Biogenic Polymers for Congenital Cardiac Surgery: In Vitro Durability Testing

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OBJECTIVES: Currently available materials in congenital cardiac surgery (CCS) are far from optimal because they do not facilitate growth, remodelling, or renewal, resulting in poorer long-term outcomes due to material-related limitations. Bacterial cellulose (BC), a biogenic polymer-based material produced by Acetobacter xylinum, has emerged as a promising alternative exhibiting excellent bio- and haemocompatibility. This study aimed to develop BC specifically for application in CCS by modifying culturing conditions to enhance its biomechanical resilience. METHODS: Bacterial cellulose was produced according to a standard protocol, and its biomechanical properties were evaluated using inflation pressure testing, thickness measurement, and uniaxial tensile testing. To improve these characteristics, 2 modifications, a change in the growth media composition and an extended incubation time, were implemented and subsequently evaluated in 5 further test series. The long-term durability of BC patches was assessed in a fatigue tester for 20 ± 0.5 million cycles, and potential structural damage was investigated using scanning electron microscopy. RESULTS: Utilizing the 2 modifications, BC patches demonstrated a capability to reach and maintain pressures exceeding 1000 mm Hg with a durability of 100% (n = 24), compared to the standard 20.8% (n = 24) at 500 mm Hg. The maximum tensile strength was enhanced from 0.311 ± 0.057 megapascal (MPa) to 0.986 ± 0.397 MPa (P < .0001), with a thickness of 3.89 ± 0.95 mm (P < .0001). In the long-term durability testing, patches endured durations equalling 6 months without failure while retaining structural integrity. CONCLUSIONS: The potential of BC for use in CCS was demonstrated by enhancing its biomechanical properties through culturing modifications, warranting further investigation and development of the biomaterial.

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