Banking and Distribution of Large Cryopreserved Arterial Homografts in Brussels: Assessment of 4 Years of Activity by the European Homograft Bank (EHB) with Reference to Implantation Results in Reconstruction of Infected Infrarenal Arterial Prostheses and Mycotic Aneurysms

Abstract

arteries have been registered from 136 donors: 122 brain death cases and 14 cadavers (mean age 34 years, male/female ratio 1.52/1); 263 arteries were cryopreserved (113 aortas, 64 aortic bifurcations, and 86 femoral); 19 were discarded for atherosclerosis (6.7%); 10 batches of arteries were partially or totally discarded because of persistent contamination and further eight batches for positive or doubtful viral serology. One hundred patients were treated in nine European centers with one (N = 69) or more EHB homografts. Indications were: infected prosthesis 70 (17 with aortoenteric fistula); mycotic aneurysm 19 (four ascending aortas, two with bronchial fistula); neoplastic infiltration of subrenal aorta one; extracardiac reconstructions/shunts 10.(continued on next page) at NORTH DAKOTA STATE UNIV LIB on May 28, 2015 ves.sagepub.com Downloaded from 20 (Abstract continued)Results from homograft reconstructions in infected prosthesis or mycotic aneurysm were available in 90 patients. There were 19 early deaths and 24 early complications, three were directly graft-related and included a fatal case of homograft rupture. Sixtyseven vascular cases were followed up from 1 month onward (mean: 16 months): 50 were uneventful; there were nine late deaths, of which two resulted from graft-related digestive hemorrhage; there were eight cases of late complications; three arteries were partly explanted as a result of focal thrombosis. Four patients were lost to follow-up. In the cases of aortoenteric fistula, however, the results were disappointing with only five late survivors of the 16 treated patients. Finally, these results show that cryopreserved arteries seem to perform as well in the midterm as the fresh ones.Both the banking activity of cryopreserved homografts and the short-to mid-term performances of the implants in cases of prosthetic or native arterial infection are very satisfactory, provided no aortoenteric fistula is present. Cryopreserved arteries can also be used for extracardiac shunts and reconstructions. '

Use of Cryopreserved Arterial Homografts for Management of Infected Prosthetic Grafts: A Multicentric Study

“…This approach allows better management of precious tissue resources. 9 Theoretically, tissue banking also provides a wider choice of tissue types and thus better compatibility between the donor and recipient. However, it must be noted that, although supply and demand were commensurate in this series, we were often obliged to assemble several segments and histocompatibility was rarely respected.…”

“…The modalities of homograft preparation (measurement, decontamination, cryopreservation, and storage) have been described in detail elsewhere. 9 In short, after rinsing in culture medium and decontamination with various antibiotics (cefoxitin, lincomycin, polyneykin, vancomycin), homografts were frozen and stored at −150°C in liquid nitrogen.…”

Banking of the human heart valves and the arteries at the European homograft bank (EHB) – Overview of a 14-year activity in this International Association in Brussels*

“…In the past, a mid and long term follow-up (FU) form has been sent to implanting surgeons or treating cardiologists, containing questions about the quality of the allograft and specific events (tissue failure, explantation, death of the recipient). Since results of the FU were not satisfactory, this practice has been abandoned in 1997 (Goffin et al 1998).…”

“…During the coming years, requests of the cardiovascular surgeons for cryopreserved valves and arteries increased, the network of MOD selection developed in different European Community Countries (ECC) and the cryobiology made a big progress in processing and cryopreservation of the human tissues. All these factors favoured the creation of the tissue banks, in order to answer the increasing requests of the surgeons for these tissues (Goffin et al 1998). European Homograft Bank (EHB) is one of the tissue banks, which was founded with the purpose of answering such requests to the surgeons.…”

“…In 1991 EHB started the banking of the human arteries, in order to meet increasing demands of the surgeons for quality-controlled arterial allografts of a different type and size (Goffin et al 1998).…”