Tissue-engineered Vascular Grafts in Children With Congenital Heart Disease: Intermediate Term Follow-up.

Abstract

Tissue engineering holds great promise for the advancement of cardiovascular surgery as well as other medical fields. Tissue-engineered vascular grafts have the ability to grow and remodel and could therefore make great advances for pediatric cardiovascular surgery. In 2001, we began a human clinical trial evaluating these grafts in patients with a univentricular physiology. Herein, we report the long-term results of patients who underwent implantation of tissue-engineered vascular grafts as extracardiac total cavopulmonary conduits. Tissue-engineered vascular grafts seeded with autologous bone marrow mononuclear cells were implanted in 25 patients with univentricular physiology. The graft is composed of a woven fabric of poly-l-lactide acid or polyglycolic acid and a 50:50 poly (l-lactic-co-ε-caprolactone) copolymer. Patients were followed up with postoperatively in a multidisciplinary clinic. Median patient age at operation was 5.5 years and the mean follow-up period was 11.1 years. There was no graft-related mortality during the follow-up period. There was also no evidence of aneurysmal formation, graft rupture, graft infection, or calcification. Seven (28%) patients had asymptomatic graft stenosis and underwent successful balloon angioplasty. Stenosis is the primary complication of the tissue-engineered vascular graft. Avoidance of anticoagulation therapy would improve patients' quality of life. Tissue-engineered vascular grafts have feasibility in pediatric cardiovascular surgery.

• Authors: Tadahisa Sugiura, Goki Matsumura, Shinka Miyamoto, Hideki Miyachi, Christopher K Breuer, Toshiharu Shinoka
• Journal: Seminars in thoracic and cardiovascular surgery (Semin Thorac Cardiovasc Surg) Vol. 30 Issue 2 Pg. 175-179 ( 2018) ISSN: 1532-9488 [Electronic] United States
• PMID: 29427773 (Publication Type: Clinical Trial, Journal Article, Video-Audio Media)
• Copyright: Copyright © 2018 Elsevier Inc. All rights reserved.

Chemical References

• Polyesters
• poly(lactic acid-co-epsilon-caprolactone)

Topics

• Adolescent
• Age Factors
• Angioplasty, Balloon
• Bioprosthesis
• Blood Vessel Prosthesis
• Blood Vessel Prosthesis Implantation (adverse effects, instrumentation)
• Child
• Child, Preschool
• Computed Tomography Angiography
• Feasibility Studies
• Female
• Follow-Up Studies
• Fontan Procedure (adverse effects, instrumentation)
• Graft Occlusion, Vascular (diagnostic imaging, physiopathology, therapy)
• Heart Defects, Congenital (diagnostic imaging, physiopathology, surgery)
• Humans
• Infant
• Male
• Polyesters (chemistry)
• Prosthesis Design
• Quality of Life
• Stem Cell Transplantation (adverse effects, methods)
• Time Factors
• Tissue Engineering (methods)
• Tissue Scaffolds
• Treatment Outcome
• Vascular Patency
• Vena Cava, Inferior (diagnostic imaging, physiopathology, surgery)
• Young Adult