Extracardiac total cavopulmonary connection using a tissue-engineered graft

Isomatsu, Yukihisa; Shinoka, Toshiharu; Matsumura, Goki; Hibino, Narutoshi; Konuma, Takeshi; Nagatsu, M; Kurosawa, Hiromi

doi:10.1016/s0022-5223(03)01042-0

Cited by 29 publications

(15 citation statements)

References 16 publications

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“…One of the most concerning issues of ECFP using artificial grafts is conduit stenosis and possibility of thrombus formation. Recently, pedicled autologous pericardium or tissue-engineered graft is being used at some centers to provide growth potential and to reduce the possibility of thrombus formation, but these kinds of grafts cannot be used universally [13][14][15][16][17][18][19]. Gore-Tex graft is the most widely used material in ECFP due to its availability in various size, relatively small amount of pseudo-intimal peel formation, and resistance to calcification.…”

Section: Discussionmentioning

confidence: 99%

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Midterm follow-up of the status of Gore-Tex graft after extracardiac conduit Fontan procedure☆

Lee

Hwang

Lim

et al. 2007

European Journal of Cardio-Thoracic Surgery

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During midterm follow-up of about 3 years, the conduit cross-sectional area decreased by 14%, and this did not differ according to the conduit size used. The extent of decrease of the conduit cross-sectional area remained stable irrespective of the follow-up duration. Sixteen millimeters conduit showed no evidence of clinically significant stenosis, but careful follow-up is warranted because of the possible conduit stenosis relative to the patients' somatic growth.

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Section: Discussionmentioning

confidence: 99%

“…To overcome the problems of artificial conduits, pedicled autologous pericardium or tissue-engineered graft as an extracardiac conduit are being used at some centers, and the longterm results are worth waiting for [13][14][15][16][17][18][19].…”

Section: Discussionmentioning

confidence: 99%

Midterm follow-up of the status of Gore-Tex graft after extracardiac conduit Fontan procedure☆

Lee

Hwang

Lim

et al. 2007

European Journal of Cardio-Thoracic Surgery

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“…The conduits were used to form extracardiac total cavopulmonary connections during repair of right ventricle outflow defects or single ventricle anatomy (Fig. 3) (39,95). Doing this provided the pulmonary system with deoxygenated blood from the systemic system.…”

Section: Tissue-engineered Vascular Conduitsmentioning

confidence: 99%

The Development of Tissue-Engineered Grafts for Reconstructive Cardiothoracic Surgical Applications

Mirensky

Breuer

2008

Pediatr Res

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Surgical correction of congenital heart defects often requires the use of valves, patches, or conduits to establish anatomic continuity. Homografts, xenografts, or mechanical prosthetic devices are frequently implanted during these surgical procedures. These grafts however lack growth potential, are associated with increased risk of thrombosis and infection and have limited durability, thus increasing the morbidity and mortality of their application in pediatric cardiac surgery. These limitations are being addressed through the development of living, biologic tissue-engineered valves, patches, and conduits. Pilot studies and phase 1 clinical trials are currently underway to evaluate their feasibility, safety, and efficacy. The optimal scaffold, cell source, and conditioning parameters, however, still remain to be determined and are areas of active research.

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“…Constructed from biodegradable polyester tubes seeded with autologous bone marrow mononuclear cells (BMCs), these grafts undergo extensive remodeling in animal recipients and appear to transform into living blood vessels, similar in morphology and function to the native veins into which they are interposed (4,5). Ongoing clinical studies evaluating BMC-seeded grafts as venous conduits for congenital heart surgery report excellent safety profiles and 100% patency rates at 1-3 years of follow-up (6)(7)(8). Additionally, these grafts demonstrate growth potential, suggesting they may be more effective for the pediatric patient population than currently available vascular grafts (8,9).…”

mentioning

confidence: 99%

Tissue-engineered vascular grafts transform into mature blood vessels via an inflammation-mediated process of vascular remodeling

Roh

Sawh-Martinez

Brennan

et al. 2010

Proc. Natl. Acad. Sci. U.S.A.

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508

499

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Biodegradable scaffolds seeded with bone marrow mononuclear cells (BMCs) are the earliest tissue-engineered vascular grafts (TEVGs) to be used clinically. These TEVGs transform into living blood vessels in vivo, with an endothelial cell (EC) lining invested by smooth muscle cells (SMCs); however, the process by which this occurs is unclear. To test if the seeded BMCs differentiate into the mature vascular cells of the neovessel, we implanted an immunodeficient mouse recipient with human BMC (hBMC)-seeded scaffolds. As in humans, TEVGs implanted in a mouse host as venous interposition grafts gradually transformed into living blood vessels over a 6-month time course. Seeded hBMCs, however, were no longer detectable within a few days of implantation. Instead, scaffolds were initially repopulated by mouse monocytes and subsequently repopulated by mouse SMCs and ECs. Seeded BMCs secreted significant amounts of monocyte chemoattractant protein-1 and increased early monocyte recruitment. These findings suggest TEVGs transform into functional neovessels via an inflammatory process of vascular remodeling.bone marrow | monocyte chemoattractant protein-1 | tissue engineering | neovascularization C ongenital heart disease is a leading cause of infant mortality, often requiring early surgical intervention to correct fatal cardiovascular malformations. Prosthetic vascular grafts are widely used in these reconstructive operations, but revisions are often necessary because of their inability to grow or effectively remodel within a growing child (1-3). A strategy to address this issue is the use of living tissue-engineered vascular grafts (TEVGs). Constructed from biodegradable polyester tubes seeded with autologous bone marrow mononuclear cells (BMCs), these grafts undergo extensive remodeling in animal recipients and appear to transform into living blood vessels, similar in morphology and function to the native veins into which they are interposed (4, 5). Ongoing clinical studies evaluating BMC-seeded grafts as venous conduits for congenital heart surgery report excellent safety profiles and 100% patency rates at 1-3 years of follow-up (6-8). Additionally, these grafts demonstrate growth potential, suggesting they may be more effective for the pediatric patient population than currently available vascular grafts (8,9).Although the functional efficacy and clinical utility of TEVGs are promising, little is known about how these BMC-seeded polyester tubes transform into living blood vessels in host recipients. It has been proposed that stem cells within the seeded BMC population differentiate into the endothelial cells (ECs) and smooth muscle cells (SMCs) of the developing neovessel, ultimately replacing the degrading polyester tube (10). This hypothesis, however, has not been directly examined.We recently developed a method for constructing small-diameter biodegradable synthetic scaffolds suitable for use as vascular grafts in mice (11). These tubular scaffolds are composed of the same materials and design used in clinical TEVGs...

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Extracardiac total cavopulmonary connection using a tissue-engineered graft

Cited by 29 publications

References 16 publications

Midterm follow-up of the status of Gore-Tex graft after extracardiac conduit Fontan procedure☆

Midterm follow-up of the status of Gore-Tex graft after extracardiac conduit Fontan procedure☆

The Development of Tissue-Engineered Grafts for Reconstructive Cardiothoracic Surgical Applications

Tissue-engineered vascular grafts transform into mature blood vessels via an inflammation-mediated process of vascular remodeling

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