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Published on: August 28, 2014
Evaluation of small caliber vascular prostheses implanted in small children: activated angiogenesis and accelerated
Y Tomizawa1, Y Takanashi, Y Noishiki
1Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical College, Japan.
Insights
Healing in pediatric vascular grafts is rarely studied. Fabric grafts showed active angiogenesis, while expanded polytetrafluoroethylene (ePTFE) grafts exhibited accelerated calcification in children with congenital heart disease.
Area of Science:
- Biomedical Engineering
- Pediatric Cardiology
- Vascular Surgery
Background:
- Small-caliber vascular prostheses are crucial for congenital heart disease repair in children.
- Assessing graft healing in pediatric patients is challenging due to specimen retrieval difficulties.
Purpose of the Study:
- To evaluate the healing characteristics of expanded polytetrafluoroethylene (ePTFE) and fabric vascular grafts used in modified Blalock Taussig shunts.
- To compare the histological differences between ePTFE and fabric grafts after implantation in pediatric patients.
Main Methods:
- Modified Blalock Taussig shunt procedures were performed in 13 pediatric patients using ePTFE and fabric grafts.
- Graft specimens were retrieved during corrective surgery (10 ePTFE, 6 fabric) and evaluated histologically.
- Implantation duration ranged from 11 months to 5 years and 7 months.
Main Results:
- All explanted grafts were patent at explantation, with an average patient age of 4 years.
- ePTFE grafts showed calcification in three instances, with macrophage infiltration; thrombus, intimal hyperplasia, and pannus detachment were common.
- Fabric grafts demonstrated significant capillary infiltration into the interstices, reaching the lumen from the perigraft side.
Conclusions:
- Fabric grafts exhibit active angiogenesis and potential for complete endothelialization in pediatric patients.
- ePTFE grafts experience accelerated calcification in cyanotic small children.
- Highly porous fabric vascular prostheses may facilitate better healing and endothelialization in pediatric congenital heart disease patients.
Abstract:
Healing characteristics of small-caliber vascular prostheses used in small children have rarely been observed because removing specimens are troublesome. Modified Blalock Taussig shunt procedures were performed using small caliber expanded polytetrafluoroethylene (ePTFE) vascular grafts and fabric grafts in 13 patients with congenital heart disease. At the time of total corrective procedures, a piece of 10 ePTFE grafts in 10 patients and six fabric grafts in four patients were removed from the distal pulmonary anastomosis, and evaluated. The implantation duration was from 11 months to 5 years and 7 months (mean, 2 years and 6 months). At removal, average patient age was 4 years and all grafts were patent. Microscopically, the wall of three ePTFE grafts were calcified, and macrophages were immunohistologically observed in the graft wall. Thrombus formation, intimal hyperplasia, and pannus detachment was common. In the fabric grafts, many capillaries infiltrated the interstices and often reached the lumen from the perigraft side. These results suggested that in cyanotic small children, angiogenesis in and around fabric grafts was active and calcification was accelerated in ePTFE grafts. Complete endothelialization throughout the length, caused by angiogenesis, might be possible in small children when highly porous fabric vascular prostheses are used.
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