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Viable vascularized autologous patch for transmural myocardial reconstruction

^a Department of Cardio-Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
^b Core Lab for Molecular and Structural Biology, Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany

Received 11 September 2008; received in revised form 12 February 2009; accepted 14 February 2009.

^_* Corresponding author. Tel.: +49 511 532 2186; fax: +49 511 532 5404. (Email: cebotari.serghei{at}mh-hannover.de).

Objective: Various patch materials currently used for cardiac reconstruction represent non-viable tissue with high susceptibility to infection and degeneration. We therefore introduce an innovative, autologous vascularized matrix with high regenerative potential for myocardial reconstruction. Methods: Autologous small bowel segments without mucosa, but with both the adjacent jejunal artery and vein, were harvested and used in a single-stage procedure for the replacement of right ventricular transmural defects (2 cm x 3 cm) in pigs (group A; n = 3). The autografts were revascularized by connecting jejunal vessels to the right internal thoracic artery and vein. Autologous pericardium was used as controls (group B; n = 3). All procedures were performed on beating hearts using a right heart bypass. After explantation (up to 6 months), the patches were investigated by standard histological analyses, immunohistochemistry and confocal microscopy. Results: Postoperative complications, for example excessive bleeding, graft rupture or dislodgement due to the dynamic cardiac contractions, did not occur. In group A, newly formed cardiomyocytes positively stained for Nkx 2.5 and myosin heavy chain were identified 1 month after operation. The cardiomyocytes were localized in close proximity to mesenteric capillaries in a disseminated-like pattern and showed a strong tendency to form islets. In contrast, explanted pericardial patches appeared as fibrotic tissue without evidence of myocardial cells inside the patch. Conclusion: We developed a novel autologous graft with preserved vascularity that can be used for myocardial grafting. This vascularized matrix undergoes autologous repopulation with cardiomyocytes after transmural myocardial replacement. Vascularization represents an important prerequisite for myocardial guided tissue regeneration.

Key Words: Cardiac general • Experimental surgery • Myocardium