AATS: Vascularized Patch Used for Cardiac Reconstruction Stimulates Myocardial Tissue-Specific Regeneration

AATS: American Association for Thoracic Surgery.

Vascularized Patch Used for Cardiac Reconstruction Stimulates Myocardial Tissue-Specific Regeneration

Serghei Cebotari¹, Sava Kostin², Igor Tudorache¹, Matthias Karck¹, Christoph Bara¹, Omke Teebken¹, Tanja Meyer¹, Alexandru Calistru¹, Andres Hilfiker¹, Axel Haverich¹; ¹Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany; ²Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany

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Objective: Several patch materials are currently used to replace diseased cardiac tissue segments in both adults and children. Most of these conduits represent either non-viable materials or bio-artificial grafts with high susceptibility to infection, tissue degeneration and calcification. Hereby, we present our experience of using autologous vascularized matrix (AutoVaM) as a viable graft for myocardial tissue repair.
Methods: AutoVaM patches based on small bowel segments without mucosa with adjacent jejunal artery and vein were harvested and used for the replacement of right atrial defects (2x3 cm) in pigs (N=6). The AutoVaMs were revascularized by connecting jejunal vessels to the right internal thoracic artery and vein. Autologous pericardium grafts were used as controls (N=6).
Results: Complications such as bleeding, graft rupture or dislodgement did not occur. Intraoperative angiography revealed regular blood perfusion of the patches with venous backflow. Histological investigations (up to 6 months) by using Nkx 2.5 and myosin heavy chain revealed newly formed cardiomyocytes inside of AutoVaM explants mostly localized in a disseminated pattern in close proximity to mesenteric capillaries. With increasing time these cells showed strong tendency to form islets and to communicate with each other via Connexin 43 containing gap-junction. In contrast, the explanted pericardial patches appeared as a fibrotic tissue with no evidence of myocytes inside the patch. Based on these experimental results, 2 patients with myocardial sarcoma underwent subtotal resection of the right artrium. The resulting defects were grafted using AutoVaM. Postoperative Echocardiography revealed systolic and diastolic motion of the graft along with the left atrium during the cardiac cycle. Control angiography performed 1 month after operation revealed patent internal thoracic - jejunal artery anastomosis and permeable capillary bed of the cardiac neo-chamber. No signs of thromboembolic complications or endocarditis were observed.
Conclusion: Vascularized intestinal graft is more superior then autologous pericardium in terms of higher regenerative potential by repopulation with myocytes. This represents a promising method for cardiac restoration.

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