Correspondence
Transplantation of a Tissue-Engineered Pulmonary Artery
N Engl J Med 2001; 344:532-533February 15, 2001
- Article
To the Editor:
Various vascular grafts are commonly used in the reconstruction of cardiovascular tissues. However, prosthetic or bioprosthetic materials lack growth potential and therefore in children require replacement as the children grow. Tissue engineering offers the potential to create replacement structures from autologous cells and biodegradable polymer scaffolds. Since they contain living cells, these structures have the potential to grow, to repair themselves, and to remodel themselves.1-4
A four-year-old girl had been found to have a single right ventricle and pulmonary atresia and had undergone pulmonary-artery angioplasty and the Fontan procedure at the age of three years, three months. Angiography seven months later revealed total occlusion of the right intermediate pulmonary artery. The application of tissue engineering in this patient was approved by the ethics committee at Tokyo Women's Medical University in April 1999. The patient's parents were thoroughly informed and consented to the procedure.
An approximately 2-cm segment of peripheral vein was explanted, and cells from its walls were isolated. The cells were cultured and expanded as previously described. The cell count in the culture increased substantially, to approximately 12×106 cells, by eight weeks. A tube that served as a scaffold for these cells was composed of a polycaprolactone–polylactic acid copolymer (weight ratio, 1:1) reinforced with woven polyglycolic acid (Figure 1Figure 1
The Tissue-Engineering Technique.). The biodegradable polymer conduit (10 mm in diameter, 20 mm in length, and 1 mm in thickness) was designed to degrade within eight weeks.Ten days after seeding, the graft was transplanted. The occluded pulmonary artery was reconstructed with the tissue-engineered vessel graft. No postoperative complications occurred. On follow-up angiography, the transplanted vessel was noted to be completely patent (Figure 1). Seven months after implantation, the patient was doing well, with no evidence of graft occlusion or aneurysmal changes on chest radiography. We suggest that in pediatric cardiovascular surgery, tissue engineering may have an important role as an alternative to transplantation and the use of artificial organs.
4 ReferencesToshiharu Shin'oka, M.D.
Yasuharu Imai, M.D.
Tokyo Women's Medical University, Tokyo 162-8666, JapanYoshito Ikada, Ph.D.
Suzuka University of Medical Science, Mie 510-0226, Japan1
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