Structure of neointima in bare metal stents and expanded poly(tetrafluoroethylene) patches in children after two-step surgical treatment of tetralogy of Fallot
Abstract
Background. Neointimal hyperplasia frequently accompanies
reconstructive cardiovascular surgery which commonly utilises metal, polymer or
xenogeneic biomaterials. If uncontrolled, neointimal hyperplasia results in
vascular occlusion ultimately requiring repeated surgery. Therefore, long-term
maintenance of primary patency requires prevention of neointimal hyperplasia by
means of rapid endothelialisation. Success of this task significantly depends
on our understanding of neointimal composition and ultrastructure.
Aim: to investigate ultrastructure of pulmonary artery
(PA) at both steps of total surgical repair in low-birth-weight children with
tetralogy of Fallot (ToF), where the first and the second step employ bare
metal stents and expanded poly(tetrafluoroethylene) patches (ePTFE, Gore-Tex).
Material and methods.
Here, we investigated
six PA segments in the stents excised from right ventricular outflow tract
(RVOT) and pulmonary artery during the total surgical repair in
low-birth-weight (<3 kg) children with ToF. Stents functioned from 2.5 to 6
months. PA with ePTFE patches were excised during the repeated replacement of
the pulmonary valve because of its failure in 10–13 years after the total
surgical repair. Tissue samples were fixed in formalin, postfixed in osmium
tetroxide, stained with uranyl acetate, dehydrated in ethanol and acetone and
impregnated into epoxy resin. Upon epoxy resin embedding, samples were grinded,
polished, counterstained with lead citrate, and visualised by backscattered
scanning electron microscopy.
Results. Neointima in stented PA was fully endothelialised and
consisted of dense or loose connective tissue which was formed by fibroblasts
and smooth muscle cells and enclosed the stent struts. Neointima at the surface
of ePTFE patches contained elastic fibers below the endothelial monolayer and a
fibroblast layer surrounded by collagen fibers. ePTFE patches suffered from
marginal calcification extending to the adjacent tissues.
Conclusion. Neointima in bare metal stents and expanded
poly(tetrafluoroethylene) patches have different histoarchitecture but is free
from acute inflammation.
Keywords:tetralogy of Fallot; stenting; neointima; bare metal stents; poly(tetrafluoroethylene)
Funding. This study was supported by the Complex Program of
Basic Research under the Siberian Branch of the Russian Academy of Sciences
within the Basic Research Topic of Research Institute for Complex Issues of
Cardiovascular Diseases No. 0419-2021-001 "Novel anti-atherosclerotic
therapies and machine learning solutions for automated diagnosis and
prognostication of cardiovascular disease". The study is financially
supported by the Ministry of Science and Higher Education of the Russian
Federation (National Project Science and Universities).
For citation: Mukhamadiyarov R.A., Evtushenko A.V., Tarasov R.S.,
Khalivopulo I.K., Lyapin A.A., Kutikhin A.G. Structure of neointima in bare
metal stents and expanded poly (tetrafluoroethylene) patches in children after
two-step surgical treatment of tetralogy of Fallot. Clinical and Experimental
Surgery. Petrovsky Journal. 2022; 10 (3): 64–75. DOI: https://doi.org/10.33029/2308-1198-2022-10-3-64-75
(in Russian)
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