HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Winfield Wells Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wells, W. Articles by Barr, M. L. Search for Related Content PubMed PubMed Citation Articles by Wells, W. Articles by Barr, M. L. Related Collections Congenital - acyanotic Congenital - cyanotic

J Thorac Cardiovasc Surg 2003;126:498-503
© 2003 The American Association for Thoracic Surgery

Surgery for congenital heart disease

Depopulated vena caval homograft: a new venous conduit

^a Department of Cardiothoracic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, Calif, USA

Received for publication May 29, 2002; revisions received June 18, 2002; revisions received October 25, 2002; accepted for publication December 9, 2002.

^* Address for reprints: Winfield J. Wells, MD, Department of Cardiothoracic Surgery, Childrens Hospital Los Angeles, 4650 Sunset Blvd, MS #66, Los Angeles, CA 90027, USA
wwells{at}chla.usc.edu

OBJECTIVE: Completion of the Fontan procedure is frequently performed by using an extracardiac conduit between the inferior vena cava and the pulmonary artery. Most centers use a polytetrafluoroethylene graft for the extracardiac conduit, and because re-endothelialization is unlikely, anticoagulation is used for a variable period. This study explores the use of an alternate large-caliber venous conduit.

METHODS: The superior vena cava was replaced in 8 minipigs with either a polytetrafluoroethylene interposition graft (2 pigs) or a depopulated (acellular), cryopreserved superior vena caval homograft (6 pigs). After 6 months, the animals were killed, and the grafts were examined for patency and histology, including immunostaining. No anticoagulation was used.

RESULTS: Polytetrafluoroethylene grafts have a cross-sectional luminal narrowing, ranging from 16% to 40%. Histology showed only partial intimal ingrowth, with excessive subendothelial fibrosis and early calcification. In contrast, the depopulated venous homografts showed minimal luminal narrowing, ranging from 2% to 9%. These grafts were completely repopulated by the recipient with an endothelial lining, which stained positively for factor VIII, and a subendothelial region appropriately recellularized by myofibroblasts, which stained positively for smooth muscle actin and procollagen. There was no evidence of an immune response to the venous homografts, as judged by staining for T-cell surface antigen, CD4, and CD8. Thrombus was not seen in any of the grafts.

CONCLUSION: Depopulated, cryopreserved vena caval homografts might be superior conduits for cavopulmonary connection during completion of the Fontan operation by using the extracardiac conduit technique.

This article has been cited by other articles:

				K. J. Zehr, M. Yagubyan, H. M. Connolly, S. M. Nelson, and H. V. Schaff Aortic root replacement with a novel decellularized cryopreserved aortic homograft: Postoperative immunoreactivity and early results J. Thorac. Cardiovasc. Surg., October 1, 2005; 130(4): 1010 - 1015. [Abstract] [Full Text] [PDF]