Tissue Engineered Vessels and Valve constructed with Autologous Bone Marrow Cells Its Clinical Applications and Evaluations

目前使用的假体和生物假体材料缺乏生长潜力，因此必须随着儿科心血管患者的成长而反复更换。组织工程学是一门新的学科，它提供了从自体细胞和可生物降解的支架创建替代结构的潜力。2000年5月，我们启动了以培养细胞为种子的组织工程血管自体移植物的临床应用。然而，细胞培养是耗时的，必须使用异种血清。为了克服这些缺点，我们开始使用手术当天就可以获得的骨髓细胞作为细胞来源。自2001年9月以来，44名患者接受了使用自体骨髓细胞种植的TEAS进行的心胸手术。患者于切皮前于全身麻醉下抽吸骨髓标本3~10mL/kg。在植入之前，这些细胞被种植到可吸收支架上。该支架由共聚…组成更多的是P(CL/LA)的Er，它通过水解降解。采用PLLA或PGA编织布对支架进行加固。应用26个组织工程导管和19个组织工程补片修复先天性心脏病。接受这种方法的患者进行了导尿术研究、CT扫描或两者兼而有之，以在术后进行评估。本组中有4例晚期死于心力衰竭伴或不伴多器官衰竭或脑出血，与TEVAS功能无关。对于有压力梯度和/或侧支的管状移植物狭窄，少数患者需要PTA，4例患者需要对组织工程补片的狭窄进行PTA。然而，这种组织工程学方法可能为在儿童心血管外科领域使用假体材料提供一种重要的替代方法。由于利用了活的自体活组织，这种新开发的血管结构可能有可能实现先天性心脏缺陷儿童的“自体组织修复”。然而，这种方法仍处于起步阶段，需要进一步的实验研究来解决目前存在的问题，还需要对患者进行更长时间的随访来证实这种方法的持久性。较少

Prosthetic and bioprosthetic materials currently in use lack growth potential and therefore must be repeatedly replaced in pediatric cardiovascular patients as they grow. Tissue engineering is a new discipline that offers the potential for creating replacement structures from autologous cells and biodegradable scaffolds. In May 2000, we initiated clinical application of tissue-engineered vascular autografts (TEVAs) seeded with cultured cells. However, cell culturing is time-consuming, and xenoserum must be used. To overcome these disadvantages, we began to use bone marrow cells, readily available on the day of surgery, as a cell source.Since September 2001, 44 patients had a cardiothoracic operation using TEVAs seeded with autologous bone marrow cells. Three to 10 mL/kg specimen of bone marrow was aspirated with the patient under general anesthesia before the skin incision. These cells were seeded onto the absorbable scaffold before implantation. This scaffold was composed of a copolym … More er of P (CL/LA) which degrades by hydrolysis. PLLA or PGA woven fabric were used for reinforcement of the scaffolds. Twenty-six tissue-engineered conduits and 19 tissue-engineered patches were used for the repair of congenital heart defects. Patients who had undergone this method had a catheterization study, CT scan, or both for the evaluation after the operation. Four late deaths due to the heart failure with or without multiple organ failure or brain bleeding in this series; these were unrelated to the TEVAs function. A few patient required PTA for the tubular graft-stenosis with pressure gradient and / or collaterals, and four patients for the stenosis of the tissue-engineered patch. However, this tissue-engineering approach may provide an important alternative to the use of prosthetic materials in the field of pediatric cardiovascular surgery. As it utilizes living autologous living tissue, this newly developed vascular structure may have the potential to achieve "auto-tissue repair" for the children with congenital heart defects. However, this approach is still in its infancy, further experimental studies to resolve the problems presented, and longer follow-up in patients are necessary to confirm the durability of this approach. Less