Porcine carotid artery replacement with biodegradable electrospun poly-e-caprolactone vascular prosthesis
Porcine carotid artery replacement with biodegradable electrospun poly-e-caprolactone vascular prosthesis
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DOI：
10.1016/j.jvs.2013.03.004
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发表时间：
2014-01-01
影响因子：
4.3
通讯作者：
Walpoth, Beat H.
中科院分区：
文献类型：
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作者：
Mrowczynski, Wojciech;Mugnai, Damiano;Walpoth, Beat H.
目的：不断寻找现成的小口径血管假体，并取得满意的早期和晚期效果。可生物降解支架，通过受体细胞再生新血管，可以成为成人和儿童，紧急和选择性心血管手术的合适选择。方法：对猪动脉置换术中新型可生物降解血管假体进行短期实验评估。11头猪采用可生物降解的聚己内酯（PCL）纳米纤维假体（内径4 mm，长5 cm）替代双侧颈动脉；或膨胀聚四氟乙烯（ePTFE）假体作为对照。围手术期抗凝采用静脉注射肝素（双基线激活凝血时间）。术后，直到研究结束1个月，动物每天服用阿司匹林和氯吡格雷。术中和牺牲时测量传递时间流。多普勒超声（1周和4周）和选择性颈动脉造影（4周）评估通畅程度。为了研究移植物与宿主的相互作用，对所有移植物进行了组织学、形态学和扫描电镜分析。结果：手术处理和止血效果良好。PCL移植通畅率为78% (7/9)，ePTFE移植通畅率为67%（4/6）。两组的过流时间和多普勒超声均未见血流、速度和直径随时间的显著变化。与天然颈动脉相比，两种假体在体内均未显示出可检测的顺应性。PCL的新生内皮化率为86%，ePTFE的新生内皮化率为58% （P = 0.008）。两种移植物的新生内膜形成相同。与ePTFE移植物相比，PCL移植物中巨噬细胞、肌成纤维细胞和毛细血管的外浸润更多，异物反应较轻。两种移植物均有相似的腔内血栓形成。结论：与ePTFE移植物相比，可生物降解的电纺PCL移植物具有良好的外科和力学性能，不形成动脉瘤，短期通畅性相似。快速内皮化和细胞向内生长证实了有利的PCL移植物与受体的生物相互作用。尽管早期效果良好，但临床应用前仍需长期随访。
Objective: There is a continuous search for shelf-ready small-caliber vascular prostheses with satisfactory early and late results. Biodegradable scaffolds, repopulated by recipient's cells regenerating a neovessel, can be a suitable option for adult and pediatric, urgent and elective cardiovascular procedures.Methods: This was a short-term experimental assessment of a new biodegradable vascular prosthesis for arterial replacement in the pig. Eleven pigs underwent bilateral carotid artery replacement with biodegradable electrospun poly-e-caprolactone (PCL) nanofiber prostheses (internal diameter, 4 mm; length, 5 cm); or expanded polytetrafluoroethylene (ePTFE) prostheses as control. Perioperative anticoagulation was achieved with intravenous heparin (double baseline activated clotting time). Postoperatively, until conclusion of the study at 1 month, animals received aspirin and clopidogrel daily. Transit time flow was measured intraoperatively and at sacrifice. Doppler ultrasound (1 and 4 weeks) and a selective carotid angiography (4 weeks) were performed to assess patency. All explanted grafts were analyzed by histology, morphometry, and scanning electron microscopy in order to study graft-host interaction.Results: Surgical handling and hemostasis of the new prostheses were excellent. Patency rate was 78% (7/9) for PCL grafts, compared with 67% (4/6) for ePTFE grafts. Transit time flow and Doppler ultrasound showed no significant changes in flow and velocity or diameter over time in both groups. Both prostheses showed no detectable in vivo compliance as compared with native carotid artery. Percent neoendothelialization was 86% for PCL and 58% for ePTFE grafts (P = .008). Neointima formation was equal in both grafts. More adventitial infiltration of macrophages, myofibroblasts, and capillaries was seen in PCL grafts with a milder foreign-body reaction when compared with ePTFE implants. Both grafts showed similar endoluminal thrombus formation.Conclusions: Biodegradable, electrospun PCL grafts showed good surgical and mechanical properties, no aneurysm formation, and similar short-term patency compared with ePTFE grafts. Rapid endothelialization and cell ingrowth confirms favorable PCL graft-recipient biological interaction. Despite good early results, long-term follow-up is required before clinical application.