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Original Articles: Adult Cardiac

Invited Commentary

Cardiovascular Surgery, Hyogo University of Health Sciences, Minatojima 1-3-6, Kobe, Hyogo, 650-8530 Japan

(Email: hmatsuda{at}huhs.ac.jp).

This report by Sato and colleagues [1] proposes a novel approach to prevent artificial graft infection using biomaterial containing basic fibroblast growth factor (FGF), which enhances angiogenetic reactions of surrounding tissue. The material is "bio-gel" composed of gelatin-microsphere containing human recombinant b-FGF and used as a wrapping for the graft. The results demonstrate apparent suppression of bacterial growth in a subcutaneously implanted prosthetic graft. The concept is attractive and believed to be an "artificial omental flap" to enhance resistance to local infection. Clinically this idea seems promising for situations with increased risks of graft infection after vascular surgery. However, further refinement of the material and the method of application may be needed.

The study itself has various limitations as the authors have mentioned. The main concerns include the following: the model described was subcutaneous implantation, not graft replacement; the timing of bacterial exposure was very late (at 7 days after implantation); the observation period was limited to 2 days; and the capillary ingrowths in the prosthetic graft itself were unclear. The study design would have been improved by comparison with allograft replacement alone; application of an intrathoracic model; use of polytetrafluoroethylene, instead of Dacron grafts; and, importantly, simultaneous administration of bacteria. It would also be interesting to see a comparison between subcutaneous implantation and an intrathoracic location, in which surrounding tissue coverage is inadequate.

Notwithstanding such limitations of the study, the authors should be congratulated for introducing this novel approach to prevent serious infectious complications in vascular replacement surgery. In particular, this technique can be readly applicable to peripheral artery surgery by using this graft in compromised patients who are highly susceptible to graft infections.

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1. Sato S, Nitta Y, Saiki Y, et al. Enhanced perigraft angiogenesis prevents prosthetic graft infection Ann Thorac Surg 2008;86:1278-1285.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Hikaru Matsuda Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Matsuda, H. Search for Related Content PubMed PubMed Citation Articles by Matsuda, H. Related Collections Great vessels Related Article