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Eur J Cardiothorac Surg 2001;20:164-169
© 2001 Elsevier Science NL
a Clinic for Cardiovascular Surgery, University Hospital, Zürich, Switzerland
b German Heart Center, Berlin, Germany
c Department of Cardiovascular Research, University Hospital, Zürich, Switzerland
Received 9 October 2000; received in revised form 8 March 2001; accepted 23 March 2001.
Corresponding author. Tel.: +41-1-255-3801; fax: +41-1-255-4369
e-mail: simon_philipp.hoerstrup{at}chi.usz.ch
Objective: Previous tissue engineering approaches to create small caliber vascular grafts have been limited by the structural and mechanical immaturity of the constructs. This study uses a novel in vitro pulse duplicator system providing a ‘biomimetic’ environment during tissue formation to yield more mature, implantable vascular grafts. Methods: Vascular grafts (I.D. 0.5 cm) were fabricated from novel bioabsorbable polymers (polyglycolic-acid/poly-4-hydroxybutyrate) and sequentially seeded with ovine vascular myofibroblasts and endothelial cells. After 4 days static culture, the grafts (n=24) were grown in vitro in a pulse duplicator system (bioreactor) for 4, 7, 14, 21, and 28 days. Controls (n=24) were grown in static culture conditions. Analysis of the neo-tissue included histology, scanning electron microscopy (SEM), and biochemical assays (DNA for cell content, 5-hydroxyproline for collagen). Mechanical testing was performed measuring the burst pressure and the suture retention strength. Results: Histology showed viable, dense tissue in all samples. SEM demonstrated confluent smooth inner surfaces of the grafts exposed to pulsatile flow after 14 days. Biochemical analysis revealed a continuous increase of cell mass and collagen to 21 days compared to significantly lower values in the static controls. The mechanical properties of the pulsed vascular grafts comprised supra-physiological burst strength and suture retention strength appropriate for surgical implantation. Conclusions: This study demonstrates the feasibility of tissue engineering of viable, surgically implantable small caliber vascular grafts and the important effect of a ‘biomimetic’ in vitro environment on tissue maturation and extracellular matrix formation.
Key Words: Tissue engineering • Vascular grafts • Pulsatile flow
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