Yale University School of Medicine, Section of Cardiac Surgery, New Haven, Conn 06520, USA.
J Thorac Cardiovasc Surg. 2010 Feb;139(2):431-6, 436.e1-2. doi: 10.1016/j.jtcvs.2009.09.057.
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.
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.
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.
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.
具有生长和重塑能力的组织工程血管移植物的开发有望推动心脏外科学的发展。2001 年，我们开始了一项临床试验，评估这些移植物在单心室生理患者中的应用。我们报告了一组接受组织工程血管移植物作为体外腔肺吻合术的患者的晚期临床和放射学监测结果。
采集患者自体骨髓，分离出单核细胞成分。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，并将其作为体外腔肺吻合术植入单心室生理患者体内。通过术后门诊随访和电话随访对患者进行随访。此外，还使用超声、血管造影、计算机断层扫描和磁共振成像进行术后移植物监测。
共植入 25 个移植物（患者中位年龄为 5.5 岁）。无移植物相关死亡率（平均随访时间为 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 例患者发生部分壁血栓形成，经华法林治疗后成功。4 例患者发生移植物狭窄，并成功进行了经皮血管成形术。
组织工程血管移植物可作为单心室生理患者的腔肺吻合术的移植物。移植物狭窄是移植物失功的主要模式。需要进一步随访和研究狭窄的发生机制。
