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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 2000 October;41(5):725-35

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Canine carotid allograft changes after photochemotherapy and external polyester sheathing

Donovan T. J., Lena C. M., Knibbs D. R., Shapiro D. S., Lavitt S. E.

From the Hart­ford Hos­pital, Sur­gical ­Research Hart­ford, Ct. (USA)


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Back­ground. The pur­pose of ­this ­study is to ­define and ­refine the ­changes in ­canine ­carotid allo­grafts ­after pho­to­chem­o­therapy and poly­ester ­sheathing. Pho­to­chem­o­therapy ­with 8-­methoxy pso­ralen (8MOP) and UVA (PUVA) was ­given ­alone or com­bined ­with intra­lu­minal vis­ible ­light (VL) 450 nm in ­proper dos­ages to ­speed the depop­u­la­tion of endo­the­lial (EC) and ­smooth ­muscle ­cells (SMC) and to mod­ulate the ­immune ­response.
­Methods. ­Novel appa­rati ­were ­made for pho­to­chem­o­therapy of 19 ­right ­canine ­carotid arte­rial allo­grafts ­with 19 ­paired ­untreated con­trols in the ­left ­carotid. ­External UVA and internal vis­ible ­light (VL 450 nm) ­were ­used ­with 8-­methoxy pso­ralen (8-MOP) as a sen­si­tizer.
­Results. ­With mod­erate ­dosage of 8-MOP (1 μg/cc) and 2-4 J/cm2 of ­external UVA (­PUVA), ­smooth ­muscle ­cells (SMC) dis­ap­peared ­faster ­from the ­media and fibro­blasts (FB) ­appeared ear­lier in the adven­titia of the ­treated ­right allo­grafts, ­reducing but not elim­i­nating the ­immune ­response. Intra­lu­minal VL did not ­enhance the ­PUVA ­effect. At 68 ­days, ­treated and con­trol allo­grafts ­showed sim­ilar dimen­sions ­with sub­sided ­immune reac­tions. The ­media thick­ness was ­reduced ­from 0.38 mm to 0.18 mm and the ­host adven­titia ­increased ­from 0.22 to 0.60 mm. Var­i­able reac­tions ­peaked ­between two and ­three ­weeks and sub­sided ­after one ­month. All allo­grafts ­remained ­open ­with ­canine ­carotid i.d.s of 2-3 mm and 80 to 100 cc/ minute arte­rial ­flows. ­Although the UVA ­dosage was mod­erate) sim­ilar ­doses ster­il­ized log 7 of ­staph ­aureus cul­tures in ­saline. The allo­grafts ­without ­smooth ­muscle ­showed mod­erate but ­stable cylin­drical dil­a­ta­tion ­without ­spasm or sten­osis and ­with an ade­quate adven­ti­tial but­tress for a ­small ­vessel. A poly­ester ­sleeve ­around ­four ­treated ­grafts was insep­a­rable ­from the allo­graft in ­less ­than 3 ­weeks and tol­er­ated ­well ­over a 70-day ­period.
Con­clu­sions. Bio­de­grad­able ­graft ­sheaths ­with bio­erod­ible hydro­gels ­with ­growth fac­tors (FGF) for ­local ­delivery may pro­vide a ­faster and ­more com­plete ­matrix remod­eling for a ­superior con­duit in the ­future.

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