Ann Thorac Surg 2005;79:1466-1467
© 2005 The Society of Thoracic Surgeons
Correspondence
Neointima in Vascular Prostheses: The Jury is Still Out: Reply
Thorsten Walles, MD
Department of Thoracic and Vascular Surgery, Heidehaus Hospital, Am Leineufer 70, Hannover D-30149, Germanytwalles@yahoo.com
Heike Mertsching, PhD
Tissue Engineering Network, Medical School Hannover, Podbielskistrasse 380, Hannover D-30659, Germany
To the Editor:
We greatly appreciate the remarks of Dr Protopapas and want to comment on them. Synthetic prostheses are successfully applied for the reconstruction of large diameter arteries (>6 mm). However, clinically applied purely synthetic vascular grafts fail in small diameter and low flow locations [1]. To overcome this problem, hybrid grafts have been developed from synthetic materials with a bioartificial endothelial lining, and first experiences have been promising. However, the same groups conceded limitations of these tissue engineered constructs, including structural immaturity and suboptimal mechanical properties resulting in unfavorable in vivo results in recent publications [2]. Lessons learned from animal experiments applying hybrid grafts during the last decade are that synthetic scaffolds need physiologic material properties mimicking the native extracellular matrix to allow functional endothelial differentiation and function [3]. Currently, no synthetic material is available that can fulfil these demands. On the other hand, biological matrices are available at present and might earlier lead to a new generation of improved (cardio-) vascular substitutes [4].
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References
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- Bordenave L, Remy-Zolghardi M, Fernandez P, Bareille R, Midy D. Clinical performance of vascular grafts lined with endothelial cells Endothelium 1999;6:267-275.[Medline]
- Hoerstrup SP, Kadner A, Melnitchouk S, et al. Tissue engineering of functional trileaflet heart valves from human marrow stromal cells. Circulation 2002;106(12 Suppl I):I143–50..
- Hubbell JA. Bioactive biomaterials Curr Opin Biotechnol 1999;10:123-129.[Medline]
- Gulbins H, Goldemund A, Uhlig A, Pritisanac A, Meiser B, Reichart B. Implantation of an autologously endothelialized homograft J Thorac Cardiovasc Surg 2003;126:890-891.[Free Full Text]
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