Extracardiac total cavopulmonary connection using a tissue-engineered graft.
OBJECTIVE
Extracardiac and lateral tunnel total cavopulmonary connection are currently 2 major options for patients with a single ventricle physiology. However, each procedure has some disadvantages over the other. We developed a new technique of extracardiac total cavopulmonary connection using a tissue-engineered graft to overcome some of the disadvantages previously associated with both the extracardiac and lateral tunnel procedures.


METHODS
Between February 2001 and October 2002, 8 patients underwent an extracardiac total cavopulmonary connection using a tissue-engineered graft in our institution. Collected bone marrow cells (1 x 10(8) mononucleocytes) from a patient (approximately 1-4 mL/kg body weight) were seeded onto a biodegradable scaffold composed of polycaprolactone-polylactic acid copolymer reinforced with woven polylactic acid. After a 2- to 4-hour cultivation, the seeded scaffold was implanted as an extracardiac conduit during the total cavopulmonary connection operation.


RESULTS
There were no hospital or late deaths. At a mean follow-up of 13.4 months (range 4-25 months), all patients are alive and asymptomatic with no need for repeat surgery. A postoperative catheter examination or computed tomography showed all tissue-engineered grafts to be patent and revealed no stenosis, obstruction, or aneurysmal change in the 8 patients.


CONCLUSIONS
We believe that extracardiac total cavopulmonary connection using a tissue-engineered graft has the potential to overcome some of the disadvantages previously associated with extracardiac or lateral tunnel total cavopulmonary connection. However, an extended follow-up period is required to clarify the long-term clinical outcome for the tissue-engineered graft.
Isomatsu
Yukihisa
Y
Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University. isomatsu@med.yokohama-cu.ac.jp
Shin'oka
Toshiharu
T
Matsumura
Goki
G
Hibino
Narutoshi
N
Konuma
Takeshi
T
Nagatsu
Masayoshi
M
Kurosawa
Hiromi
H
D000293:Adolescent; D000328:Adult; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D001854:Bone Marrow Cells / Q000166:cytology; D002478:Cells, Cultured; D002648:Child; D002675:Child, Preschool; D018610:Heart Bypass, Right; D006330:Heart Defects, Congenital / Q000601:surgery; D006352:Heart Ventricles / Q000002:abnormalities; D006801:Humans; D007223:Infant; D023822:Tissue Engineering