VIDEO 1.

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Preclinical study of patient-specific cell-free nanofiber tissue-engineered vascular grafts (TEVGs) using 3D printing in a sheep model. Despite advances in surgical management of congenital heart disease, significant morbidity and mortality arise due to surgical complexity. Patient-specific graft design before surgery has the potential to overcome these challenges and improve patients’ quality of life. This study demonstrates our integrated approach of 3D imaging, 3D printing, and tissue engineering technology to design and create patient-specific vascular grafts before surgery in a sheep model. There were no significant differences in burst pressure and compliance between grafts and native inferior vena cava (IVC). The grafts showed native-like neotissue formation at 6 months after surgery with their scaffolds almost fully degraded, with only 2% of the initial scaffolds remaining on average. Extracellular matrix, elastin, and collagen production and endothelialization were similar in grafts and native IVC, with no vascular calcification. The presence of multilayer smooth muscle cells and a decreasing pressure gradient at 6 months compared with 3 months suggested graft remodeling. There was a significant positive relationship between graft wall thickness and CD68⁺ macrophage infiltration into the scaffold. We have demonstrated the feasibility of creating patient-specific nanofiber TEVGs using combined technology of electrospinning and 3D printing. Video available at: http://www.jtcvsonline.org/article/S0022-5223(16)31466-0/addons.