A novel three-layer large-diameter artificial blood vessel based on levorotatory polylactic acid and polycaprolactone based on electrospinning and ultrasonic reaming: Preliminary animal evaluation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Wenjun ¹ , GAO Yang ¹ , GAO Feng ¹ , SHI Lei ¹ , LIU Wei ¹ , FAN Weiwang ¹ , XU Chang ² , ZHENG Hong ¹ ,  DONG Xufeng ¹ ,  ZHUANG Xijing ¹

1. Department of Cardiovascular Surgery, Dalian University of Technology Affiliated Central Hospital (Dalian Municipal Central Hospital), Dalian, 116000, Liaoning, P. R. China;
2. Institute of Cardiovascular and Cerebrovascular Medicine, Dalian University of Technology, Dalian, Liaoning, 116000, P. R. China;
3. The First Operating Room, Dalian University of Technology Affiliated Central Hospital (Dalian Municipal Central Hospital), Dalian, 116000, Liaoning, P. R. China;
4. School of Materials and Engineering, Dalian University of Technology, Dalian, 116000, Liaoning, P. R. China;

Corresponding author：

DONG Xufeng, Email: dlmchcsd@126.com; ZHUANG Xijing, Email: dlmchcsd@126.com

Keywords：

Large diameter artificial blood vessels; levorotatory polylactic acid; polycaprolactone; three layers of artificial blood vessels

DOI：

10.7507/1007-4848.202408006

Video：

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Objective To select levorotatory polylactic acid (PLLA) and polycaprolactone (PCL) as the main materials, use electrostatic spinning and ultrasonic broaching processing technique to prepare a similar to natural vascular diameter gradient structure of large diameter artificial blood vessels, and evaluate its potential applications. Methods Using PLLA and PCL as raw materials, through the electrospinning process, using core shafts of different diameters as collection devices, artificial vascular materials with a natural-like structure were constructed. Using end to end anastomosis method to experimental pig thoracic descending aorta replacement of artificial blood vessels. Results Computed tomography angiography (CTA) results showed that the artificial vascular graft was patent at 1 week and 6 weeks after operation. Animal experimental pathology examination revealed, artificial blood vessels unobstructed, the lining of endothelial cells, and elastic fiber, roughly three layer structure formed similar natural aorta. Artificial blood vessel wall visible elastic fibers, elastic fibers and collagen fibers with natural blood vessels distribution was similar. Immunohistochemical examination showed that the artificial blood vessels had a strong immune response to ERG staining, Actin staining, and Vementin staining. Scanning electron microscopy showed that endothelial cells were formed in the inner layer of the artificial blood vessel. Conclusion PLLA and photo as raw material, the use of electrostatic spinning and ultrasonic reaming technology preparation of large diameter artificial blood vessels, imitation of natural structure may have potential good flow resistance, good endothelial and may have induced in-situ natural function of angiogenesis.

