Depopulated vena caval homograft: A new venous conduit

Winfield J. Wells, Mahmoud Malas, Craig J. Baker, Susanne M. Quardt, Mark L. Barr, Davis C. Drinkwater, Vaughn A. Starnes

Research output: Contribution to journalArticle

Abstract

Objective: Completion of the Fontan procedure is frequently performed by using an extracardiac conduit between the inferior vena cava and the pulmonary artery. Most centers use a polytetrafluoroethylene graft for the extracardiac conduit, and because re-endothelialization is unlikely, anticoagulation is used for a variable period. This study explores the use of an alternate large-caliber venous conduit. Methods: The superior vena cava was replaced in 8 minipigs with either a polytetrafluoroethylene interposition graft (2 pigs) or a depopulated (acellular), cryopreserved superior vena caval homograft (6 pigs). After 6 months, the animals were killed, and the grafts were examined for patency and histology, including immunostaining. No anticoagulation was used. Results: Polytetrafluoroethylene grafts have a cross-sectional luminal narrowing, ranging from 16% to 40%. Histology showed only partial intimal ingrowth, with excessive subendothelial fibrosis and early calcification. In contrast, the depopulated venous homografts showed minimal luminal narrowing, ranging from 2% to 9%. These grafts were completely repopulated by the recipient with an endothelial lining, which stained positively for factor VIII, and a subendothelial region appropriately recellularized by myofibroblasts, which stained positively for smooth muscle actin and procollagen. There was no evidence of an immune response to the venous homografts, as judged by staining for T-cell surface antigen, CD4, and CD8. Thrombus was not seen in any of the grafts. Conclusion: Depopulated, cryopreserved vena caval homografts might be superior conduits for cavopulmonary connection during completion of the Fontan operation by using the extracardiac conduit technique.

Original languageEnglish (US)
Pages (from-to)498-503
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume126
Issue number2
DOIs
StatePublished - Aug 1 2003
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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  • Cite this

    Wells, W. J., Malas, M., Baker, C. J., Quardt, S. M., Barr, M. L., Drinkwater, D. C., & Starnes, V. A. (2003). Depopulated vena caval homograft: A new venous conduit. Journal of Thoracic and Cardiovascular Surgery, 126(2), 498-503. https://doi.org/10.1016/S0022-5223(03)00208-3