Introduction
Cryopreserved allograft heart valves (CAHV) show longer event-free survival
compared to other types of protheses. However, all patients develop early
and/or late allograft failure. Negative predictors are clinical, and there
is a lack of evidence whether they correspond with the microscopic structure
of CAHV. We assessed histopathological signs of structural degeneration,
degree of cellular preservation, and presence of antigen-presenting cells
(APC) in CAHV and correlated the changes with donor clinical
characteristics, cryopreservation times, and CAHV types and diameters.
Methods
Fifty-seven CAHV (48 pulmonary, nine aortic) used for transplantation between
November/2017 and May/2019 were included. Donor variables were age, gender,
blood group, height, weight, and body surface area (BSA). Types and
diameters of CAHV, cold ischemia time, period from decontamination to
cryopreservation, and cryopreservation time were recorded. During surgery,
arterial wall (n=56) and valvar cusp (n=20) samples were obtained from the
CAHV and subjected to microscopy. Microscopic structure was assessed using
basic staining methods and immunohistochemistry (IHC).
Results
Most of the samples showed signs of degeneration, usually of mild degree, and
markedly reduced cellular preservation, more pronounced in aortic CAHV,
correlating with arterial APC counts in both basic staining and IHC. There
was also a correlation between the degree of degeneration of arterial
samples and age, height, weight, and BSA of the donors. These findings were
independent of preservation times.
Conclusion
CAHV show markedly reduced cellular preservation negatively correlating with
the numbers of APC. More preserved CAHV may be therefore prone to stronger
immune rejection.