Patient specific 3D printed tissue engineered vascular graft for aortic reconstruction designed by artificial intelligence algorithm.

1这项研究的目标是创建针对患者的、血液动力学优化的组织工程化 2用于主动脉弓修复术的血管移植物(TEVG)。这些TEVG针对高压进行了优化 3循环使用3D打印技术和人工智能，并将随着患者的成长，希望 4避免了未来需要手术替换移植物，这种情况可能发生在当代的牙弓重建中 5材料。先天性心脏病(CHD)是先天畸形导致的主要死亡原因。尽管 6先天性心脏病的外科治疗取得重大进展，这是发病率和死亡率的一个重要来源 7主动脉弓不同解剖结构手术的复杂性。之前的研究已经证明 8手术重建狭窄或发育不全的大动脉后所产生的弓形几何形状对 9最大限度地减少能量损失和拱门内的不良血流，这可能会导致高血压，异常 10血管反应和心功能不全。确保针对患者的移植物设计实现理想的重建 术前能量损失和壁切应力最小的11路手术可能会给患者带来长期好处 12健康和生活质量。 13我们已经在小动物和大动物身上证实了TEVG的天然血管样新组织形成 14项研究。基于这些经验，我们开发了一种结合3D打印的新型3D打印技术 15个金属芯棒，采用纳米纤维电纺技术。通过这种3D打印技术，我们展示了 在绵羊模型中，16只TEVG在静脉循环中形成了天然的新生血管样结构。对于下一步，我们 17旨在开发可应用于主动脉重建的动脉循环移植物。我们还将发展 18自动设计算法设计最佳移植物形状，以减少患者特定的时间和成本 19设计。我们假设，使用我们的3D打印技术可以设计出针对患者的TEVG， 20辅助术前成像和血流数据、计算机辅助设计(CAD)、自动设计 基于计算流体动力学(CFD)结果的21种算法，并将展示适当的肿瘤组织 22形成和生长，同时保持最佳设计的血流动力学。 23该项目将是向临床应用患者专用血管移植物迈出的重要一步 24概括了土生土长的解剖和机械性能。这项工作的成果将产生更广泛的影响 25关于用于植入的其他更复杂的心血管结构的设计和制造。这一范式 26血管移植技术的转变将提高儿科患者护理的质量和安全性。

1 The goal of this study is to create patient-specific, hemodynamically optimized, tissue engineered 2 vascular grafts (TEVG) for use in aortic arch repair surgery. These TEVGs are optimized for high pressure 3 circulation using 3D printing technology and artificial intelligence, and will grow with the patient, in hopes of 4 obviating need for future surgeries to replace grafts, which can occur with contemporary arch reconstruction 5 materials. Congenital heart disease (CHD) is the leading cause of death due to congenital anomalies. Despite 6 significant advances in surgical management for CHD, one significant source of morbidity and mortality arises 7 from the complexity of surgery for diverse anatomies in the aortic arch. Previous studies have demonstrated 8 that the resultant arch geometry after surgical reconstruction of stenotic or hypoplastic aortas is important to 9 minimize reduce energy loss and undesirable flow inside the arch, which can lead to hypertension, abnormal 10 vascular response and ventricular dysfunction. Ensuring a patient-specific graft design for ideal reconstructed 11 route before surgery with minimum energy loss and wall shear stress may yield long-term benefits for patient 12 health and quality of life. 13 We have demonstrated native vessel like neotissue formation of TEVG in small and large animal 14 studies. Based on these experiences, we have developed a novel 3D printing technology combining 3D printed 15 metal mandrels with nanofiber electro-spun technology. With this 3D printing technology, we showed that 16 TEVG developed native like neovessel formation in venous circulation in a sheep model. For this next step, we 17 aim to develop grafts in arterial circulation that can be applied to aortic reconstruction. We will also develop 18 automatic design algorithms to design optimal graft shape in order to reduce time and cost of patient specific 19 design. We hypothesize that patient-specific TEVG using our 3D printing technology can be designed, 20 aided by pre-operative imaging and flow data, computer assisted design (CAD), automatic design 21 algorithms based on computation fluid dynamics (CFD) results, and will demonstrate proper neotissue 22 formation and growth while maintaining optimally designed hemodynamics. 23 This project will be an important step towards clinical application of patient-specific vascular grafts that 24 recapitulate the native anatomy and mechanical properties. The results of this work will have a broader impact 25 on the design and fabrication of other more complex cardiovascular structures for implantation. This paradigm 26 shift in vascular graft technology will improve the quality and safety of pediatric patient care.