Late-term results of tissue-engineered vascular grafts in humans
Late-term results of tissue-engineered vascular grafts in humans
复制标题
DOI：
10.1016/j.jtcvs.2009.09.057
复制
发表时间：
2010-02-01
影响因子：
6
通讯作者：
Shinoka, Toshiharu
中科院分区：
文献类型：
--
作者：
Hibino, Narutoshi;McGillicuddy, Edward;Shinoka, Toshiharu
目的：开发一种具有生长和重塑能力的组织工程血管移植物，对推进心脏手术具有重要意义。2001年，我们开始了一项人体试验，在单心室生理患者中评估这些移植物。我们报告了一组接受组织工程血管移植物作为心外腔肺连接管道植入的患者的后期临床和影像学监测情况。
方法：获取自体骨髓并收集单核细胞成分。将单核细胞接种到由聚乙醇酸和ε - 己内酯/L - 丙交酯组成的可生物降解支架上，并作为心外腔肺连接管道植入单心室生理患者体内。通过术后门诊随访和电话随访患者。此外，超声检查、血管造影、计算机断层扫描和磁共振成像用于术后移植物监测。
结果：共植入25个移植物（患者中位年龄为5.5岁）。无移植物相关死亡（平均随访5.8年）。无动脉瘤形成、移植物破裂、移植物感染或异位钙化的证据。1例患者出现部分壁内血栓，经华法林治疗成功。4例患者出现移植物狭窄，并成功接受了经皮血管成形术。
结论：组织工程血管移植物可用于单心室生理患者作为连接管道。移植物狭窄是移植物失败的主要模式。有必要进一步随访并研究狭窄的机制。（《胸心血管外科杂志》2010年；139：431 - 436）
Objective: The development of a tissue-engineered vascular graft with the ability to grow and remodel holds promise for advancing cardiac surgery. In 2001, we began a human trial evaluating these grafts in patients with single ventricle physiology. We report the late clinical and radiologic surveillance of a patient cohort that underwent implantation of tissue-engineered vascular grafts as extracardiac cavopulmonary conduits.Methods: Autologous bone marrow was obtained and the mononuclear cell component was collected. Mononuclear cells were seeded onto a biodegradable scaffold composed of polyglycolic acid and epsilon-caprolactone/L-lactide and implanted as extracardiac cavopulmonary conduits in patients with single ventricle physiology. Patients were followed up by postoperative clinic visits and by telephone. Additionally, ultrasonography, angiography, computed tomography, and magnetic resonance imaging were used for postoperative graft surveillance.Results: Twenty-five grafts were implanted (median patient age, 5.5 years). There was no graft-related mortality (mean follow-up, 5.8 years). There was no evidence of aneurysm formation, graft rupture, graft infection, or ectopic calcification. One patient had a partial mural thrombosis that was successfully treated with warfarin. Four patients had graft stenosis and underwent successful percutaneous angioplasty.Conclusion: Tissue-engineered vascular grafts can be used as conduits in patients with single ventricle physiology. Graft stenosis is the primary mode of graft failure. Further follow-up and investigation for the mechanism of stenosis are warranted. (J Thorac Cardiovasc Surg 2010; 139: 431-6)