Long-Term Outcome of Homograft Implants Related to Donor and Tissue Characteristics

Axelsson, Ida; Malm, Torsten

doi:10.1016/j.athoracsur.2018.03.014

Cited by 6 publications

(6 citation statements)

References 14 publications

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“…6 a). Studies comparing different ischemic times in relation to long-term performance of homografts have not been able to find any differences between homografts with ischemic times up to 24 h compared to a maximum of 48 h (Meyns et al 2005 ; Kalfa et al 2011 ; Axelsson and Malm 2018 ). Recent studies of decellularized homografts have shown promising results, indicating that cell viability in the homograft is not needed to ensure homograft quality at implantation.…”

Section: Discussionmentioning

confidence: 99%

“…In alliance with the EDQM guidelines, a blood sample is required from the donor for serological testing within 24 h of death to avoid hemolysis. After preparation, antibiotic decontamination is conducted for a minimum of 24 h and a maximum of 96 h. The allowed extended time spans lead to a larger pool of possible donors, and more time to retrieve and transport the hearts to the tissue bank (Axelsson and Malm 2018 ; Bester et al 2018 ).…”

Section: Introductionmentioning

confidence: 99%

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Impact of storage time prior to cryopreservation on mechanical properties of aortic homografts

et al. 2023

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Optimal time spans in homograft procurement are still debatable among tissue banks and needs to be further investigated. Cell viability decreases at longer preparation intervals, but the effect on collagen and elastic fibers has not been investigated to the same extent. These fibers are of importance to the homograft elasticity and strength. The objective of this study was to analyze the mechanical properties of homograft tissue at different time spans in the procurement process. Ten aortic homografts were collected at the Tissue Bank in Lund. Twelve samples were obtained from each homograft, cryopreserved in groups of three after 2–4 days, 7–9 days, 28–30 days, and 60–62 days in antibiotic decontamination. Mechanical testing was performed with uniaxial tensile tests, calculating elastic modulus, yield stress and energy at yield stress. Two randomly selected samples were assessed with light microscopy. Procurement generated a total of 120 samples, with 30 samples in each time group. Elastic modulus and yield stress was significantly higher in samples cryopreserved after 2–4 days (2.7 MPa (2.5-5.0) and 0.78 MPa (0.68-1.0)) compared to 7–9 days (2.2 MPa (2.0-2.6) and 0.53 MPa (0.46–0.69)), p = 0.008 and 0.011 respectively. Light microscopy did not show any difference in collagen and elastin at different time spans. There was a significant decrease in elastic modulus and yield stress after 7 days of decontamination at 4 °C compared to 2–4 days. This could indicate some deterioration of elastin and collagen at longer decontamination intervals. Clinical significance of these findings remains to be clarified.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of storage time prior to cryopreservation on mechanical properties of aortic homografts

et al. 2023

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“…The preparation, antibiotic decontamination and cryopreservation of the homograft have been described elsewhere (Axelsson and Malm 2018 ). During preparation, the cusps and vessels are closely reviewed for damage and insufficiency.…”

Section: Methodsmentioning

confidence: 99%

“…The preparation, antibiotic decontamination and cryopreservation of the homograft have been described elsewhere (Axelsson and Malm 2018).…”

Section: Donors and Homograftsmentioning

confidence: 99%

Impact of valve fenestrations and structural changes in homografts on the long-term outcome in the recipient

2021

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Homografts have long been used for right ventricular outflow tract (RVOT) reconstruction. Tissue banks struggle to meet the clinical demand of tissue, with insufficient donor availability and strict recommendations on tissue quality with high proportions of discards. This study analyzes the long-term outcome of patients receiving a homograft with small fenestrations of the cusps or other structural changes, to evaluate if minor impairment of the homograft affects the durability. Homograft characteristics and patient outcome were described. Follow-up was maximum 24 years. Structural changes of the homografts were analyzed in relation to patient outcome, using univariable and multivariable Cox proportional hazard regression. Between 1995 and 2018, 468 patients received 535 homografts in the RVOT in Lund. Median recipient age was 13 years. There were 137 (26.9%) reinterventions. Freedom from reintervention was 75.8% (95% CI 71.3–79.7%) at 10 years and 57.4% (95% CI 50.0–64.0%) at 20 years. Small fenestrations of the cusps, fibrosis of the cusps and minor atheromatosis of the vessel did not show any statistically significant impact on long-term outcome, hazard ratio = 0.46 (95% CI 0.11–1.87, p = 0.276) and hazard ratio = 0.80 (95% CI 0.25–2.56, p = 0.704). Minor structural changes of the homografts seem to be acceptable without affecting the long-term durability.

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“…Short ischemic time intend to keep homograft quality and prevent adverse events after implantation, but studies indicate that it would be safe to implant homografts with prolonged ischemic time (Meyns et al 2005 ; Kalfa et al 2011 ; Axelsson and Malm 2018 ; Bester et al 2018 ). Looking at the homograft structure after prolonged ischemic time, it is shown that cellular viability decreases (Wallace et al 1992 ; Niwaya et al 1995 ; Gall et al 1998 ).…”

Section: Introductionmentioning

confidence: 99%

Impact of prolonged storage time on homograft ultrastructures: an attempt to find optimal guidelines for homograft processing

von Konow,

Eliasson,

Nilsson

et al. 2024

Cell Tissue Bank

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According to guidelines, total ischemic time for homografts at processing must be kept short to avoid degeneration. Many homografts are discarded due to practical inability to finish all steps from procurement to cryopreservation within the time limit. Although, several studies have shown that homografts with prolonged ischemic time show adequate quality and performance. Twenty aortic and 12 pulmonary homografts were collected and biopsies were retrieved at preparation (day 0) and after 1, 2, 3, 4, 7, 14, 21, 28, and 60 days in antibiotic decontamination at 4 °C. Biopsies were prepared for light microscopy (LM) and transmission electron microscopy (TEM). Assessment generated scores for cells, elastin, and collagen. Relative differences between times were compared with Wilcoxon signed rank test. Bonferroni corrected p value of 0.0056 was considered significant. LM could only reveal decrease in cell count at 60 days in aortic homografts, no other differences was detected. TEM showed affected cell appearance in day 3 and day 4 and beyond for aortic and pulmonary homografts respectively. Elastin appearance was affected at day 60 for aortic and day 21 for pulmonary homografts. Collagen appearance was affected at day 28 for aortic homografts, with no significant differences in pulmonary homografts. Cell degeneration starts early after homograft procurement, but elastic and collagen fibers are more resistant to degeneration. Overall structure integrity as seen in LM was not affected at all, while TEM could reveal small degeneration signs in individual elastic fibers and collagen bundles at 21 and 28 days respectively.

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Long-Term Outcome of Homograft Implants Related to Donor and Tissue Characteristics

Cited by 6 publications

References 14 publications

Impact of storage time prior to cryopreservation on mechanical properties of aortic homografts

Impact of storage time prior to cryopreservation on mechanical properties of aortic homografts

Impact of valve fenestrations and structural changes in homografts on the long-term outcome in the recipient

Impact of prolonged storage time on homograft ultrastructures: an attempt to find optimal guidelines for homograft processing

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