Boston - American Association for Thoracic Surgery

89 TH ANNUAL MEETING MAY 9–MAY 13, 2009BOSTON, MASSACHUSETTSTUESDAY MORNINGMAY 12, 20097:00 a.m. CARDIAC SURGERY FORUM SESSIONBallroom A–C, Hynes Convention Center(5 minutes presentation, 7 minutes discussion)Moderators: John A. Kern, Bruce R. RosengardF1. Vascularized Patch Used for Cardiac Reconstruction StimulatesMyocardial Tissue-Specific RegenerationSerghei Cebotari, 1 Sava Kostin, 2 Igor Tudorache, 1 Matthias Karck, 1Christoph Bara, 1 Omke Teebken, 1 Tanja Meyer, 1 Alexandru Calistru, 1Andres Hilfiker, 1 Axel Haverich 1*1. Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover,Germany; 2. Max-Planck-Institute for Heart and Lung Research, Bad Nauheim,GermanyInvited Discussant: Bruce R. RosengardOBJECTIVE: Several patch materials are currently used to replace diseased cardiactissue segments in both adults and children. Most of these conduits representeither non-viable materials or bio-artificial grafts with high susceptibility to infection,tissue degeneration and calcification. Hereby, we present our experience ofusing autologous vascularized matrix (AutoVaM) as a viable graft for myocardialtissue repair.METHODS: AutoVaM patches based on small bowel segments without mucosawith adjacent jejunal artery and vein were harvested and used for the replacementof right atrial defects (2 × 3 cm) in pigs (N = 6). The AutoVaMs were revascularizedby connecting jejunal vessels to the right internal thoracic artery and vein. Autologouspericardium grafts were used as controls (N = 6).RESULTS: Complications such as bleeding, graft rupture or dislodgement did notoccur. Intraoperative angiography revealed regular blood perfusion of the patches withvenous backflow. Histological investigations (up to 6 months) by using Nkx 2.5and myosin heavy chain revealed newly formed cardiomyocytes inside of AutoVaMexplants mostly localized in a disseminated pattern in close proximity to mesentericcapillaries. With increasing time these cells showed strong tendency to form isletsand to communicate with each other via Connexin 43 containing gap-junction. Incontrast, the explanted pericardial patches appeared as a fibrotic tissue with no evidenceof myocytes inside the patch. Based on these experimental results, 2 patients* AATS Member122