BACKGROUND: Autologous vein grafts are widely used for bypass procedures in cardiovascular surgery. However, these grafts are susceptible to failure due to vein graft disease. Our study aimed to evaluate the impact of the latest-generation FRAME external support on vein graft remodeling in a preclinical model. METHODS: We performed autologous internal jugular vein interposition grafting in porcine carotid arteries for one month. Four grafts were supported with a FRAME mesh, while seven unsupported grafts served as controls. The conduits were examined through flowmetry, angiography, macroscopy, and microscopy. RESULTS: The one-month patency rate of FRAME-supported grafts was 100% (4/4), whereas that of unsupported controls was 43% (3/7, Log-rank p = 0.071). On explant angiography, FRAME grafts exhibited significantly more areas with no or mild stenosis (9/12) compared to control grafts (3/21, p = 0.0009). Blood flow at explantation was higher in the FRAME grafts (145 ± 51 mL/min) than in the controls (46 ± 85 mL/min, p = 0.066). Area and thickness of neo-intimal hyperplasia (NIH) at proximal anastomoses were similar for the FRAME and the control groups: 5.79 ± 1.38 versus 6.94 ± 1.10 mm2, respectively (p = 0.558) and 480 ± 95 vs. 587 ± 52 μm2/μm, respectively (p = 0.401). However, in the midgraft portions, the NIH area and thickness were significantly lower in the FRAME group than in the control group: 3.73 ± 0.64 vs. 6.27 ± 0.64 mm2, respectively (p = 0.022) and 258 ± 49 vs. 518 ± 36 μm2/μm, respectively (p = 0.0002). CONCLUSIONS: In our porcine model, the external mesh FRAME improved the patency of vein-to-carotid artery grafts and protected them from stenosis, particularly in the mid regions. The midgraft neo-intimal hyperplasia was two-fold thinner in the meshed grafts than in the controls.

1st Surgical Clinic 1st Faculty of Medicine Charles University U Nemocnice 499 2 128 08 Prague Czech Republic

3rd Faculty of Medicine Charles University Ruska 87 100 00 Prague Czech Republic

Cardiovascular Surgery Department Institute for Clinical and Experimental Medicine Videnska 1958 9 140 21 Prague Czech Republic

Clinical and Transplant Pathology Centre Institute for Clinical and Experimental Medicine Videnska 1958 9 140 21 Prague Czech Republic

Department of Anatomy 2nd Faculty of Medicine Charles University 5 Uvalu 84 150 06 Prague Czech Republic

Department of Imaging Methods Institute for Clinical and Experimental Medicine Videnska 1958 9 140 21 Prague Czech Republic

Department of Pathology and Molecular Medicine 3rd Faculty of Medicine Charles University and Thomayer University Hospital Ruska 87 100 00 Prague Czech Republic

Experimental Medicine Centre Institute for Clinical and Experimental Medicine Videnska 1958 9 140 21 Prague Czech Republic

Institute of Anatomy 1st Faculty of Medicine Charles University U Nemocnice 3 Praha 2 128 00 Prague Czech Republic

Laboratory of Molecular Structure Characterization Institute of Microbiology of the Czech Academy of Sciences Vídeňská 1083 142 00 Prague Czech Republic

Transplantation Surgery Department Institute for Clinical and Experimental Medicine Videnska 1958 9 140 21 Prague Czech Republic

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