A novel bioengineered small-caliber vascular graft incorporating heparin and sirolimus: Excellent 6-month patency Yosuke Ishii, MD, Shun-ichiro Sakamoto,

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Presentation transcript:

A novel bioengineered small-caliber vascular graft incorporating heparin and sirolimus: Excellent 6-month patency Yosuke Ishii, MD, Shun-ichiro Sakamoto, MD, Russell T. Kronengold, PhD, Renu Virmani, MD, Elias A. Rivera, MHS, Scott M. Goldman, MS, Ericka J. Prechtel, MS, James G. Hill, MS, Ralph J. Damiano, MD The Journal of Thoracic and Cardiovascular Surgery Volume 135, Issue 6, Pages 1237-1246 (June 2008) DOI: 10.1016/j.jtcvs.2007.09.077 Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Explanted H and HS grafts at 6 months. There was no stenosis at the anastomotic sites and center of the grafts. H, Heparin alone; HS, heparin + sirolimus. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1237-1246DOI: (10.1016/j.jtcvs.2007.09.077) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 A, Preoperative and postoperative graft compliance. B, Preoperative and postoperative graft tensile strength. ∗P < .05. ∗∗P < .01. H, Heparin alone; HS, heparin + sirolimus. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1237-1246DOI: (10.1016/j.jtcvs.2007.09.077) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Proximal and distal anastomotic strengths. ∗P < .01. N, Newton; H, heparin alone; HS, heparin + sirolimus. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1237-1246DOI: (10.1016/j.jtcvs.2007.09.077) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Histology and immunohistochemical findings of the grafts at 6 months. Normal-appearing endothelial cells were aligned with the blood flow. The endothelial cell layer is smooth from the native aorta to the graft in H, HS, and C grafts. There were less endothelial cells in the ePTFE graft. Moderate cellular infiltration was observed in the graft wall in the H and HS grafts (upper: Movat stain 40×). A layer of endothelial cells is shown on inside of the H, HS, and C grafts. Moderate neocapillary formation is shown in the graft wall in the H, HS, and C grafts (lower: von Willebrand factor stain 100×, red dots in the graft wall). ePTFE, Expanded polytetrafluoroethylene; H, heparin alone; HS, heparin + sirolimus. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1237-1246DOI: (10.1016/j.jtcvs.2007.09.077) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Serial changes in neointima formation, luminal fibrin/platelet formation, endothelialization, and cellular infiltration at the anastomotic sites and center of the grafts. The histologic index was calculated by dividing the sum of the grade by the number of sample grafts (grade/n). ePTFE, Expanded polytetrafluoroethylene; H, heparin alone; HS, heparin + sirolimus. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1237-1246DOI: (10.1016/j.jtcvs.2007.09.077) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 Neointima thickness at the proximal and distal anastomoses. ePTFE, Expanded polytetrafluoroethylene; H, heparin alone; HS, heparin + sirolimus. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1237-1246DOI: (10.1016/j.jtcvs.2007.09.077) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 7 SEM findings. Endothelial cells covered the inside of the H and HS grafts. The layer of endothelial cells of the HS graft was smoother than that of the H graft. The C graft had rough endothelial cells. The ePTFE graft had less endothelial cells and marked fibrin/platelet deposition. ePTFE, Expanded polytetrafluoroethylene; H, heparin alone; HS, heparin + sirolimus. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 1237-1246DOI: (10.1016/j.jtcvs.2007.09.077) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions