DOI
https://doi.org/10.25772/Y8NB-TQ25
Author ORCID Identifier
https://orcid.org/0000-0002-8467-973X
Defense Date
2022
Document Type
Dissertation
Degree Name
Doctor of Philosophy
Department
Mechanical and Nuclear Engineering
First Advisor
Dr. Joao S. Soares
Second Advisor
Dr. Gary Tepper
Third Advisor
Dr. Stefano Toldo
Fourth Advisor
Dr. Laleh Golshahi
Fifth Advisor
Dr. Michael McClure
Abstract
Coronary artery bypass surgery (CABG) remains one of the most common cardiac surgical procedures performed worldwide, frequently involving multiple bypasses, and commonly employing the patient’s internal mammary artery, radial artery, or saphenous vein. CABG is often not possible because native vessels were already employed in previous interventions or are diseased themselves. Synthetic vascular grafts are currently integral tools of vascular surgery and have had relative success in large-caliber applications providing substantial benefit to aortic or iliac grafting; however, small diameter (< 6 mm) arterial grafts have not yet translated into clinical effectiveness due to thrombosis and anastomotic intimal hyperplasia. ETVGs present an exciting potential alternative in vascular grafting by offering a blood vessel substitute that could exhibit all the functional characteristics of native vasculature. In addition to relieving supply limitations associated with coronary artery bypass surgery ETVGs are especially ideal for pediatric patients with congenital heart disease who require grafts that grow as they do, eliminating the need for reoccurring invasive surgeries.
Though the role of biomechanics in regulating cellular behavior promoting non-thrombogenicity, vasoactivity, and ECM synthesis and maintenance is well established, scientists have yet to find the optimum culture conditions to obtain viable small diameter ETVGs suitable for clinical application. Mechanical conditioning is widely recognized as one of the most relevant methods to enhance tissue accretion and microstructure, leading to engineered tissues with improved mechanical behaviors. However, determining optimal conditioning protocols for ETVGs is rather empirical and based on extensive trial-and-error iterations. We are unable to predict this cause-and-effect relationship accurately, and thus unable to reliably produce ETVGs with targeted properties. This is only magnified when considering the phase after deployment where the understanding of the in vivo performance of the grafts until fully absorbed is crucial to improve patency.
Rights
© Sarah Saunders
Is Part Of
VCU University Archives
Is Part Of
VCU Theses and Dissertations
Date of Submission
8-10-2022