Florian Ernst Martin Herrmann1, Peter Lamm2, Petra Wellmann3, Stefan Milz4, Christian Hagl3, Gerd Juchem3. 1. Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany. Electronic address: Florian.Herrmann@med.uni-muenchen.de. 2. Department of Cardiac Surgery, Chirurgisches Klinikum Muenchen Sued, Munich, Germany. 3. Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany. 4. Department of Anatomy, Ludwig Maximilian University, Munich, Germany.
Abstract
BACKGROUND: Lack of autologous graft material restricts the ability to treat patients requiring coronary artery bypass surgery (CABG). An off the shelf tissue engineered small diameter vascular graft is the holy grail of cardiovascular surgery. METHODS: Allograft saphenous veins were harvested from organ donors, cryopreserved, deendothelialized and then seeded with autologous endothelial cells prior to implantation during coronary artery bypass surgery. All patients treated were followed-up until death and angiographic results were collected. Grafts were explanted during autopsy and immunohistochemistry was performed. RESULTS: Twelve patients received 15 engineered grafts. Mean patient survival was 9.1 ± 1.8 years. Six month graft patency was 80 (95% CI: 59-100) and 9 month graft patency was 50 (95% CI: 27-93) - graft patency detected up to 32 months after surgery. Immunohistochemistry in grafts explanted showed a presence of CD31 and CD68 positive cells in the luminal region of the vessel walls and layers of Collagen Type I in the abluminal vessel walls. CONCLUSIONS: Our small diameter tissue engineered vascular graft shows openness up to 32 months after implantation. Immunohistochemistry suggests that monocyte activation may lead to vessel remodeling with thickening of the vessel wall. Research should concentrate on a manipulation of remodeling processes.
BACKGROUND: Lack of autologous graft material restricts the ability to treat patients requiring coronary artery bypass surgery (CABG). An off the shelf tissue engineered small diameter vascular graft is the holy grail of cardiovascular surgery. METHODS: Allograft saphenous veins were harvested from organ donors, cryopreserved, deendothelialized and then seeded with autologous endothelial cells prior to implantation during coronary artery bypass surgery. All patients treated were followed-up until death and angiographic results were collected. Grafts were explanted during autopsy and immunohistochemistry was performed. RESULTS: Twelve patients received 15 engineered grafts. Mean patient survival was 9.1 ± 1.8 years. Six month graft patency was 80 (95% CI: 59-100) and 9 month graft patency was 50 (95% CI: 27-93) - graft patency detected up to 32 months after surgery. Immunohistochemistry in grafts explanted showed a presence of CD31 and CD68 positive cells in the luminal region of the vessel walls and layers of Collagen Type I in the abluminal vessel walls. CONCLUSIONS: Our small diameter tissue engineered vascular graft shows openness up to 32 months after implantation. Immunohistochemistry suggests that monocyte activation may lead to vessel remodeling with thickening of the vessel wall. Research should concentrate on a manipulation of remodeling processes.
Authors: Vasileios Exarchos; Ema Zacharova; Sebastian Neuber; Costanza Giampietro; Sarah E Motta; Hristian Hinkov; Maximilian Y Emmert; Timo Z Nazari-Shafti Journal: Front Cardiovasc Med Date: 2022-09-14