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2.	Li Q, Li B, Xi S, et al. Experience with aortic arch inclusion technique using artificial blood vessel for type A aortic dissection: an application study. J Cardiothorac Surg, 2024, 19(1): 189.
3.	Czerny M, Grabenwöger M, Berger T, et al. EACTS/STS guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ. Eur J Cardiothorac Surg, 2024, 65(2): ezad426.
4.	Isselbacher EM, Preventza O, Hamilton Black J, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation, 2022, 146(24): e334-e482.
5.	Natanov R, Shrestha ML, Martens A, et al. Acute aortic dissection type A in younger patients (<60 years old) - Does full arch replacement provide benefits compared to limited approach? Braz J Cardiovasc Surg, 2023, 39(1): e20220434.
6.	Chen Y, Feng Y, Wang T, et al. In vivo endothelialization and neointimal hyperplasia assessment after rabbit carotid endarterectomy with bovine pericardium. Ann Transl Med, 2021, 9(6): 471.
7.	Rovas G, Bikia V, Stergiopulos N. Design and computational optimization of compliance-matching aortic grafts. Front Bioeng Biotechnol, 2023, 11: 1179174.
8.	Wang W, Gao F, He X, et al. Efficacy of tolvaptan in postoperative volume therapy for acute Stanford type A aortic dissection. BMC Cardiovasc Disord, 2023, 23(1): 95.
9.	何学志, 高峰, 高洋, 等. 扩大主动脉外膜内翻并人工血管端翻转吻合处理急性A型主动脉夹层根部的近期效果. 中国胸心血管外科临床杂志, 2022, 29(3): 371-376.He XZ, Gao F, Gao Y, et al. Short-term effects of extended adventitial inversion with graft eversion anastomosis technique in the root treatment of acute type A aortic dissection. Chin J Clin Thorac Cardiovasc Surg, 2022, 29(3): 371-376.
10.	Jalaie H, Steitz J, Afify M, et al. In vivo endothelialization and neointimal hyperplasia assessment after angioplasty of sheep carotid artery with a novel polycarbonate polyurethane patch. J Biomater Appl, 2019, 34(2): 208-218.
11.	Gaudino M, Benedetto U, Fremes S, et al. Association of radial artery graft vs saphenous vein graft with long-term cardiovascular outcomes among patients undergoing coronary artery bypass grafting: A systematic review and meta-analysis. JAMA, 2020, 324(2): 179-187.
12.	Agrafiotis E, Mayer C, Grabenwöger M, et al. Global and local stiffening of ex vivo-perfused stented human thoracic aortas: A mock circulation study. Acta Biomater, 2023, 161: 170-183.
13.	马金辉, 张岚林, 阳晟, 等. 升主动脉包裹联合Ⅰ型杂交全主动脉弓修复术治疗主动脉弓部病变的临床疗效分析. 中国胸心血管外科临床杂志, 2024, 31(9): 1313-1318.Ma JH, Zhang LL, Yang S, et al. Clinical effect of ascending aorta banding combined with typeⅠ hybrid aortic arch repair on aortic arch diseases. Chin J Clin Thorac Cardiovasc Surg, 2024, 31(9): 1313-1318.
14.	蒙茂龙, 王尧, 卢平凡, 等. 改良Bentall手术中应用残余瘤壁根部包裹技术的近期疗效. 中国胸心血管外科临床杂志, 2024, 31(2): 283-287.Meng ML, Wang Y, Lu PF, et al. Short-term results of sleeve wrapping technique using remnant aortic wall in modified Bentall procedure. Chin J Clin Thorac Cardiovasc Surg, 2024, 31(2): 283-287.
15.	周晓辉, 关强, 刘睿, 等. 主动脉瓣置换术+升主动脉成形术后升主动脉直径变化及中远期临床结果分析. 中国胸心血管外科临床杂志, 2023, 30(3): 381-388.Zhou XH, Guan Q, Liu R, et al. Reduction ascending aortoplasty in adult patients undergoing aortic valve replacement: Aorta diameter change, mid- and long-term clinical results. Chin J Clin Thorac Cardiovasc Surg, 2023, 30(3): 381-388.
16.	Gu Y, Tian C, Qin Y, et al. The novel hybrid polycarbonate polyurethane/polyester three-layered large-diameter artificial blood vessel. J Biomater Appl, 2022, 36(6): 965-975.
17.	Liu D, Meng Q, Hu J. Bacterial nanocellulose hydrogel: A promising alternative material for the fabrication of engineered vascular grafts. Polymers (Basel), 2023, 15(18): 3812.
18.	Naegeli KM, Kural MH, Li Y, et al. Bioengineering human tissues and the future of vascular replacement. Circ Res, 2022, 131(1): 109-126.
19.	Turner ME, Blum KM, Watanabe T, et al. Tissue engineered vascular grafts are resistant to the formation of dystrophic calcification. Nat Commun, 2024, 15(1): 2187.
20.	Di Francesco D, Pigliafreddo A, Casarella S, et al. Biological materials for tissue-engineered vascular grafts: Overview of recent advancements. Biomolecules, 2023, 13(9): 1389.
21.	Li Z, Giarto J, Zhang J, et al. Design and synthesis of P(AAm-co-NaAMPS)-alginate-xanthan hydrogels and the study of their mechanical and rheological properties in artificial vascular graft applications. Gels, 2024, 10(5): 319.
22.	Jeong HJ, Nam H, Kim JS, et al. Dragging 3D printing technique controls pore sizes of tissue engineered blood vessels to induce spontaneous cellular assembly. Bioact Mater, 2023, 31: 590-602.
23.	Bellani CF, Yue K, Flaig F, et al. Suturable elastomeric tubular grafts with patterned porosity for rapid vascularization of 3D constructs. Biofabrication, 2021, 13(3): 035020.
24.	Uehara H, Uchiyama M, Imazuru T. Placement of stent grafts with different calibers into the true and false lumens of anastomotic aneurysms after descending aortic replacement for aortic dissection. J Cardiothorac Surg, 2024, 19(1): 9.
25.	Liu D, Han J, Zhuang X, et al. Evaluation of mechanical properties and biocompatibility of three-layer PCL/PLLA small-diameter vascular graft with pore diameter gradient. Eur Poly J, 2023, 186: 111864.
26.	Gu Y, Tian C, Qin Y, et al. The novel hybrid polycarbonate polyurethane/polyester three-layered large-diameter artificial blood vessel. J Biomater Appl, 2022, 36(6): 965-975.
27.	Yao Y, Zaw AM, Anderson DEJ, et al. Fucoidan and topography modification improved in situ endothelialization on acellular synthetic vascular grafts. Bioact Mater, 2022, 22: 535-550.
28.	Fernandes A, Miéville A, Grob F, et al. Endothelial-smooth muscle cell interactions in a shear-exposed intimal hyperplasia on-a-dish model to evaluate therapeutic strategies. Adv Sci (Weinh), 2022, 9(28): e2202317.
29.	D'Alessio A. Role of Endothelial cell metabolism in normal and tumor vasculature. Cancers (Basel), 2023, 15(7): 1921.
30.	Weber J, Weber M, Feile A, et al. Development of an in vitro blood vessel model using autologous endothelial cells generated from footprint-free hiPSCs to analyze interactions of the endothelium with blood cell components and vascular implants. Cells, 2023, 12(9): 1217.
31.	Kole GE, Hasirci V, Yucel D. Development of a tri-layered vascular construct and in vitro evaluation of endothelization. Macromol Biosci, 2024, 24(5): e2300369.
32.	Zhao D, Yuan W, Fang C, et al. Biomimetic vascular grafts with circumferentially and axially oriented microporous structures for native blood vessel regeneration. Adv Funct Mater, 2024, 34(1): 2308888.

