Boston - American Association for Thoracic Surgery

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89 TH ANNUAL MEETING MAY 9–MAY 13, 2009BOSTON, MASSACHUSETTST5. Tissue Engineered Vascular Grafts in Humans: CorrelatingClinical Outcomes to Vascular Neotissue Formation in MiceNarutoshi Hibino, 1 Edward McGillicuddy, 1 Tai Yi, 1 Goki Matsumura, 2Uji Naito, 2 Hiromi Kurosawa, 2* Christopher Breuer, 1 Toshiharu Shinoka 1*1. Yale University School of Medicine, New Haven, CT, USA; 2. Tokyo Women’sMedical University, Tokyo, JapanInvited Discussant: John E. Mayer, Jr.OBJECTIVE: The development of a tissue engineered vascular graft (TEVG) thatpossesses the ability to grow holds great promise for advancing the field of cardiacsurgery. In 2001, we initiated a human trial evaluating the use of TEVGs as conduitsin patients with single ventricle physiology. Concurrently, we developed andoptimized a murine model to investigate the mechanisms underlying vascular neotissueformation. This study correlates the clinical feasibility and long term outcomesof TEVGs in humans with the basic biology of vascular neotissue formationin mice.METHODS: Human Trial: Autologous bone marrow (BM) mononuclear cellswere seeded onto a biodegradable tubular scaffold fabricated from a polyglycolicacid (PGA) mesh coated with a co-polymer of l-lactide and -caprolactone (P(LA/CL)).Twenty-five TEVGs were implanted as extracardiac total cavopulmonary connections(EC TCPCs) in patients with single ventricle abnormalities. Patient age rangedfrom 1 to 24 years (median: 5.5 years). Post-operatively, patients were followed byserial angiography and/or CT. Mouse Model: Biodegradable PGA-P(LA/CL) scaffolds,0.6 mm in diameter, were implanted into the IVC in mice (N = 12). Six scaffoldswere seeded with murine BM prior to implantation and six scaffolds wereimplanted unseeded. Following implantation, grafts were followed with serialultrasonography. All mice were sacrificed 14 days following implantation for histologicalanalysis of the grafts.RESULTS: Human Trial: There was no graft-related mortality during the followupperiod (mean 4.2 years). There was no evidence of aneurysm formation, graftrupture, or ectopic calcification. Five patients (20%) developed silent graft stenoseswhich did not require intervention. Two conduits (8%) developed critical graftstenoses that were successfully treated with balloon angioplasty. Mouse Model:All seeded grafts remained patent, while 5 unseeded grafts (83%) developed significantstenoses. Seeded grafts expressed von Willebrand factor on the luminalaspect, consistent with early endotheliazation. Unseeded grafts, however, demonstrateddense populations of cells expressing smooth muscle actin, transforminggrowth factor-beta, and macrophage-3 antigen consistent with macrophage-driveninflammation.CONCLUSION: In humans undergoing EC TCPC, use of TEVGs is associatedwith acceptable morbidity and mortality. In mice, BM seeded grafts demonstrateincreased patency, early endotheliazation, and an attenuated inflammatoryresponse compared to unseeded grafts.* AATS Member204
AMERICAN ASSOCIATION FOR THORACIC SURGERYT6. Abdominal Debranching with Thoracic Endografting for theTreatment of Thoraco-Abdominal Aneurysm in 21 ConsecutivePatientsJacques Kpodonu, 1 Venkatesh Ramaiah, 2 Grayson H. Wheatley, 2Julio Rodriguez-Lopez, 2 David Caparrelli, 2† Rame Iberdemaj, 2Edward B. Diethrich 21. Hoag Memorial Presbyterian, Newport Beach, CA, USA; 2. ArizonaHeart Institute, Phoenix, AZ, USAInvited Discussant: Roy K. GreenbergOBJECTIVE: Hybrid revascularization techniques combining visceral debranchingwith endovascular stent graft placement provides a less invasive approach totreat thoracoabdominal aneurysms. We review our clinical experience with thishybrid technique.METHODS: Twenty-one consecutive patients (11 males and 10 females) withmean age 70 years range (35–93) underwent hybrid surgical reconstructions forcomplex thoraco abdominal aneurysms over a 24 month period (March 2005–March 2007). Elective repair was performed on 20 patients with 6 patients havingprior aortic surgery. Mean proximal neck, distal neck and aortic sac diameterwere 30.3 mm, 23 mm and 6.7 cm respectively. Hybrid repair was performed onCrawford type 1 n = 1, Crawford type II n = 3, Crawford type III n = 7, Crawfordtype IV n = 4, Crawford Type V n = 6. Endograft deployment was transfemorallyn = 13 and dacron conduit graft n = 8 using standardized endovascular techniques.Inflow conduit was descending thoracic aorta n = 10, aorta bifemoral graft n = 3,tube graft n = 3, right iliac artery n = 4, left iliac artery n = 1. Procedure was stagedin 3 patients. Outcome variables including treatment failures (endoleak, aorticrupture, reintenvention) or aortic related deaths were assessed. Follow-up includedclinical examination, chest and abdominalradiographic, CT scan at discharge, 6months, 1 year and yearly thereafter.WEDNESDAYMorningRESULTS: Patient demographics included hypertension (100%), coronary arterydisease (64%), peripheral vascular disease (100%), diabetes (7%), obesity (21%),chronic obstructive lung disease (78%) renal insufficiency (28.6%). Mean operatingtime and blood loss were 4.25 hours and 0.9L respectively. Debranched vesselsincluded right renal n = 15, left renal n = 16, celiac n = 15 superior mesenteric n = 18.One endograft was deployed in 9 patients and 2 endografts in 12 patients. 30 daymortality was 5.7% (n = 1/21) from complications relating to surgery. At follow up1.5%(n = 1/64) vessel (renal) was lost. Complications included transient leftextremity weakness n = 1, renal insufficiency requiring hemodialysis n = 2, lower* AATS Member† Resident Traveling Fellowship 2007205
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Boston - American Association for Thoracic Surgery

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