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Ann Thorac Surg 2006;81:1466-1471
© 2006 The Society of Thoracic Surgeons

Original article: Cardiovascular

Tissue Engineering of Viable Pulmonary Arteries for Surgical Correction of Congenital Heart Defects

Rainer G. Leyh, MD, PhD a , * , Mathias Wilhelmi, MD a , Philip Rebe, MD b , Sergey Ciboutari, MD a , Axel Haverich, MD, PhD a , Heike Mertsching, PhD b

a Division of Thoracic and Cardiovascular Surgery, Hanover Medical School, Hanover, Germany
b Leibniz Research Laboratories for Biotechnology and Artificial Organs, Hanover, Germany

Accepted for publication August 29, 2005.

* Address correspondence to Dr Leyh, Division of Thoracic and Cardiovascular Surgery, Hufelandstr 55, Essen 45122, Germany (Email: dleyh{at}gmx.de).

Presented at the Fortieth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 26–28, 2004.

BACKGROUND: Tissue-engineered pulmonary arteries could overcome the drawbacks of homografts or prosthetic conduits used in the repair of many congenital cardiac defects. However, the ideal scaffold material for tissue-engineered conduits is still subject of intensive debate. In this study, we evaluated an acellularized allogeneic matrix scaffold for pulmonary artery tissue engineering with and without in-vitro reseeding with autologous endothelial cells in the pulmonary circulation in a growing sheep model.

METHODS: Ovine pulmonary arteries (n = 10) were acellularized by trypsin/ethylenediamine tetraacetic acid incubation. Autologous endothelial cells were harvested from carotid arteries, and the pulmonary conduits were seeded with endothelial cells. We implanted in-vitro, autologous, reendothelialized (group A, n = 5) and acellularized pulmonary conduits (group B, n = 5) in the pulmonary circulation. The animals were sacrificed 6 months after the operation. Explanted valves were examined histologically and by immunohistochemistry.

RESULTS: The conduit diameter increased in both groups (group A, 44% ± 11%; group B, 87% ± 18%; p < 0.05). In group A, however, a proportional increase in diameter was present, whereas in group B, a disproportionate increase resulting in aneurysm formation was observed. Histologically, the conduit wall integrity was destroyed in group B and preserved in group A. In group B, the extracellularmatrix degenerated with a reduced amount of collagens and proteoglycanes. Furthermore, no elastic fibers were detectable. In contrast, the extracellularmatrix in group A was close to native ovine tissue.

CONCLUSIONS: Tissue-engineered pulmonary conduits (autologous endothelial cells and allogeneic matrix scaffolds) functioned well in the pulmonary circulation. They demonstrated an increase in diameter and an extracellular matrix comparable to that of native ovine tissue.






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