1. Sirota DA, Zhulkov MO, Khvan DS, et al. Predictors of lethality, remodeling, and aorta-related events in different types of proximal aortic dissection surgery. Sovrem Tekhnologii Med, 2023, 15(1): 38-50.
2. Li Q, Li B, Xi S, et al. Experience with aortic arch inclusion technique using artificial blood vessel for type A aortic dissection: an application study. J Cardiothorac Surg, 2024, 19(1): 189.
3. Czerny M, Grabenwöger M, Berger T, et al. EACTS/STS guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ. Eur J Cardiothorac Surg, 2024, 65(2): ezad426.
4. Isselbacher EM, Preventza O, Hamilton Black J, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation, 2022, 146(24): e334-e482.
5. Natanov R, Shrestha ML, Martens A, et al. Acute aortic dissection type A in younger patients (<60 years old) - Does full arch replacement provide benefits compared to limited approach? Braz J Cardiovasc Surg, 2023, 39(1): e20220434.
6. Chen Y, Feng Y, Wang T, et al. In vivo endothelialization and neointimal hyperplasia assessment after rabbit carotid endarterectomy with bovine pericardium. Ann Transl Med, 2021, 9(6): 471.
7. Rovas G, Bikia V, Stergiopulos N. Design and computational optimization of compliance-matching aortic grafts. Front Bioeng Biotechnol, 2023, 11: 1179174.
8. Wang W, Gao F, He X, et al. Efficacy of tolvaptan in postoperative volume therapy for acute Stanford type A aortic dissection. BMC Cardiovasc Disord, 2023, 23(1): 95.
9. 何学志, 高峰, 高洋, 等. 扩大主动脉外膜内翻并人工血管端翻转吻合处理急性A型主动脉夹层根部的近期效果. 中国胸心血管外科临床杂志, 2022, 29(3): 371-376.He XZ, Gao F, Gao Y, et al. Short-term effects of extended adventitial inversion with graft eversion anastomosis technique in the root treatment of acute type A aortic dissection. Chin J Clin Thorac Cardiovasc Surg, 2022, 29(3): 371-376.
10. Jalaie H, Steitz J, Afify M, et al. In vivo endothelialization and neointimal hyperplasia assessment after angioplasty of sheep carotid artery with a novel polycarbonate polyurethane patch. J Biomater Appl, 2019, 34(2): 208-218.
11. Gaudino M, Benedetto U, Fremes S, et al. Association of radial artery graft vs saphenous vein graft with long-term cardiovascular outcomes among patients undergoing coronary artery bypass grafting: A systematic review and meta-analysis. JAMA, 2020, 324(2): 179-187.
12. Agrafiotis E, Mayer C, Grabenwöger M, et al. Global and local stiffening of ex vivo-perfused stented human thoracic aortas: A mock circulation study. Acta Biomater, 2023, 161: 170-183.
13. 马金辉, 张岚林, 阳晟, 等. 升主动脉包裹联合Ⅰ型杂交全主动脉弓修复术治疗主动脉弓部病变的临床疗效分析. 中国胸心血管外科临床杂志, 2024, 31(9): 1313-1318.Ma JH, Zhang LL, Yang S, et al. Clinical effect of ascending aorta banding combined with typeⅠ hybrid aortic arch repair on aortic arch diseases. Chin J Clin Thorac Cardiovasc Surg, 2024, 31(9): 1313-1318.
14. 蒙茂龙, 王尧, 卢平凡, 等. 改良Bentall手术中应用残余瘤壁根部包裹技术的近期疗效. 中国胸心血管外科临床杂志, 2024, 31(2): 283-287.Meng ML, Wang Y, Lu PF, et al. Short-term results of sleeve wrapping technique using remnant aortic wall in modified Bentall procedure. Chin J Clin Thorac Cardiovasc Surg, 2024, 31(2): 283-287.
15. 周晓辉, 关强, 刘睿, 等. 主动脉瓣置换术+升主动脉成形术后升主动脉直径变化及中远期临床结果分析. 中国胸心血管外科临床杂志, 2023, 30(3): 381-388.Zhou XH, Guan Q, Liu R, et al. Reduction ascending aortoplasty in adult patients undergoing aortic valve replacement: Aorta diameter change, mid- and long-term clinical results. Chin J Clin Thorac Cardiovasc Surg, 2023, 30(3): 381-388.
