Grafts and Patches: Optimized but Not Optimal Materials for Congenital Heart Surgery

Abstract

A variety of materials are available for the surgery of children with congenital heart defects. In addition to growth-related mismatch, degeneration of the material in particular frequently leads to reoperation. Therefore, the choice of conduits and patches should be made carefully. This article provides an overview of the most commonly implanted materials in pediatric cardiac surgery.Structural changes can be detected in all available materials. Depending on the age at implantation and the site of implantation, the extent and time course of material degeneration vary. Autologous material is still the gold standard in reconstructive surgery. Biological materials have largely replaced artificial materials in clinical use.The search for the ideal material continues. In pediatric cardiac surgery, there are only optimized but no optimal materials.

Keywords: Conduit; Congenital heart surgery; Patch.

Fig. 1

Strongest, already macroscopically visible, calcifications in explants: A: Contegra® graft; B: homograft

Fig. 2

A: Inflammation in the context of endocarditis of a Contegra.® graft (EvG staining). B: Selective visualization of calcification of a homograft (Alizarin red staining)

Fig. 3

Degeneration (loosened tissue, reduced number of elastic fibers and partially destroyed collagen network) caused by the production process: top: native jugular vein of a young bull with intact birefringence in polarization image (right image) and bottom: Contegra.® graft with significantly reduced birefringence (right image: polarization)