Ann Thorac Surg 1995;60:S353-S358
© 1995 The Society of Thoracic Surgeons
Articles
Acellular matrix: A biomaterials approach for coronary artery bypass and heart valve replacement
MD Gregory J. Wilson*,
PhD David W. Courtman,
DVM, PhD Petr Klement,
PhD J. Michael Lee,
PhD Herman Yeger
Centre for Biomaterials and Departments of Cellular and Molecular Pathology, Surgery, and Metallurgy and Materials Science, University of Toronto; Department of Pathology and Division of Cardiovascular Research, Hospital for Sick Children; and Division of Cardiovascular Surgery, The Toronto Hospital, Toronto, Ontario, Canada
* Address reprint requests to Dr Wilson, The Toronto Hospital, Room CCRW 1-885, 200 Elizabeth St, Toronto, Ontario M5G 2C4 Canada
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Abstract
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We have developed a multistep detergent-enzymatic extraction process (involving hypotonic and hypertonic solutions, the detergents octyl-phenoxy-polyethoxyethanol and sodium dodecyl sulfate, as well as DNAse and RNAse) which, while inhibiting autolysis, removes all cells from tissues and, with them, cellular antigens together with lipids and more soluble glycosaminoglycans. What remains is acellular matrix with the structural proteins well conserved and normally arranged. Canine arteries extracted to acellular matrix were implanted as coronary artery bypass allografts in a canine model, without the use of cardiopulmonary bypass, and compared with autogenous saphenous veins. Of nine pilot acellular matrix implants, four were patent, as compared with four of seven saphenous vein grafts. All occlusions in both graft types occurred acutely soon after implantation, with almost all patent grafts followed up for 6 months. The acellular matrix allografts showed no inflammation and only minimal cellular repopulation. This model needs further development, but appears promising for preclinical evaluation. Canine aortic and pulmonic valves extracted to acellular matrix using a modification of our extraction process, eliminating the detergent sodium dodecyl sulfate, were implanted heterotopically as allografts in the left main pulmonary artery in dogs, a location chosen to avoid the need for cardiopulmonary bypass. At 1 month, two-dimensional echocardiography of six implants showed leaflet motion and 3-to 5-mm Hg transvalvular gradients. Expiant histology of four valves at 1 month showed no inflammation, cellular repopulation at the base of the valve, and partial endothelialization. Although much remains to be done, the acellular matrix process has the potential to produce a coronary artery bypass graft with performance similar to that of autogenous saphenous vein and a bioprosthetic heart valve with performance similar to cryopreserved homografts, both from an abundant supply of nonhuman tissues
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Footnotes
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** Presented at the VI International Symposium for Cardiac Bioprostheses, Vancouver, BC, Canada, July 29–31, 1994.
*** This research was supported by grants from the Medical Research Council of Canada (arteries) and from the Ontario Heart and Stroke Foundation (heart valves).
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References
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