Abstract
Introduction
Even today, the search for the ideal cardiac valve continues. With advantages of having superior flow dynamics, avoidance of anticoagulation, and resistance to infection, homograft has been shown to have an edge over conventional prosthetic and bioprosthetic valves. But they suffer from disadvantages of limited availability and durability. Our center operates one of the oldest functioning valve banks in the country. We present our experience with homograft valve banking with antibiotic and cryopreserved homografts spread over a quarter century.
Methods
For donor selection, procurement, sterilization, and preservation, the recommendations of the American Association of Tissue Banks are being followed in accordance with statutory provisions of the Transplantation of Human Organs Act, 1994.
Results
During 25-year period (1993–2017), 777 hearts were procured. Age of the donors ranged from 2 to 60 years and hearts were procured within 24 h of death. A total of 1646 homografts (774 pulmonary, 774 aortic, 60 mitral valves, 20 descending thoracic aortae, and 18 monocusps) were harvested. A total of 546 (32%) homografts were rejected for various reasons. Nine hundred sixty-seven (56.7%) homografts were used in different procedures. Of these, 478 were pulmonary homografts, 425 were aortic homografts, 39 mitral homografts, 18 monocusps, and 7 descending thoracic aorta homografts. One hundred fifty-four (16%) homografts were antibiotic preserved and the rest 813 (84%) were cryopreserved.
Conclusions
It is possible to run a homograft valve bank with minimum costs. Though, cryopreservation is more expensive, it provides an opportunity to store the valves for an indefinite period and maintain an uninterrupted supply of homografts.
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References
Choudhary SK, Srivastava S, Chander H, et al. Early experience with homograft valve banking. Asian Cardiovasc Thorac Ann. 1997;5:137–40.
The American Association of Tissue Banks. Technical manual for tissue banking. Arlington: AATB; 1993.
Transplantation of Human Organs Act 1994. Central Act 42;1994.
Angell WW, Angell JD, Oury JH, Lamberti JJ, Grehl TM. Long-term follow-up of viable frozen aortic homografts. A viable homograft valve bank. J Thorac Cardiovasc Surg. 1987;93:815–22.
Kirklin JW, Blackstone EH, Maehara T, et al. Intermediate-term fate of cryopreserved allograft and xenograft valved conduits. Ann Thorac Surg. 1987;44:598–606.
O'brien MF, McGiffin DC, Stafford EG, et al. Allograft aortic valve replacement: long-term comparative clinical analysis of the viable cryopreserved and antibiotic 4° C stored valves. J Card Surg. 1991;6:534–43.
Bodnar E, Matsuki O, Parker R, Ross DN. Viable and nonviable aortic homografts in the subcoronary position: a comparative study. Ann Thorac Surg. 1989;47:799–805.
O'brien MF, Stafford EG, Gardner MA, Pohlner PG, McGiffin DC. A comparison of aortic valve replacement with viable cryopreserved and fresh allograft valves, with a note on chromosomal studies. J Thorac Cardiovasc Surg. 1987;94:812–23.
Jamieson WR. Modern cardiac valve devices—bioprostheses and mechanical prostheses: state of the art. J Card Surg. 1993;8:89–98.
Bloomfield P, Wheatley DJ, Prescott RJ, Miller HC. Twelve-year comparison of a Bjork–Shiley mechanical heart valve with porcine bioprostheses. N Engl J Med. 1991;324:573–9.
Haydock D, Barratt-Boyes B, Macedo T, Kirklin JW, Blackstone E. Aortic valve replacement for active infectious endocarditis in 108 patients. A comparison of freehand allograft valves with mechanical prostheses and bioprostheses. J Thorac Cardiovasc Surg. 1992;103:130–9.
McGiffin DC, Galbraith AJ, McLachlan GJ, et al. Aortic valve infection. Risk factors for death and recurrent endocarditis after aortic valve replacement. J Thorac Cardiovasc Surg. 1992;104:511–20.
Glazier JJ, Verwilghen JO, Donaldson RM, Ross DN. Treatment of complicated prosthetic aortic valve endocarditis with annular abscess formation by homograft aortic root replacement. J Am Coll Cardiol. 1991;17:1177–82.
Longmore DB, Lockey E, Ross DN, Pickering BN. The preparation of aortic-valve homografts. Lancet. 1966;288:463–4.
Smith JC. The pathology of human aortic valve homografts. Thorax. 1967;22:114–38.
Yacoub M, Kittle CF. Sterilization of valve homografts by antibiotic solutions. Circulation. 1970;41:II-29-II-32.
Barratt-Boyes BG, Roche AH, Brandt PW, Smith JC, Lowe JB. Aortic homograft valve replacement: a long-term follow-up of an initial series of 101 patients. Circulation. 1969;40:763–75.
Gall K, Smith S, Willmette C, Wong M, O’Brien M. Allograft heart valve sterilization: a six-year in-depth analysis of a twenty-five–year experience with low-dose antibiotics. J Thorac Cardiovasc Surg. 1995;110:680–7.
Strickett MG, Barratt-Boyes BG, MacCulloch D. Disinfection of human heart valve allografts with antibiotics in low concentration. Pathology. 1983;15:457–62.
Wain WH, Pearce HM, Riddell RW, Ross DN. A re-evaluation of antibiotic sterilization of heart valve allografts. Thorax. 1977;32:740–2.
Villalba R, Mirabet V, Rendal E, et al. Microbiological analysis of cryopreserved human heart valves after storage: a survey of 3 banks in Spain. Cell Tissue Bank. 2009;10:345–9.
Jashari R, Tabaku M, Van Hoeck B, Cochéz C, Callant M, Vanderkelen A. Decontamination of heart valve and arterial allografts in the European Homograft Bank (EHB): comparison of two different antibiotic cocktails in low temperature conditions. Cell Tissue Bank. 2007;8:247–55.
Germain M, Thibault L, Jacques A, Tremblay J, Bourgeois R. Heart valve allograft decontamination with antibiotics: impact of the temperature of incubation on efficacy. Cell Tissue Bank. 2010;11:197–204.
Fan YD, Van Hoeck B, Holovska V, Jashari R. Evaluation of decontamination process of heart valve and artery tissues in European Homograft Bank (EHB): a retrospective study of 1,055 cases. Cell Tissue Bank. 2012;13:297–304.
Verghese S, Padmaja P, Sindhu B, Elizabeth SJ, Lesley N, Cherian KM. Homograft valve bank: our experience in valve banking. Indian Heart J. 2004;56:299–306.
Heng WL, Albrecht H, Chiappini P, Lim YP, Manning L. International heart valve bank survey: a review of processing practices and activity outcomes. J Transplant. 2013. https://doi.org/10.1155/2013/163150.
Choudhary SK, Mathur A, Chander H, et al. Aortic valve replacement with biological substitute. J Card Surg. 1998;13:1–8.
Acknowledgments
The homograft valve bank at our center was established and nurtured by Professor A. Sampath Kumar for 15 years. Authors are thankful to him.
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Choudhary, S., Bansal, N., Kumar, I. et al. Audit of homograft valve bank. Indian J Thorac Cardiovasc Surg 36, 14–20 (2020). https://doi.org/10.1007/s12055-019-00829-8
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DOI: https://doi.org/10.1007/s12055-019-00829-8