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J Thorac Cardiovasc Surg 2001;122:1208-1218
© 2001 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease (CHD)

Reconstruction of the right ventricular outflow tract with a bovine jugular vein graft fixed with a naturally occurring crosslinking agent (genipin) in a canine model

From the Division of Cardiovascular Surgery,^a Veterans General Hospital-Taichung, and College of Medicine, National Yang-Ming University, Taipei, Taiwan; Biomedical Engineering Center,^b Industrial Technology Research Institute, Hsinchu, Taiwan; and the Department of Chemical Engineering,^c National Tsing Hua University, Hsinchu, Taiwan.

This work was supported by a grant from the National Science Council of Taiwan, Republic of China (NSC-88-2314-E-008-002).

Received for publication Feb 14, 2001. Revisions requested March 20, 2001; revisions received April 10, 2001. Accepted for publication April 21, 2001. Address for reprints: Hsing-Wen Sung, PhD, Department of Chemical Engineering, National Tsing Hua University, Hsinchu, Taiwan 30013 (E-mail: hwsung{at}che.nthu.edu.tw).

Abstract

Objective: This study was designed to evaluate a newly developed biologic valved conduit fixed with genipin used to reconstruct the right ventricular outflow tract in a canine model.
Methods: Fresh bovine jugular veins with a retained native valve procured from a slaughterhouse were used as raw materials to fabricate the valved conduits. A naturally occurring crosslinking agent, genipin, was used to fix the procured jugular veins. The glutaraldehyde-fixed counterpart was used as a control. A canine model was used in the study.
Results: Echocardiography revealed that the motion of the valvular leaflets in both the glutaraldehyde- and genipin-fixed conduits was satisfactory. The transvalvular pressure gradients of both studied groups were minimal. No endothelium-like cells were observed on the luminal surface of the conduit and the valvular leaflet for the glutaraldehyde-fixed group throughout the entire course of the study. In contrast, endothelium-like cells were observed on the entire surface of the genipin-fixed valved conduit retrieved at 6 months postoperatively in all the cases studied. There was no evidence of luminal fibrous peel in any the valved conduits studied. Degradation of valvular leaflet in one of the glutaraldehyde-fixed conduits was observed. In this particular case, thrombus formation was also observed on the surface of the valvular leaflet. On the other hand, no apparent degradation or thrombus formation was observed on the surfaces of the genipin-fixed valvular leaflet and conduit. A significantly more severe inflammatory reaction was observed for the glutaraldehyde-fixed conduit than for its genipin-fixed counterpart throughout the entire course of the study. The calcium contents of the samples before implantation and those retrieved at distinct implantation duration were minimal for both the glutaraldehyde- and genipin-fixed tissues.
Conclusion: Although further studies are necessary, the genipin-fixed valved conduit appears to have great potential in helping mitigate the complications observed in the commercially available conduits.

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