Elastica degeneration and intimal hyperplasia lead to Contegra® conduit failure
| Autor: | Sven Martens, Boulos Asfour, Klaus-Michael Mueller, Sabrina Lueck, Armin Darius Peivandi, Edward Malec, Martina Seiler |
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| Rok vydání: | 2019 |
| Předmět: |
Heart Defects
Congenital Male Pulmonary and Respiratory Medicine medicine.medical_specialty Intimal hyperplasia Adolescent Ventricular Outflow Obstruction Blood Vessel Prosthesis Implantation Jugular vein Animals Humans Medicine Ventricular outflow tract Child Device Removal Bioprosthesis Hyperplasia business.industry Infant General Medicine medicine.disease Blood Vessel Prosthesis Prosthesis Failure Surgery Tissue Degeneration Apposition surgical procedures operative Child Preschool Cattle Female Heterotopic ossification Rubber Tunica Intima Cardiology and Cardiovascular Medicine business Calcification |
| Zdroj: | European Journal of Cardio-Thoracic Surgery. 56:1154-1161 |
| ISSN: | 1873-734X 1010-7940 |
| Popis: | OBJECTIVES Currently, Contegra® grafts (processed bovine jugular vein conduits) are widely used for reconstructive surgery of the right ventricular outflow tract in patients with congenital heart disease (CHD). We analysed explanted Contegra conduits from 2 institutions histologically to get a possible hint at the underlying pathomechanisms of degenerative alterations and to find histological correlations of graft failure. Additionally, we compared the explants with a non-implanted processed graft and a native jugular vein obtained from a young bull. METHODS The explanted Contegra grafts were gathered during reoperations of 13 patients (male: n = 9, 69.2%; female: n = 4, 30.8%). After standardized histological preparation, samples were stained with dyes haematoxylin and eosin and Elastica van Gieson. Additionally, X-ray pictures revealed the extent of calcification and chelaplex (III)-descaling agent was used to decalcify selected explants. RESULTS Processing of the native jugular vein leads to tissue loosening and a loss of elastic fibres. For graft failure after implantation, 2 pathomechanisms were identified: original graft alteration as well as intimal hyperplasia. Elastica degeneration and rearrangement with interfibrillary matrix structures were the main developments observed within the graft itself. Intimal hyperplasia was characterized by fibrous tissue apposition, calcification and heterotopic ossification. CONCLUSIONS Regression of the elastic fibre network leads to rigidification of the conduit. In Contegra grafts, atherosclerosis-like changes can be considered the leading cause of graft stenosis and insufficiency. We conclude that both observed mechanisms lead to early reoperation in CHD patients. |
| Databáze: | OpenAIRE |
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