Objective To summarize the experience of extraanatomic aortic bypass grafting through median sternotomy for onestage treatment of aortic coarctation and associated cardiac diseases, and to improve surgical effect of the diseases. Methods Between July 1997 and July 2008, 31 consecutive patients(20 male,11 female; age 31.9±11.7 years) with aortic coarctation and associated cardiac anomalies underwent onestage surgical repair through median sternotomy. The associated cardiac anomalies included: aortic valve insufficiency or stenosis(n=22); mitral valve insufficiency or stenosis (n=9); patent ductus arteriosus (n=5); ascending aortic aneurysm (n=4); ventricular septal defect (n=3); coronary artery disease (n=2). Extra-anatomic aortic bypass grafting was used to repair the coarctation. Routing of the grafts was: ascendingto posterior pericardial descending aorta (n=9) and ascendingtoinfrarenal abdominal aorta (n=22). Concomitant cardiac procedures included: aortic valve replacement in 16; Bentall procedures in 6; mitral valve repair or replacement in 9; ascending aortic replacement or aortoplasty in 4; patent ductus arteriosus closure in 5; ventricular septal defect closure in 3 and coronary artery bypass grafting in 2. Results One patient died of septic shock 39 days after operation with an inhospital mortality of 3.2%. Mean systolic blood pressure gradient between upper and lower extremities decreased from 64.2±25.3 mm Hg preoperatively to 13.7±10.2 mm Hg postoperatively (Plt;0.05). Twentyseven patients were followed up from 4 to 73 months, there were no late deaths，reoperations or graftrelated complications. Conclusion Extraanatomic aortic bypass grafting can be performed simultaneously through median approach in patients with aortic coarctation and associated cardiac diseases. It is an effective and safe treatment option for onestage surgical repair in adults and adolescents. Both ascendingto posterior pericardial descending aorta and ascendingtoinfrarenal abdominal aorta bypass have favorable results.
Objective To study the feasibility of transplanting human saphanous vein endothelial cells to luminal surface of blood vessel prosthesis and to play a theoretical foundation for the clinical application of autologous endothelial cell transplantation. Methods Human saphanous vein endothelial cells were harvested with 0.1% collagenase and cultivated in vitro for 13.08±1.24 days. The cultures were confirmed as endothelial cells with the fourescent linked anti-Ⅷ antigen antibodies. The content of both 6-keto-PGF1α and Von Willebrand factor (vWF) in the supernatant were detected with ELISA and radioimmunoassay. The multiplied cells were lined in vitro onto the luminal surface of expanded polytetraflouroethylene (ePTFE) grafts precoated with fibrin glue and fibronectin, then cultivated again for 9 days. Results 11.46±2.69×１０６ of available endothelial cells could be regularly obtained, the number of endothelial cells increased 147.93±88.68 times when culture were terminated. All the cells diploid cells with a purity of 99%. The content of both 6-keto-PGF1α and vWF in the media showed no significant difference between the primary and subculture passages. The luminal surface of grafts was covered completely by a spindlelike endothelial monolayer and an even fibrin glue matrix could be seen underneath. Conclusion Endothelial cells derived from human saphanous veins might be feasible to be transplanted onto the luminal surface of ePTFE and present a potential clinical application.