title: Porcine carotid artery replacement with biodegradable electrospun poly-e-caprolactone vascular prosthesis.
abstract: OBJECTIVE
  There is a continuous search for shelf-ready small-caliber vascular prostheses with satisfactory early and late results. Biodegradable scaffolds, repopulated by recipient's cells regenerating a neovessel, can be a suitable option for adult and pediatric, urgent and elective cardiovascular procedures.
  
  
  METHODS
  This was a short-term experimental assessment of a new biodegradable vascular prosthesis for arterial replacement in the pig. Eleven pigs underwent bilateral carotid artery replacement with biodegradable electrospun poly-ε-caprolactone (PCL) nanofiber prostheses (internal diameter, 4 mm; length, 5 cm); or expanded polytetrafluoroethylene (ePTFE) prostheses as control. Perioperative anticoagulation was achieved with intravenous heparin (double baseline activated clotting time). Postoperatively, until conclusion of the study at 1 month, animals received aspirin and clopidogrel daily. Transit time flow was measured intraoperatively and at sacrifice. Doppler ultrasound (1 and 4 weeks) and a selective carotid angiography (4 weeks) were performed to assess patency. All explanted grafts were analyzed by histology, morphometry, and scanning electron microscopy in order to study graft-host interaction.
  
  
  RESULTS
  Surgical handling and hemostasis of the new prostheses were excellent. Patency rate was 78% (7/9) for PCL grafts, compared with 67% (4/6) for ePTFE grafts. Transit time flow and Doppler ultrasound showed no significant changes in flow and velocity or diameter over time in both groups. Both prostheses showed no detectable in vivo compliance as compared with native carotid artery. Percent neoendothelialization was 86% for PCL and 58% for ePTFE grafts (P = .008). Neointima formation was equal in both grafts. More adventitial infiltration of macrophages, myofibroblasts, and capillaries was seen in PCL grafts with a milder foreign-body reaction when compared with ePTFE implants. Both grafts showed similar endoluminal thrombus formation.
  
  
  CONCLUSIONS
  Biodegradable, electrospun PCL grafts showed good surgical and mechanical properties, no aneurysm formation, and similar short-term patency compared with ePTFE grafts. Rapid endothelialization and cell ingrowth confirms favorable PCL graft-recipient biological interaction. Despite good early results, long-term follow-up is required before clinical application.
authors.affiliation: Service of Cardiovascular Surgery, Geneva University Hospital, University of Geneva, Faculty of Medicine, Geneva, Switzerland; Department of Pediatric Cardiac Surgery, Poznań University of Medical Sciences, Poznań, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Mrówczyński
authors.affiliation: Service of Cardiovascular Surgery, Geneva University Hospital, University of Geneva, Faculty of Medicine, Geneva, Switzerland.
authors.forename: Damiano
authors.initials: D
authors.lastname: Mugnai
authors.affiliation: School of Pharmaceutical Sciences University of Lausanne, University of Geneva, Geneva, Switzerland.
authors.forename: Sarra
authors.initials: S
authors.lastname: de Valence
authors.affiliation: Division of Clinical Pathology, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Tille
authors.affiliation: Service of Cardiovascular Surgery, Geneva University Hospital, University of Geneva, Faculty of Medicine, Geneva, Switzerland.
authors.forename: Ebrahim
authors.initials: E
authors.lastname: Khabiri
authors.affiliation: Service of Cardiovascular Surgery, Geneva University Hospital, University of Geneva, Faculty of Medicine, Geneva, Switzerland.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Cikirikcioglu
authors.affiliation: School of Pharmaceutical Sciences University of Lausanne, University of Geneva, Geneva, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Möller
authors.affiliation: Service of Cardiovascular Surgery, Geneva University Hospital, University of Geneva, Faculty of Medicine, Geneva, Switzerland. Electronic address: beat.walpoth@hcuge.ch.
authors.forename: Beat H
authors.initials: BH
authors.lastname: Walpoth
mesh_terms: D020341:Absorbable Implants; D000818:Animals; D000925:Anticoagulants / Q000494:pharmacology; D001783:Blood Flow Velocity; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000601:surgery*; D023421:Models, Animal; D057139:Nanofibers; D058426:Neointima; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology; D011091:Polyesters / Q000737:chemistry*; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D011859:Radiography; D013552:Swine; D013997:Time Factors; D054457:Tissue Scaffolds; D018608:Ultrasonography, Doppler; D014654:Vascular Patency
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D011091:Polyesters; C016240:polycaprolactone; D011138:Polytetrafluoroethylene