{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T23:18:12Z","timestamp":1784762292208,"version":"3.55.0"},"reference-count":29,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T00:00:00Z","timestamp":1748908800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: Among aortic diseases in children, congenital defects such as coarctation of the aorta (CoA), interrupted aortic arch (IAA), hypoplastic aortic arch (HAA), and hypoplastic left heart syndrome (HLHS) predominate. Tissue patches are applied in pediatric cardiovascular surgery for the repair of congenital aortic defects as a filling material to replenish missing tissue or as a substitute material for the complete reconstruction of the vascular wall along the course of the vessel. This retrospective single-center study aimed to present the safety and feasibility of extracellular matrix (ECM) biological scaffolds in pediatric aortic surgery. Patients and methods: There were 26 patients (17 newborns and nine children), who underwent surgical procedures in the Department of Pediatric Cardiac Surgery (Pozna\u0144, Poland) between 2023 and 2024. The patients\u2019 population was divided into two subgroups according to the hemodynamic nature of the primary diagnosis of the congenital heart defect and the performed pediatric cardiovascular surgery. The first group included 18 (72%) patients after aortic arch repair for interrupted aortic arch and\/or hypoplastic aortic arch, while the second group included seven (28%) patients after aortopulmonary anastomosis. In the first group, patches were used to reconstruct the aortic arch by forming an artificial arch with three separate patches sewn together, primarily addressing the hypoplastic or interrupted segments. In the second group, patches were applied to augment the anastomosis site between the pulmonary trunk and the aortic arch, specifically at the connection points in procedures, such as the Damus\u2013Kaye\u2013Stansel or Norwood procedures. The analysis was based on data acquired from the national cardiac surgery registry. Results: The overall mortality in the presented group was 15%. All procedures were performed using median sternotomy with a cardiopulmonary bypass. The cardiopulmonary bypass (CPB) and aortic cross-clamp (AoX) median times were 144 (107\u2013176) and 53 (33\u201379) min, respectively. There were two (8%) cases performed in deep hypothermic circulatory arrest (DHCA). The median postoperative stay in the intensive care unit (ICU) was 284 (208\u2013542) h. The median mechanical ventilation time was 226 (103\u2013344) h, including 31% requiring prolonged mechanical ventilation support. Postoperative acute kidney failure requiring hemodiafiltration (HDF) was noticed in 12% of cases. Follow-up data, collected via routine transthoracic echocardiography (TTE) and clinical assessments over a median of 418 (242.3\u2013596.3) days, showed no evidence of patch-related complications such as restenosis, aneurysmal dilation, or calcification in surviving patients. One patient required reintervention on the same day due to a significantly narrow ascending aorta, unrelated to patch failure. No histological data from explanted patches were available, as no patches were removed during the study period. The median (Q1\u2013Q3) hospitalization time was 21 (16\u201343) days. Conclusions: ProxiCor\u00ae biological patches derived from the extracellular matrix can be safely used in pediatric patients with congenital aortic arch disease. Long-term follow-up is necessary to confirm the durability and growth potential of these patches, particularly regarding their resistance to calcification and dilation.<\/jats:p>","DOI":"10.3390\/jcm14113955","type":"journal-article","created":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T03:57:34Z","timestamp":1749009454000},"page":"3955","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Extracellular Matrix Tissue Patch for Aortic Arch Repair in Pediatric Cardiac Surgery: A Single-Center Experience"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7319-2133","authenticated-orcid":false,"given":"Marcin","family":"G\u0142adki","sequence":"first","affiliation":[{"name":"Department of Pediatric Cardiac Surgery, Poznan University of Medical Sciences, 60-572 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4148-3486","authenticated-orcid":false,"given":"Anita","family":"W\u0119clewska","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiac Surgery, Poznan University of Medical Sciences, 60-572 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pawe\u0142 R.","family":"Bednarek","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiac Surgery, Poznan University of Medical Sciences, 60-572 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8080-2764","authenticated-orcid":false,"given":"Tomasz","family":"Urbanowicz","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, 61-848 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4213-8708","authenticated-orcid":false,"given":"Anna","family":"Olasi\u0144ska-Wi\u015bniewska","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, 61-848 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bart\u0142omiej","family":"Koci\u0144ski","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiac Surgery, Poznan University of Medical Sciences, 60-572 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2442-4644","authenticated-orcid":false,"given":"Marek","family":"Jemielity","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiac Surgery, Poznan University of Medical Sciences, 60-572 Pozna\u0144, Poland"},{"name":"Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, 61-848 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1016\/j.pcl.2020.06.008","article-title":"Outcomes in Hypoplastic Left Heart Syndrome","volume":"67","author":"Metcalf","year":"2020","journal-title":"Pediatr. Clin. N. Am."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1093\/icvts\/ivab264","article-title":"Cormatrix\u00ae for vessel reconstruction in paediatric cardiac surgery-a word of caution","volume":"34","author":"Weis","year":"2022","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"566","DOI":"10.5966\/sctm.2012-0044","article-title":"Concise review: Tissue-engineered vascular grafts for cardiac surgery: Past, present, and future","volume":"1","author":"Kurobe","year":"2012","journal-title":"Stem Cells Transl. Med."},{"key":"ref_4","first-page":"285","article-title":"Progress in the application of patch materials in cardiovascular surgery","volume":"48","author":"Shao","year":"2023","journal-title":"Zhong Nan Da Xue Xue Bao Yi Xue Ban."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1053\/j.semtcvs.2017.09.013","article-title":"Calcification or Not. This Is the Question. A 1-Year Study of Bovine Pericardial Vascular Patches (CardioCel) in Minipigs","volume":"30","author":"Salameh","year":"2018","journal-title":"Semin. Thorac. Cardiovasc. