Human Blood Vessel–Derived Endothelial Progenitors for Endothelialization of Small Diameter Vascular Prosthesis

BACKGROUND:Coronary bypass graft failure as a result of acute thrombosis and intimal hyperplasia has been the major challenge in surgical procedures involving small-diameter vascular prosthesis. Coating synthetic grafts with patients' own endothelial cells has been suggested to improve the patency rate and overall success of bypass surgeries. METHODOLOGY/PRINCIPAL FINDINGS:We isolated endothelial progenitor cells (EPCs) from leftover pieces of human saphenous vein/mammary artery. We demonstrate that EPCs can be expanded to generate millions of cells under low-density culture conditions. Exposure to high-density conditions induces differentiation to endothelial cell phenotype. EPC-derived endothelial cells show expression of CD144high, CD31, and vWF. We then assessed the ability of differentiated endothelial cells to adhere and grow on small diameter expanded polytetrafluoroethylene (ePTFE) tubings. Since ePTFE tubings are highly hydrophobic, we optimized protocols to introduce hydrophilic groups on luminal surface of ePTFE tubings. We demonstrate here a stepwise protocol that involves introduction of hydrophilic moieties and coating with defined ECM components that support adhesion of endothelial cells, but not of blood platelets. CONCLUSION/SIGNIFICANCE:Our data confirms that endothelial progenitors obtained from adult human blood vessels can be expanded in vitro under xenoprotein-free conditions, for potential use in endothelialization of small diameter ePTFE grafts. These endothelialized grafts may represent a promising treatment strategy for improving the clinical outcome of small-caliber vascular grafts in cardiac bypass surgeries

Single-stage transpericardial repair of acute aortic dissection associated with recoarctation

WOS: 000168524900028PubMed ID: 1132624

First do no harm: postoperative thromboprophylaxis following open heart surgery

We recently operated on a patient with an acute aortic dissec-tion Stanford Type A. The postoperative period was uneventful. Our intensive care unit team started anticoagulation for throm-boprophylaxis within the first postoperative day, basing their de-cision on the European Association for Cardio-thoracic Surgery (EACTS) guidelines [1]. After reviewing these and other guidelines carefully, we realize that the EACTS guidelines give a general rec-ommendation for all comers, advising that all patients who undergo cardiac surgery receive prophylactic anticoagulation from the first postoperative day [1]. We find that this recommen-dation is too broad and merits discussion until updated guide-lines are available. There is a risk of deep vein thrombosis (DVT) and pulmonary embolism (PE) following cardiac surgery. This complication is not rare, but it not as high as in other types of surgery, such a

The histological effect of harmonic scalpel and electrocautery in lung resections. An experimental study in a rat model

PubMed ID: 15041940Aim. In the last decade, ultrasonically activated scalpels (the Harmonic Scalpel, HS) have been developed and used for both open and endoscopic surgical procedures. The present study compares the deepness of lung tissue damage caused by HS and unipolar electrocautery (EC) in rats. Methods. Ten rats were used for the study. Morphological damage on lung parenchyma of the rats was measured with the ocular micrometer in light microscopy. Results. The mean depth of the tissue damage was 0.23±0.08 mm in the HS group, and 0.33±0.10 mm in the EC group. The difference was statistically significant between the 2 groups (p=0.028). Conclusion. HS induces significantly less tissue damage than EC in rat lungs