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Ann Thorac Surg 2001;71:S327-S331
© 2001 The Society of Thoracic Surgeons

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Bioprosthetic valves and conduits: new developments

Clinical autologous in vitro endothelialization of 153 infrainguinal ePTFE grafts

^a First Department of Surgery and Ludwig Boltzman Institute for Applied Cardiovascular Biology, Lainz Hospital, Vienna, Austria
^b Center of Cardiac Surgery, University of Erlangen, Nuremburg, Germany
^c Department of Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa

Address reprint requests to Dr Zilla, Department of Cardiothoracic Surgery, Cape Heart Centre, University of Cape Town Medical School, Anzio Rd, 7925 Observatory, Cape Town, South Africa
e-mail: zilla{at}capeheart.uct.ac.za

Presented at the VIII International Symposium on Cardiac Bioprostheses, Cancun, Mexico, Nov 3–5, 2000.

Background. Over the past 17 years, our group has developed and clinically applied an in vitro endothelialization procedure whereby infrainguinal expanded polytetrafluoroethylene (ePTFE) prostheses are confluently lined with cultured autologous endothelial cells before implantation. After a successful randomized pilot study from 1989 to 1993, the procedure was adopted for routine operations.

Methods. Since June 1993, 153 endothelialized ePTFE grafts were implanted in the infrainguinal position in 136 patients (102 above knee (AK) and 51 below knee (BK), 89 men and 47 women, mean age 64.7 ± 9.4 years). Seventeen patients received an endothelialized prosthesis bilaterally. Autologous endothelial cells were harvested from 4- to 5-cm segments of a subcutaneous vein (in 86% the cephalic vein), grown to first-passage mass cultures and confluently lined onto 6- (n = 113) or 7-mm (n = 40) inner diameter (ID) ePTFE grafts, precoated with fibrin glue. The observation period for 6-mm grafts was 7 years, and for 7-mm grafts was 4 years. Patency assessment for Kaplan–Meier survivorship analyses was based on duplex sonography and angiography.

Results. Kaplan–Meier survivorship function revealed a primary patency rate of 62.8% after 7 years (SE = 0.05) for all infrainguinal reconstructions (60% AK/70.8% BK). The primary patency for stage II and III patients was 64.4% after 7 years. The more recent group of 7-mm ID grafts showed a primary patency of 83.7% after 4 years.

Conclusions. Our data provide strong evidence that autologous endothelial cell lining distinctly improves the patency of small diameter vascular grafts.

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