The Studies Of Congenital Coronary Artery Anomalies＆Vascular Grafts

Objectives: Congenital coronary artery anomaly is a rare condition,and the surgical experience is relatively limited.Current vascular grafts have many deficits.We aim to summarize our experience and construct biocompatible vascular grafts.Methods: We retrospectively reviewed 47 patients who underwent surgical repair of isolated congenital coronary artery fistula from January 2001 to March 2015,and 3 patients who underwent surgical repair of congenital left main coronary artery atresia from January 2014 to December 2016.We also winded the porous electrospunned micrometer-scaled polycaprolactone fibres around the silicone rod and subcutaneously implanted the vascular grats into SD rats.Two weeks after subcutaneous implantation,explants were used as vascular grafts and were autotransplanted as infrarenal aortic interposition grafts.Animals were monitored for 4 weeks and euthanized to evaluate neotissue formation.Results: All patients survived after repair for coronary artery fistula.Residual shunt was observed in 8 patients.Extracardiac repair was associated with a higher risk of recanalization.Among 3 patients after repair for coronary artery atresia,1 died after surgery,1 died 2 months after discharge,and another one recovered well during the follow-up period.Autologous cells infiltrated into the whole layer of the biomaterial after 2 weeks of subcutaneous implantation in rats.Four weeks after autotransplantation,the vascular grafts showed favourable patency without thrombosis.The lumen was covered by an endothelial layer,and the number of contractile smooth muscle cells increased.Several layers of elastic fibres were observed underneath the endothelium.Conclusions: Surgical repair of isolated congenital coronary artery fistula in pediatric patients can be performed with low mortality and morbidity,whereas infantile coronary artery atresia is associated with higher surgical mortality.Our novel vascular grafts based on polycaprolactone micrometer-scale fibres and in vivo tissue engineering technique has showed favourable patency and regenerative ability.