AN INTEGRATED APPROACH TO THE DESIGN AND ENGINEERING OF HYBRID ARTERIAL PROSTHESES

Purpose: A newly devised hybrid small-caliber graft was developed. The graft consisted of three components: a microporous polyurethane graft (inside diameter 3 mm; length 5 cm) with compliance close to that of a natural artery; an artificial basement membrane composed of a complex gel of type I collagen and dermatan sulfate, which showed enhanced adhesion and growth of endothelial cells (ECs) and reduced adhesion of platelets in vitro; and an autogenous EC monolayer with high degrees of cell-substrate and cell-cell interactions, which was performed before implantation. Methods: Twenty EC-seeded grafts were implanted bilaterally into carotid arteries of dogs without anticoagulant. The implantation period was up to 26 weeks. Results: The overall patency rate for seeded grafts was 75%. The percentage of endothelial coverage of seeded grafts was 98% as implanted, 92% at 2 weeks, and 100% after 12 weeks. The mean intimal thickness of grafts was around 80 mu m at 12 weeks. Little additional increase was observed at 26 weeks. Conclusions: It appears that the complete endothelialization as implanted, high cell-to-substrate adhesive strength that resists hydrodynamic shear stress, and biomechanical compatibility of the polyurethane graft functioned cooperatively to provide a vascular graft with high antithrombogenicity and minimal hyperplasia. The integrated approach of combining biomechanical and cellular engineering designs leading to an important functional smaller-caliber graft is discussed.