Prosthetic replacement of the superior vena cava with a custom-made pericardial graft: an experimental study

Prosthetic replacement of the vena cava has been disappointing, mainly because of the hemodynamic characteristics of the venous system and the physical properties of the prostheses used. Spiral grafts constructed with autogenous saphenous vein have been the most successful prostheses to date, but their use is limited to replacement of short segments, and intraoperative construction is time consuming. The authors report their experience with a graft constructed of extra-thick bovine pericardium (PX) and surgical staples. Externally stented polytetrafluoroethylene (PTFE) was used as a control. The superior vena cava was replaced in 13 ewes; PTFE was used in 6 (group 1) and PX in 7 (group 2). Mean follow-up was 15 +/- 8 months for group 1 and 13 +/- 8 for group 2. Cumulative graft follow-up totalled 4612 graft-days. There was one graft occlusion in each group. Patency rates (80%) were similar for the two groups. Histologic changes in pericardial grafts were more marked but did not influence patency. This study reports the longest experimental follow-up (maximum 23 months) and graft patency to date for replacement of the superior vena cava. Both types of graft performed excellently.