N. Chakfe et al., ALBUMIN AS A SEALANT FOR A POLYESTER VASCULAR PROSTHESIS - ITS IMPACTON THE HEALING SEQUENCE IN HUMANS, Journal of Cardiovascular Surgery, 37(5), 1996, pp. 431-440
Objective. Although the healing characteristics of albumin impregnated
vascular prostheses have been extensively studied in animal models, t
hey have never been studied in. humans, We therefore examined the heal
ing sequence and the albumin degradation rate of this type of prosthes
is harvested from humans, We also addressed the possible relationship
between the implantation of cross-linked albumin and a specific inflam
matory reaction. Methods. Thirty albumin-impregnated polyester vascula
r prostheses were collected in our institution from January 1991 to Fe
bruary 1993. The mean duration of implantation of the prostheses was 8
.4+/-9.7 (SD) months (range: 1 hour to 26 months). Twenty two prosthes
es were patent at the time of explantation and 4 had been thrombosed f
or less than 24 hours, In 18 cases, the prostheses were surgically rem
oved because of a complication or a reoperation, and during an autopsy
in 12 cases. Each harvested specimen was submitted to histological an
d immunohistochemical studies in order to demonstrate the presence of
human albumin sealant, and to determine the inflammatory cell constitu
ents. Results. The albumin-impregnated prostheses were poorly infiltra
ted by healing tissues after 2 years of implantation An external capsu
le was constantly observed after 2 months of implantation with a nonsp
ecific chronic inflammatory reaction localized between the capsule and
the polyester yarns, We observed large amounts of albumin sealant aft
er 2 months, a gradual degradation with time, and traces after 2 years
of implantation in humans, The luminal surface of the ex-plant was ma
inly covered with organized fibrin, No histological signs of a specifi
c inflammatory reaction were observed. Conclusions. The healing of the
albumin impregnated prosthesis was poor and the degradation rate of t
he albumin sealant was significantly delayed, when compared to animal
models, This difference in degradation rate could be related to inters
pecies differences of phagocytic cells enzymatic machinery, Finally, i
mplantation of glutaraldehyde cross-linked albumin in humans is safe,
since me observed an aspecific chronic foreign body inflammatory react
ion.