Factors in the early failure of cryopreserved homograft pulmonary valves in children: Preserved immunogenicity?

Baskett, Roger J.F.; Ross, David B.; Nanton, Maurice A.; Murphy, David A.

doi:10.1016/s0022-5223(96)70130-7

Cited by 115 publications

(83 citation statements)

References 31 publications

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“…Patients receiving such xenograft valves are at increased risk of infectious complications such as endocarditis and will require additional valve replacement surgeries because of graft degeneration and limited durability (27,28). Pediatric patients have a higher incidence of homograft calcification (29) and accelerated rates of graft degeneration, which may be attributable to age-related immune mechanisms (30,31). Although cryopreserved homografts are the most biocompatible replacement heart valve available, donor scarcity, transmission of infection and transplantassociated problems limit their use (32,33).…”

Section: Tissue-engineered Cardiac Valvesmentioning

confidence: 99%

The Development of Tissue-Engineered Grafts for Reconstructive Cardiothoracic Surgical Applications

Mirensky

Breuer

2008

Pediatr Res

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Surgical correction of congenital heart defects often requires the use of valves, patches, or conduits to establish anatomic continuity. Homografts, xenografts, or mechanical prosthetic devices are frequently implanted during these surgical procedures. These grafts however lack growth potential, are associated with increased risk of thrombosis and infection and have limited durability, thus increasing the morbidity and mortality of their application in pediatric cardiac surgery. These limitations are being addressed through the development of living, biologic tissue-engineered valves, patches, and conduits. Pilot studies and phase 1 clinical trials are currently underway to evaluate their feasibility, safety, and efficacy. The optimal scaffold, cell source, and conditioning parameters, however, still remain to be determined and are areas of active research.

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Section: Tissue-engineered Cardiac Valvesmentioning

confidence: 99%

The Development of Tissue-Engineered Grafts for Reconstructive Cardiothoracic Surgical Applications

Mirensky

Breuer

2008

Pediatr Res

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“…This is particularly true in children, in whom evidence of structural deterioration may be has high as 56% at 4 years. 3 Preservation methods were first developed to standardize tissue specimen availability and to preserve the structural integrity of the allograft valves before implantation. 4,5 Preservation methods included chemical preservation, irradiation, and freeze drying but resulted in an unacceptable incidence of structural deterioration.…”

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confidence: 99%

Cryopreservation of Rat Aortic Valves Results in Increased Structural Failure

Légaré

Lee²

2000

Circulation

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Background-The cause of valve allograft failure is most likely multifactorial and may include mechanical, immunological, and other factors. Cryopreservation of these valves is often used to extend storage times. However, there has been considerable confusion as to the effects of cryopreservation on valve durability. Our objective was to determine the effects of cryopreservation on histopathological changes in rat aortic valve grafts. Methods and Results-Syngeneic rat aortic valve grafts (Lewis to Lewis; nϭ24) and allogeneic rat aortic valve grafts (Brown Norway to Lewis; nϭ24) were implanted infrarenally, either fresh or after cryopreservation. At 7, 14, and 28 days, the valves were explanted, and histological and immunohistochemical examinations were performed in a blinded fashion. Fresh syngeneic graft leaflets retained their normal structure for the 28-day period of observation. Cryopreserved syngeneic grafts showed retrovalvar thrombus formation, with leaflet destruction at 7, 14, and 28 days. Fresh allogeneic graft leaflets showed significant leaflet thickening and progressive destruction at 14 and 28 days. Cryopreserved allogeneic grafts had evidence of retrovalvar thrombus formation with leaflet destruction at 7, 14, and 28 days. Cryopreserved syngeneic grafts resulted in significant infiltration of mononuclear (ED1 ϩ ) cells not seen with fresh syngeneic grafts but similar to fresh allogeneic grafts. All allogeneic grafts resulted in significant infiltration of T-lymphocytes (CD3 ϩ , CD8 ϩ , CD43 ϩ ). Conclusions-Cryopreservation appears to predispose syngeneic and allogeneic rat aortic valve leaflets to accelerated injury and destruction.

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“…6 Although the mechanism has not been elucidated, a biological valve has been reported as one of the reasons why the immune response is high when the patient is young. 15 As described previously, it is considered that a fresh decellularized heart valve can be a durable, superior artificial valve with less immune reaction. However, because the supply of allografts is limited, it is important to acquire them whenever possible.…”

Section: Discussionmentioning

confidence: 99%

Application of a Fresh Decellularized Pulmonary Allograft for Pulmonary Valve Replacement in Japan

Ozawa

Ueno

Terabe

et al. 2018

Circ J

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Background: Tissue engineering has advanced the technique of decellularization of the heart valve. The valve is reseeded with the patient's own cells after implantation with suppression of immunologic reactions. The same advantage has been reported for fresh decellularized heart valves, and more than 10 years of excellent outcomes have been achieved. We began performing such heart valve implantations in 2013 as part of a clinical study at Osaka University. We report our evaluation of the safety and efficacy of heart valve implantation. Methods and Results:Human pulmonary valves from the German Society for Tissue Transplantation (n=2) or from Japanese heart transplant recipient heart (n=4) were used to make decellularized heart valves; the decellularization process was the same as that used in Europe. Valves were implanted in 5 adults with pulmonary valve insufficiency after tetralogy of Fallot repair and in 1 infant with a double-outlet right ventricle with pulmonary stenosis. Postoperative echocardiography and cardiac magnetic resonance imaging revealed that the valve and ventricular function were significantly improved and maintained postoperatively. Conclusions:Decellularized heart valves could be the new material used as artificial heart valves. Pulmonary allografts derived from the hearts of heart transplant recipients are considered to be useful material for decellularized heart valves. The application of this valve to Japanese clinical circumstances and using the hearts of heart transplant recipients is considered to be very significant.

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Factors in the early failure of cryopreserved homograft pulmonary valves in children: Preserved immunogenicity?

Cited by 115 publications

References 31 publications

The Development of Tissue-Engineered Grafts for Reconstructive Cardiothoracic Surgical Applications

The Development of Tissue-Engineered Grafts for Reconstructive Cardiothoracic Surgical Applications

Cryopreservation of Rat Aortic Valves Results in Increased Structural Failure

Application of a Fresh Decellularized Pulmonary Allograft for Pulmonary Valve Replacement in Japan

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