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J Thorac Cardiovasc Surg 2002;124:1165-1175
© 2002 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease (CHD)

Small intestine without mucosa as a growing vascular conduit: A porcine experimental study

Om P. Tucker, MDa, Thomas Syburraa, Monique Augstburger, RNa, Guy van Melle, PhDb, Sandra Gebhard, MDc, Fred Bosman, MDb, Ludwig K. von Segesser, MDa

From the Departments of Cardiovascular Surgery,a Statistics,b and Pathology,c University Hospital Vaudois, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

Read at the Twenty-seventh Annual Meeting of The Western Thoracic Surgical Association, San Diego, Calif, June 20-23, 2001.

Received for publication June 28, 2001. Revisions requested Nov 19, 2001; revisions received Jan 24, 2002. Accepted for publication March 27, 2002. Address for reprints: Om P. Tucker, MD, Department of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (E-mail: omptucker{at}hotmail.com).

Objective: This study was conducted to check the feasibility of using small intestine without mucosa as a growing vascular conduit.
Method: Autologous proximal jejunum without mucosa after treatment with heparin bonding was used as a free inferior vena cava interpositional graft between the renal veins and bifurcation of inferior vena cava in 8 piglets. Intravenous ultrasonography was performed at 1 to 3 months after the operation and at autopsy.
Results: One intraoperative death was related to anesthesia. At a mean follow-up of 80 days for the 7 surviving pigs, the weight had increased by 201%, from a mean of 32 kg to a mean of 94 kg. The grafts had increased in length by 128%, from a mean of 2.3 cm at implantation to a mean of 5.1 cm (P < .018) at explantation. In 6 animals the diameter of the graft was equal to that of the adjacent inferior vena cava. At postmortem examination, 6 grafts were patent. The single blocked graft had been patent 1 month after surgery. One graft had extensive septae inside, 2 had minor septae, 2 had microscopic septae, and 2 had no septae at all. Normal appearing adventitia, fibrous tissue, and endothelium (factor VIII-related antigen positive) lined all the grafts. In all 7 grafts, scattered proliferating fibroblasts (MIB1 positive) were observed.
Conclusions: Small intestine without mucosa remodels and acts like a live, growing, layered, endothelialized, nonthrombogenic (after re-endothelialization) vascular conduit in a growing pig. This graft material could have potential as a growing vascular conduit in children.






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