiology, we aim to present an up-to-date overview of all factors involved in extracellular matrix remodeling, their interactions and potential underlying molecular mechanisms.

【 授权许可】

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