Status: Funded - Open
Autologous umbilical vein as a shunt conduit in neonatal cardiac surgery
David Hoganson, M.D.
BACKGROUND: Small diameter systemic to pulmonary shunts available for use in children with congenital heart disease are made of Teflon and have high rates of stenosis, thrombosis and reintervention.
GAP: Shunts in congenital cardiac surgery have imperfect hemodynamics and do not have endothelialized surfaces. It is not known if the high rates of stenosis and reintervention could be reduced if the shunts were created with an endothelialized conduit with physiologic hemodynamics.
HYPOTHESIS: Autologous umbilical veins may be stored for up to one weeks after birth then implanted as a shunt material for patients with congential heart disease.
METHODS: Umbilical veins will be tested under static and flow culture conditions and evaluated for mechanical integrity, cellular viability, preservation of endothelial function and ability to be sutured into ideal shape shunt determined by computational fluid dynamics driven optimization.
RESULTS: Results of flow culture utilizing the Lifeport preservation system have demonstrated viability and very acceptable mechanical properties of harvested umbilical veins.
IMPACT: Endothelialized shunts with improved hemodynamics may significantly reduce the considerable morbidity and mortality related to shunts placed in infants. Shunts currently have an intervention rate between 27 and 70% and children with BT shunts have an interstage mortality rate of 5-19% with shunt thrombosis being an expected leading cause of mortality.