Mayo Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, Minnesota.
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Tissue Eng Part B Rev. 2020 Feb;26(1):26-45. doi: 10.1089/ten.TEB.2019.0229. Epub 2019 Nov 27.
Currently, despite the success of percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG) remains among the most commonly performed cardiac surgical procedures in the United States. Unfortunately, the use of autologous grafts in CABG presents a major clinical challenge as complications due to autologous vessel harvest and limited vessel availability pose a significant setback in the success rate of CABG surgeries. Acellular extracellular matrix (ECM) scaffolds derived from xenogeneic vascular tissues have the potential to overcome these challenges, as they offer unlimited availability and sufficient length to serve as "off-the-shelf" CABGs. Unfortunately, regardless of numerous efforts to produce a fully functional small diameter xenogeneic ECM scaffold, the combination of factors required to overcome all failure mechanisms in a single graft remains elusive. This article covers the major failure mechanisms of current xenogeneic small diameter vessel ECM scaffolds, and reviews the recent advances in the field to overcome these failure mechanisms and ultimately develop a small diameter ECM xenogeneic scaffold for CABG. Impact Statement Currently, the use of autologous vessel in coronary artery bypass graft (CABG) is common practice. However, the use of autologous tissue poses significant complications due to tissue harvest and limited availability. Developing an alternative vessel for use in CABG can potentially increase the success rate of CABG surgery by eliminating complications related to the use of autologous vessel. However, this development has been hindered by an array of failure mechanisms that currently have not been overcome. This article describes the currently identified failure mechanisms of small diameter vascular xenogeneic extracellular matrix scaffolds and reviews current research targeted to overcoming these failure mechanisms toward ensuring long-term graft patency.
目前，尽管经皮冠状动脉介入治疗（PCI）取得了成功，但冠状动脉旁路移植术（CABG）仍然是美国最常见的心脏外科手术之一。不幸的是，在 CABG 中使用自体移植物带来了重大的临床挑战，因为自体血管采集和有限的血管供应所引起的并发症严重影响了 CABG 手术的成功率。源自异种血管组织的去细胞细胞外基质（ECM）支架具有克服这些挑战的潜力，因为它们提供了无限的可用性和足够的长度，可以作为“现成的”CABG。不幸的是，尽管人们付出了大量努力来生产具有完全功能的小直径异种 ECM 支架，但在单个移植物中克服所有失效机制所需的综合因素仍然难以捉摸。本文涵盖了当前异种小直径血管 ECM 支架的主要失效机制，并回顾了该领域克服这些失效机制的最新进展，最终开发出用于 CABG 的小直径 ECM 异种支架。
目前，在冠状动脉旁路移植术（CABG）中使用自体血管是常见做法。然而，自体组织的使用由于组织采集和有限的可用性而带来了重大并发症。开发替代血管用于 CABG 可以通过消除与使用自体血管相关的并发症，从而有可能提高 CABG 手术的成功率。然而，这种发展受到一系列尚未克服的失效机制的阻碍。本文描述了小直径血管异种细胞外基质支架目前确定的失效机制，并回顾了旨在克服这些失效机制以确保长期移植物通畅性的当前研究。