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Harris, A.G., Salih, T., Ghorbel, M.T., Caputo, M., Biglino, G., and Carrabba, M. (2023). Biological Scaffolds for Congenital Heart Disease. Bioengineering, 10.","DOI":"10.3390\/bioengineering10010057"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1007\/s00246-023-03153-6","article-title":"Grafts and Patches: Optimized but Not Optimal Materials for Congenital Heart Surgery","volume":"44","author":"Peivandi","year":"2023","journal-title":"Pediatr. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1177\/026765919701200207","article-title":"Intermittent antegrade\/selective cerebral perfusion during circulatory arrest for repair of the aortic arch","volume":"12","author":"Maas","year":"1997","journal-title":"Perfusion"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"S59","DOI":"10.1016\/j.jtcvs.2012.11.073","article-title":"Selective cerebral perfusion: A review of the evidence","volume":"145","author":"Spielvogel","year":"2013","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1051\/ject\/201244098","article-title":"History and use of del Nido cardioplegia solution at Boston Children\u2019s Hospital","volume":"44","author":"Matte","year":"2012","journal-title":"J. Extra. Corpor. Technol."},{"key":"ref_11","first-page":"1492","article-title":"The impact of deep and moderate body temperatures on end-organ function during hypothermic circulatory arrest","volume":"40","author":"Khaladj","year":"2011","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1177\/1089253206297409","article-title":"Therapeutic hypothermia","volume":"11","author":"Arrica","year":"2007","journal-title":"Semin. Cardiothorac. Vasc. Anesth."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Goco\u0142, R., Hudziak, D., Bis, J., Mendrala, K., Morkisz, \u0141., Podsiad\u0142o, P., Kosi\u0144ski, S., Pi\u0105tek, J., and Darocha, T. (2021). The Role of Deep Hypothermia in Cardiac Surgery. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18137061"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3232","DOI":"10.1111\/jocs.16827","article-title":"Medium-term follow-up of autologous pericardial patches for pediatric aortic arch reconstruction","volume":"37","author":"Pavy","year":"2022","journal-title":"J. Card. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"501","DOI":"10.23736\/S0021-9509.16.08061-7","article-title":"The long-term follow-up of large-diameter Dacron\u00ae vascular grafts in surgical practice: A review","volume":"60","author":"Spadaccio","year":"2019","journal-title":"J. Cardiovasc. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Durko, A.P., Yacoub, M.H., and Kluin, J. (2020). Tissue Engineered Materials in Cardiovascular Surgery: The Surgeon\u2019s Perspective. Front. Cardiovasc. Med., 7.","DOI":"10.3389\/fcvm.2020.00055"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/S0022-5223(03)00030-8","article-title":"Comparison of polytetrafluoroethylene patch aortoplasty and end-to-end anastomosis for coarctation of the aorta","volume":"126","author":"Walhout","year":"2003","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1161\/01.CIR.92.9.132","article-title":"Coarctation of the aorta. Repair with polytetrafluoroethylene patch aortoplasty","volume":"92","author":"Backer","year":"1995","journal-title":"Circulation"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1177\/21501351211003502","article-title":"Reconstruction of the Aortic Arch in Neonates and Infants: The Importance of Patch Material","volume":"12","author":"Kurul","year":"2021","journal-title":"World J. Pediatr. Congenit. Heart Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1093\/ejcts\/ezs638","article-title":"Short-term experience of porcine small intestinal submucosa patches in paediatric cardiovascular surgery","volume":"44","author":"Witt","year":"2013","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1093\/icvts\/ivt268","article-title":"Evaluation of a tissue-engineered bovine pericardial patch in paediatric patients with congenital cardiac anomalies: Initial experience with the ADAPT-treated CardioCel\u00ae patch","volume":"17","author":"Neethling","year":"2013","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e10706","DOI":"10.1002\/btm2.10706","article-title":"Cardiovascular patches applied in congenital cardiac surgery: Current materials and prospects","volume":"10","author":"Sun","year":"2024","journal-title":"Bioeng. Transl. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1093\/icvts\/ivv076","article-title":"Early and mid-term clinical experience with extracellular matrix scaffold for congenital cardiac and vascular reconstructive surgery: A multicentric Italian study","volume":"21","author":"Padalino","year":"2015","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1186\/s13019-019-0871-5","article-title":"Pericardial closure with extracellular matrix scaffold following cardiac surgery associated with a reduction of postoperative complications and 30-day hospital readmissions","volume":"14","author":"Rego","year":"2019","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"188","DOI":"10.21037\/tp.2018.02.01","article-title":"Tissue engineered vascular grafts for pediatric cardiac surgery","volume":"7","author":"Shoji","year":"2018","journal-title":"Transl. Pediatr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"H585","DOI":"10.1152\/ajpheart.00372.2022","article-title":"ECM roles and biomechanics in cardiac tissue decellularization","volume":"323","author":"Whitehead","year":"2022","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1290","DOI":"10.1016\/j.jtcvs.2015.08.007","article-title":"The clinical application potential of extracellular matrix in cardiac tissue engineering","volume":"150","author":"Maeda","year":"2015","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"4375","DOI":"10.3390\/ijms10104375","article-title":"ECM-based materials in cardiovascular applications: Inherent healing potential and augmentation of native regenerative processes","volume":"10","author":"Piterina","year":"2009","journal-title":"Int. J. Mol. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.actbio.2008.09.013","article-title":"Extracellular matrix as a biological scaffold material: Structure and function","volume":"5","author":"Badylak","year":"2009","journal-title":"Acta Biomater."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/11\/3955\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:46:55Z","timestamp":1760032015000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/11\/3955"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,3]]},"references-count":29,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["jcm14113955"],"URL":"https:\/\/doi.org\/10.3390\/jcm14113955","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,3]]}}}