16. Gu Y, Tian C, Qin Y, et al. The novel hybrid polycarbonate polyurethane/polyester three-layered large-diameter artificial blood vessel. J Biomater Appl, 2022, 36(6): 965-975.
17. Liu D, Meng Q, Hu J. Bacterial nanocellulose hydrogel: A promising alternative material for the fabrication of engineered vascular grafts. Polymers (Basel), 2023, 15(18): 3812.
18. Naegeli KM, Kural MH, Li Y, et al. Bioengineering human tissues and the future of vascular replacement. Circ Res, 2022, 131(1): 109-126.
19. Turner ME, Blum KM, Watanabe T, et al. Tissue engineered vascular grafts are resistant to the formation of dystrophic calcification. Nat Commun, 2024, 15(1): 2187.
20. Di Francesco D, Pigliafreddo A, Casarella S, et al. Biological materials for tissue-engineered vascular grafts: Overview of recent advancements. Biomolecules, 2023, 13(9): 1389.
21. Li Z, Giarto J, Zhang J, et al. Design and synthesis of P(AAm-co-NaAMPS)-alginate-xanthan hydrogels and the study of their mechanical and rheological properties in artificial vascular graft applications. Gels, 2024, 10(5): 319.
22. Jeong HJ, Nam H, Kim JS, et al. Dragging 3D printing technique controls pore sizes of tissue engineered blood vessels to induce spontaneous cellular assembly. Bioact Mater, 2023, 31: 590-602.
23. Bellani CF, Yue K, Flaig F, et al. Suturable elastomeric tubular grafts with patterned porosity for rapid vascularization of 3D constructs. Biofabrication, 2021, 13(3): 035020.
24. Uehara H, Uchiyama M, Imazuru T. Placement of stent grafts with different calibers into the true and false lumens of anastomotic aneurysms after descending aortic replacement for aortic dissection. J Cardiothorac Surg, 2024, 19(1): 9.
25. Liu D, Han J, Zhuang X, et al. Evaluation of mechanical properties and biocompatibility of three-layer PCL/PLLA small-diameter vascular graft with pore diameter gradient. Eur Poly J, 2023, 186: 111864.
26. Gu Y, Tian C, Qin Y, et al. The novel hybrid polycarbonate polyurethane/polyester three-layered large-diameter artificial blood vessel. J Biomater Appl, 2022, 36(6): 965-975.
27. Yao Y, Zaw AM, Anderson DEJ, et al. Fucoidan and topography modification improved in situ endothelialization on acellular synthetic vascular grafts. Bioact Mater, 2022, 22: 535-550.
28. Fernandes A, Miéville A, Grob F, et al. Endothelial-smooth muscle cell interactions in a shear-exposed intimal hyperplasia on-a-dish model to evaluate therapeutic strategies. Adv Sci (Weinh), 2022, 9(28): e2202317.
29. D'Alessio A. Role of Endothelial cell metabolism in normal and tumor vasculature. Cancers (Basel), 2023, 15(7): 1921.
30. Weber J, Weber M, Feile A, et al. Development of an in vitro blood vessel model using autologous endothelial cells generated from footprint-free hiPSCs to analyze interactions of the endothelium with blood cell components and vascular implants. Cells, 2023, 12(9): 1217.
31. Kole GE, Hasirci V, Yucel D. Development of a tri-layered vascular construct and in vitro evaluation of endothelization. Macromol Biosci, 2024, 24(5): e2300369.
32. Zhao D, Yuan W, Fang C, et al. Biomimetic vascular grafts with circumferentially and axially oriented microporous structures for native blood vessel regeneration. Adv Funct Mater, 2024, 34(1): 2308888.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesA novel three-layer large-diameter artificial blood vessel based on levorotatory polylactic acid and polycaprolactone based on electrospinning and ultrasonic reaming: Preliminary animal evaluation

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