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J Thorac Cardiovasc Surg 2000;120:134-141
© 2000 The American Association for Thoracic Surgery

SURGERY FOR ACQUIRED CARDIOVASCULAR DISEASE

Clinical experience with autologous endothelial cell–seeded polytetrafluoroethylene coronary artery bypass grafts

From the Department of Cardiovascular Surgery^a and the Department of Cardiology,^b University Hospital Charité, Humboldt University Berlin, Germany.

Supported by grants of the Humboldt University Berlin.

Address for reprints: H. R. Laube, MD, PhD, Department of Cardiovascular Surgery, University Hospital Charité, Humboldt, University Berlin, Schumannstrasse 20/21, D-10117 Berlin, Germany (E-mail: horst.laube{at}charite.de ).

Objective: Autologous endothelial cell seeding was used to improve the patency of 4-mm polytetrafluoroethylene vascular prostheses.
Methods: Since 1995, 14 patients with coronary artery disease received 21 autologous endothelial cell–seeded polytetrafluoroethylene vascular bypass grafts for coronary artery revascularization. The polytetrafluoroethylene grafts were seeded with the endothelial cells in a multiple step procedure, including cell culture techniques before coronary bypass operation. With the use of extracorporal circulation and cardioplegic arrest, a bypass operation was performed by means of conventional surgical techniques.
Results: After a mean postoperative follow-up of 27.7 months (range, 7.5-48 months), the graft patency rate is 90.5%. Follow-up angiograms of the aorta-coronary polytetrafluoroethylene bypass grafts showed patent bypasses in all cases except two. Angiograms of all 19 patent endothelial cell–seeded polytetrafluoroethylene bypass grafts showed a smooth luminal borderline without stenotic regions. The percutaneous transluminal angioscopic evaluation showed a glossy white and smooth endoluminal graft surface without any fibrin, platelet, or erythrocyte deposits. Intravascular ultrasonographic examinations confirmed the results.
Conclusion: Patency of autologous endothelial cell–seeded 4-mm polytetrafluoroethylene vascular prostheses as coronary artery bypass grafts was much better than that of unseeded polytetrafluoroethylene grafts. Further evaluations and a larger population of patients will prove whether the encouraging patency will last.

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