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Ann Thorac Surg 2006;81:1942-1943
© 2006 The Society of Thoracic Surgeons

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Correspondence

Reply

To the Editor:

In reply to the comments of Dohmen and Konertz [1] on our article concerning the development of a seeding device and procedure published in The Annals of Thoracic Surgery [2], in our discussion we mentioned this group's device, emphasizing the differences between our device and technique. We used a rather large number of cells for seeding, and this explains the lower endothelial cell adhesion. We achieved a confluent endothelial cell covering immediately after cell seeding, which was proven by scanning electron microscopy. Because cell adhesion was 74%, this means that we used a larger cell number than required and does not mean a poorer result of the device or procedure. However, on the cylinder there was no cell attachment because endothelial cells do not easily attach to metal surfaces. One additional difference was the pre-seeding with autologous fibroblasts that improved endothelial cell adhesion and resistance to shear stress [3]. We also proved that this pre-seeding resulted in an enhanced synthesis of extracellular matrix proteins, such as the basement membrane proteins collagen IV and laminin Is.

It is not proven yet whether decellularization definitely improves durability and outcome of homografts, especially when implanted in the aortic position. We did prove that our grafts were free from endothelial cell covering after cryopreservation. We totally agree with Dohmen and Konertz [1] that for now biological scaffolds are the only ones that insure maintenance of valvular function. However, decellularization procedures compromise durability, at least with porcine prostheses [4]. Therefore our intention is to change as little as possible of the biological matrix of the prostheses. We have already implanted such endothelialized homografts in the aortic position [5]. However, any benefit to the patient must be shown by truly long-term follow-up, which means 10 years or longer. To date, we have only shown feasibility of these techniques in a clinical setting.

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1. Dohmen PM, Konertz W. Seeding human endothelial cells on complex three-dimensional scaffolds(letter) Ann Thorac Surg 2006;81:1942.[Free Full Text]
2. Gulbins H, Pritisanac A, Uhlig A, et al. Seeding of human endothelial cells on valve containing aortic mini-rootsdevelopment of a seeding device and procedure. Ann Thorac Surg 2005;79:2119-2126.[Abstract/Free Full Text]
3. Gulbins H, Pritisanac A, Petzold R, et al. A low-flow adaptation phase improves shear-stress resistance of artificially seeded endothelial cells Thorac Cardiovasc Surg 2005;53:96-102.[Medline]
4. Simon P, Kasimir MT, Seebacher G, et al. Early failure of the tissue engineered porcine heart valve SYNERGRAFT in pediatric patients Eur J Cardiothorac Surg 2003;23:1002-1006discussion 1006.[Abstract/Free Full Text]
5. Gulbins H, Goldemund A, Uhlig 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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