Long-term evaluation of a new selectively biodegradable vascular graft coated with polyethylene oxide-polylactic acid for right ventricular conduit. An experimental study.
Low-porosity woven Dacron grafts have been used extensively as an extracardiac conduit in the surgical treatment of congenital and acquired heart diseases involving total heparinization. Caution is still warranted in their use, however, because of long-term complications, including calcification and development of obstructive fibrous peel. In contrast, high-porosity grafts offer much better tissue anchorage and healing but cannot be used under heparinization. We have developed a compound vascular prosthesis in which a knitted Dacron graft is coated with a polymeric biodegradable sealant. Polyethylene oxide-polylactic acid-segmented copolymers comprised the degradable component of the graft. In vitro studies showed that the coated prosthesis exhibited a highly flexible elastomer-like mechanical response. The prostheses were completely watertight, and significant degradation started after 1 week, with absorption completed after 3 weeks. Seven woven and six knitted polyethylene oxide-polylactic acid-coated Dacron grafts used as extracordiac conduits (16 mm), connecting the right ventricle and the pulmonary artery were implanted in dogs. The dogs were killed after 12 to 18 months, and the results are reported. Scanning electron microscopy examination showed peel detachment and nonhomogenous intimal surface with fenestrations in the woven graft group, but complete healing and incorporation of the pseudointima with homogenous, thin lining of the luminal surface in the polyethylene oxide-polylactic acid-coated group. Histologic studies indicated much superior healing and anchorage of the periprosthetic tissue and the pseudointima in the polyethylene oxide-polylactic acid-coated grafts. The biodegradable polymer was fully degraded and exhibited a complete incorporation of the compound vascular prosthesis. This study indicates the superior healing properties of these selectively biodegradable grafts, which might increase long-term patency and decrease complications of right ventricular conduits.
Uretzky
G
G
Joseph Lunenfeld Cardiac Surgery Research Center, Hadassah University Hospital, Jerusalem, Israel.
Appelbaum
Y
Y
Younes
H
H
Udassin
R
R
Nataf
P
P
Baccioglu
E
E
Pizof
G
G
Borman
J B
JB
Cohn
D
D
D000818:Animals; D001673:Biodegradation, Environmental; D001807:Blood Vessel Prosthesis; D004285:Dogs; D005069:Evaluation Studies as Topic; D006352:Heart Ventricles / Q000601:surgery; D007773:Lactates; D008855:Microscopy, Electron, Scanning; D011092:Polyethylene Glycols; D011093:Polyethylene Terephthalates; D011108:Polymers; D011651:Pulmonary Artery / Q000601:surgery
D007773:Lactates; D011093:Polyethylene Terephthalates; D011108:Polymers; C058523:polyethylene oxide-polylactic acid block copolymer; D011092:Polyethylene Glycols