A comparison of aortic valve replacement with viable cryopreserved and fresh allograft valves, with a note on chromosomal studies

O’Brien, Mark F.; Stafford, E. G.; Gardner, Martin; Pohlner, Peter; McGiffin, David C.; Kirklin, John W.

doi:10.1016/s0022-5223(19)36152-5

Cited by 337 publications

(72 citation statements)

References 15 publications

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“…One study suggests the continued viability of homograft tissue with proliferation of donor cells, especially with cryopreserved tissue. 8 The histologic finding in this report, like that of many previous reports, revealed continued cellularity of homograft valve tissue many years following implantation.20·21 This may be a factor in the resistance to degeneration and longevity of homograft valve tissue.…”

Section: Discussionsupporting

confidence: 66%

Homograft Replacement of Single Aortic Valve Cusps: 22 Years Follow-up

Katz

Barnhart

Johnson

et al. 1988

Journal of Cardiac Surgery

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Single aortic valve cusp replacement with fresh aortic homografts were performed in four patients from November 1966 to April 1970. All had preoperative aortic insufficiency due to destruction of a single cusp, with the remaining two cusps structurally and functionally intact. Replacement was performed using the noncoronary cusp from fresh aortic valve homografts. Patient one had homograft cusp replacement of the left coronary cusp at age 13 due to bacterial endocarditis. She recently underwent mitral valve replacement; study and inspection of the aortic valve showed it to be structurally and functionally intact 22 years following homograft cusp replacement. Patient two sustained a gunshot wound perforating his right coronary cusp. He underwent single cusp replacement in January 1967. Currently, he is asymptomatic and has been without evidence of significant aortic valve dysfunction for the past 21 years. Patient three had destruction of the noncoronary cusp due to endocarditis and had homograft cusp replacement in October 1967. Four and a half years later he developed recurrent endocarditis, presented with severe congestive heart failure due to aortic insufficiency, and died. Patient four had bacterial endocarditis affecting the right coronary cusp and had replacement in April 1970. In February 1980, he underwent aortic valve replacement for aortic stenosis. Inspection revealed calcification of the other two cusps with the homograft cusp structurally normal. In summary, follow‐up of homograft replacement of single aortic valve cusps from 4 ½ to 22 years, shows it to be a durable and feasible alternative to prosthetic valve replacement.

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Section: Discussionsupporting

confidence: 66%

Homograft Replacement of Single Aortic Valve Cusps: 22 Years Follow-up

Katz

Barnhart

Johnson

et al. 1988

Journal of Cardiac Surgery

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“…Allografts (aortic or pulmonary) have exceptionally good haemodynamics and a low incidence of thromboembolic complications and do not need any anticoagulation. 5 Such valves are especially efficacious for replacing those excised for endocarditis. It is generally believed that these valves have better haemodynamics than most stented bioprostheses.…”

Section: Introductionmentioning

confidence: 99%

Bioprosthetic heart valves: modes of failure

2009

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Valve replacement started in 1960, with the surgeon now having a significant variety of prosthetic heart valves from which to choose. These valves are broadly divided into mechanical heart valves (MHV) and bioprosthetic heart valves (BHV). Improvements in the performance and ease of usage of BHV without the need for anticoagulant therapy are among the desired features of BHV and hence the increasingly preferred choice over their mechanical counterparts. However, with increased use the post-implantation complications have become more apparent, and these include: calcification, cusp tears, pannus growth, infective endocarditis, valve thrombosis and other factors specific to valve type. In this review we describe these complications in order to bring awareness among surgeons, clinicians and pathologists. Diagnosis, treatment and preventive measures, if taken in a timely manner, can help reduce their impact and further enhance the quality of life of patients with prosthetic heart valves.

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“…For proper evaluation of any valve prosthesis, bioprosthetic, prosthetic, or human, it is imperative to appreciate the frequency of compl,cations present with all types of commonly used valves. Tables 1 and 2 demonstrate that the homografl compares quite favorably with all other prostheses commonly used in this coun- Differences in structural performance between the cryopreserved and antibiotic sterilized allograft valve at 4°C have been emphasized previously by O'Brien et al 3 Freedom from reoperation with the cryopresewed homograft was 86% at 15 years compared to less than 63% with the antibiotic stored valve. This successful experience stimulated worldwide interest for the continued use of the freehand or infra-coronary aortic allograft for aortic valve replacement, even though the technical magnitude of the allograft operation is significantly greater than that found with other prostheses.…”

Section: ;9[suppl): 188-19 1)mentioning

confidence: 63%

Aortic Valve Replacement in the Young

Jones

1994

J Cardiac Surgery

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The attractiveness of the aortic allograft in any form, whether it be free style or root, is the high 10-year freedom from thromboembolism, absence of requirement for anticoagulants, use in active infections, excellent hemodynamics, and freedom from reoperation. The 10-year freedom from all valve related complications has been reported to be around 92% versus only 75% for the porcine bioprosthetic valve. Gradients across the allograft aortic valve are comparable to that of the St. Jude valve (St. Jude Medical, St. Paul, MN, USA) with valve areas approaching 2 cm2 in the extremely large homograft. Between November 1986 and September 1993, the author used the aortic allograft as a freehand procedure in 51 patients and for root replacement in 22 patients. Stimulus for use of limited root replacement with the allograft in aortic valve replacement has occurred because of the unpredictability of the freehand operation with regard to valve insufficiency. This has been done in spite of the Ross modification of retaining the noncoronary sinus. Evaluation of freehand allograft function by echo analysis has demonstrated an unacceptable incidence of insufficiency not found when a small segment of the allograft root is used. The native coronary arteries, however, must be transposed to the donor root, which of itself has the potential of introducing new problems not seen with other valve substitutes. Complications with the freehand allograft have consisted of explanation in eight patients, four early and four late. Six of the early and late explanations have been for insufficiency. Techniques of valve and valve root implantation will be presented in detail.(ABSTRACT TRUNCATED AT 250 WORDS)

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A comparison of aortic valve replacement with viable cryopreserved and fresh allograft valves, with a note on chromosomal studies

Cited by 337 publications

References 15 publications

Homograft Replacement of Single Aortic Valve Cusps: 22 Years Follow-up

Homograft Replacement of Single Aortic Valve Cusps: 22 Years Follow-up

Bioprosthetic heart valves: modes of failure

Aortic Valve Replacement in the Young

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