Boston - American Association for Thoracic Surgery

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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
AMERICAN ASSOCIATION FOR THORACIC SURGERYwith myocardial sarcoma underwent subtotal resection of the right artrium. Theresulting defects were grafted using AutoVaM. Postoperative Echocardiographyrevealed systolic and diastolic motion of the graft along with the left atrium duringthe cardiac cycle. Control angiography performed 1 month after operation revealedpatent internal thoracic-jejunal artery anastomosis and permeable capillary bed ofthe cardiac neo-chamber. No signs of thromboembolic complications or endocarditiswere observed.CONCLUSION: Vascularized intestinal graft is more superior then autologouspericardium in terms of higher regenerative potential by repopulation with myocytes.This represents a promising method for cardiac restoration.TUESDAYMorning123
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AATS FUTURE MEETINGSMay 1-5, 2010Me
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Boston - American Association for Thoracic Surgery

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