“Fresh” free-hand, non-viable allografts for aortic valve replacement: Operative techniques and 15-year results

Abstract

The first unstented allograft valve inserted orthotopically for replacement of the aortic valve (AVR) was performed by Duran and Gunning working with Mr. Donald Ross in London; these pioneering attempts were reported by Ross in 1962 (11) and by Barratt-Boyes in 1964 (1). These investigators, and others, have continued using this method for AVR in selected patients for nearly three decades, and have recently updated their long-term results (2, 7, 8, 9, 10, 12). At Stanford, our initial experience with free-hand allograft AVR was accumulated between 1964 and 1971. A hiatus of 11 years followed; renewed interest in the use of allografts for AVR in children and adolescents started in 1982 at Stanford, due to dissatisfaction with the 51/n 10-year durability of porcine xenograft valves in young patients, reports of reasonable long-term durability using both antibiotic stored (non-viable) and cryopreserved (“viable”) valves (7, 8), and the demonstration of cell viability in cryopreserved allograft valves (4) (although this latter hypothesis continues at the present time, in our opinion, to be unproved in terms of clinical significance). We have subsequently expanded the use of “fresh” (4 °C antibiotic storage for ≤ 241/n 48 h) allograft valves obtained locally from organ donors whose hearts cannot be used for transplantation and commercially marketed cryopreserved allografts (CryoLife, Inc.) for AVR in carefully selected patients in a cautious manner.