Small intestine without mucosa as a growing vascular conduit: A porcine experimental study

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 124; no. 6; pp. 1165 - 1175
• Main Authors: Tucker, Om P., Syburra, Thomas, Augstburger, Monique, van Melle, Guy, Gebhard, Sandra, Bosman, Fred, von Segesser, Ludwig K.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2002; AATS/WTSA
• Subjects: Animals; Blood Vessel Prosthesis; Follow-Up Studies; Intestinal Mucosa; Jejunum - growth & development; Jejunum - transplantation; Jejunum - ultrastructure; Swine; Time Factors; Vena Cava, Inferior - surgery
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1067/mtc.2002.125818

Objective: This study was conducted to check the feasibility of using small intestine without mucosa as a growing vascular conduit. Method: Autologous proximal jejunum without mucosa after treatment with heparin bonding was used as a free inferior vena cava interpositional graft between the renal veins and bifurcation of inferior vena cava in 8 piglets. Intravenous ultrasonography was performed at 1 to 3 months after the operation and at autopsy. Results: One intraoperative death was related to anesthesia. At a mean follow-up of 80 days for the 7 surviving pigs, the weight had increased by 201%, from a mean of 32 kg to a mean of 94 kg. The grafts had increased in length by 128%, from a mean of 2.3 cm at implantation to a mean of 5.1 cm (P <.018) at explantation. In 6 animals the diameter of the graft was equal to that of the adjacent inferior vena cava. At postmortem examination, 6 grafts were patent. The single blocked graft had been patent 1 month after surgery. One graft had extensive septae inside, 2 had minor septae, 2 had microscopic septae, and 2 had no septae at all. Normal appearing adventitia, fibrous tissue, and endothelium (factor VIII-related antigen positive) lined all the grafts. In all 7 grafts, scattered proliferating fibroblasts (MIB1 positive) were observed. Conclusions: Small intestine without mucosa remodels and acts like a live, growing, layered, endothelialized, nonthrombogenic (after re-endothelialization) vascular conduit in a growing pig. This graft material could have potential as a growing vascular conduit in children. J Thorac Cardiovasc Surg 2002;124:1165-75