First Report of Histological Evaluation of Human Tissue-Engineered Vasculature

Abstract

, 25 patients underwent a Fontan procedure using tissue-engineered vasculature (TEV) under informed consent and institutional review board approval [1]. Six of these 25 patients died, although no graft-related mortality occurred. The case presented herein is the first case in which the family agreed to the performance of an autopsy to elucidate the late-term histological characteristics of human TEV. A 16-year-old girl had a history of heart murmur and cyanosis at birth, followed by diagnoses of heterotaxy syndrome (polysplenia), a single right ventricle, pulmonary stenosis, bilateral superior vena cava, a hemiazygos connection, and a common atrium with mild to moderate regurgitation from a common atrioventricular valve. She underwent a Fontan procedure with common atrioventricular valve plasty following staged operations at the age of 4 years. A 12-mm-diameter biodegradable scaffold seeded with mononuclear bone marrow cells was interposed between the hepatic vein and pulmonary artery to accomplish the Fontan procedure [1]. At the age of 16 years, she died of multiple organ failure, low cardiac output syndrome, disseminated intravascular coagulation, pancytopenia, and brain abscessation. An autopsy of the patient was performed, and the tissue samples were evaluated either macroscopically or microscopically for histological analyses. Macroscopic examination showed well-formed tissue-engineered vessels connected to the pulmonary artery (Figure 1A).