Aortic valve replacement with Dacron-supported grafts

Watson, Derek; Pearson, Kami; Cawley, J. C.; Rhea, W.G.; Donnelly, R. J.; Dexter, Franklin

doi:10.1136/thx.23.6.621

Cited by 7 publications

(2 citation statements)

References 31 publications

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“…The early clinical experience with frame-mounted homograft aortic valves was disappointing (Watson et al, 1968;Donnelly, Rhea, and Watson 1969). We have previously described the development of a technique for mounting and testing such valves so that mechanical integrity could be ensured at the time of surgical use (Donnelly et al, 1971).…”

Section: Discussionmentioning

confidence: 99%

Post-mortem shrinkage of homograft aortic valves

Dexter¹,

Donnelly²,

Deverall³

et al. 1972

Thorax

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Experience has shown that some frame-mounted homograft aortic valves, although competent immediately after mounting, are incompetent when subsequently presented for surgical use. Retraction and shrinkage of the cusps appears to be the cause of this change. Clinical and experimental studies have shown that shrinkage of homograft aortic valves occurs over an approximately five-day period after death of the donor and it is recommended that this period should elapse before mounting homograft aortic valves on to support frames.

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Section: Discussionmentioning

confidence: 99%

Post-mortem shrinkage of homograft aortic valves

Dexter¹,

Donnelly²,

Deverall³

et al. 1972

Thorax

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“…Despite the advantages of homograft valves there have been few reports describing the use of aortic valve homografts for mitral valve replacement (Yacoub and Kittle, 1969;Angell, Wuerflein, and Shumway, 1967;Watson et al, 1968;Angell, Iben, Gianelly, and Shumway, 1969;Bigelow, Trimble, Auger, and Wigle, 1967;Angell, Stinson, Iben, and Shumway, 1968;Hubka, Sigka, and Holec, 1967). The average human aortic valve area is 2-8 cm2, which is well above the critical mitral area of 1 to 15 cm2.…”

mentioning

confidence: 99%

Mitral valve replacement with mounted aortic valve homografts

Rogers

Chambers

Gotsman

et al. 1972

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The clinical results of isolated mitral valve replacement with mounted aortic valve homografts undertaken in 29 patients is presented. In 15 of these patients haemodynamic evaluations were made before and after operation. The results attest to the haemodynamic suitability of the homograft aortic valve in the mitral position and it would appear from this initial study that there will be little difference in the durability of orthotopic and heterotopic aortic homograft valves.Experience over the past eight years with transplantation of aortic valve homografts to the subcoronary position has clearly demonstrated their advantages. Unlike mechanical prostheses the homograft aortic valve permits unobstructed central flow; thromboembolic complications are rare and homograft valve failure of any variety is not a cause of sudden death (Barratt-Boyes and Roche, 1969). Late homograft valve failure is currently confined to leaflet rupture which is related to the method of preparation of the homograft. Methods of sterilization and storage which do not damage the mucopolysaccharides, collagen, and elastin that make up the leaflet should improve the durability of the homograft, and the present method of antibiotic sterilization may achieve this.Despite the advantages of homograft valves there have been few reports describing the use of aortic valve homografts for mitral valve replacement

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Light and electron microscopy studies on homograft and heterograft heart valves

Aparicio¹,

Donnelly²,

Dexter³

et al. 1975

The Journal of Pathology

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Light and electron microscopical changes were studied in 23 valvular homografts and six pig aortic heterografts, which had been inserted into patients for lengths of time varying from three days to 54 months. Prior to insertion, eleven of the homografts had been sterilised by beta-propriolactone and freeze-dried, the other twelve had been sterilised by gamma-radiation. The morphological changes in the freeze-dried group were characterised by moderate to severe structural changes including gross vacuolation, fibrinoid degeneration and calcification in the absence of any significant cellular events. It is concluded that the structural changes were due to physico-chemical degradation of the collagen due to improper preservation of the graft, prior to insertion. The morphological changes in the homografts treated with gamma-radiation were fewer and less severe in that there was less vacuolation of the matrix, less fibrinoid degeneration and no examples of calcification. Clear-cut examples of graft regeneration were never observed in either group, but the significance of minor cellular infiltrates in two of the gamma-irradiated grafts is discussed in terms of abortive regeneration. The heterografts showed moderate to intense cellularity, predominantly of macrophages. It is postulated that graft rejection phenomena are responsible for the graft failure in this group.

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Aortic valve replacement with Dacron-supported grafts

Cited by 7 publications

References 31 publications

Post-mortem shrinkage of homograft aortic valves

Post-mortem shrinkage of homograft aortic valves

Mitral valve replacement with mounted aortic valve homografts

Light and electron microscopy studies on homograft and heterograft heart valves

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