INTEGRITY AND VIABILITY OF HOMOGRAFT VALVES

被引：27

作者：

FISCHLEIN, T

SCHUTZ, A

UHLIG, A

FREY, R

KRUPA, W

BABIC, R

THIERY, J

REICHART, B

机构：

[1] Department of Cardiac Surgery, University of Munich, Großhadern Medical Center, Munich

[2] Department of Pathology, University of Munich, Großhadern Medical Center, Munich

[3] Department of Clinical Chemistry, University of Munich, Großhadern Medical Center, Munich

[4] University of Munich Großhadern, Department of Cardiac Surgery, Munich, D-81377

来源：

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY | 1994年 / 8卷 / 08期

关键词：

HOMOGRAFT; PRESERVATION TECHNIQUE; VALVE LEAFLET MORPHOLOGY; ENDOTHELIAL CELL VIABILITY; PGI(2) RELEASE;

D O I：

10.1016/1010-7940(94)90084-1

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Since it has been suggested that the leaflet tissue viability influences durability after homologous valve replacement, we compared different harvest and preservation techniques in order to examine the quality and smoothness of homograft conservation. We analyzed human aortic and pulmonary valve leaflets obtained from 'heart-beating donors' (HBD) during heart transplantation and from 'non-heart-beating donors' (NHBD) during coroner's autopsies. Valves were either cryopreserved in liquid nitrogen or stored at 4-degrees-C in nutrient medium similar to the procedure reported in our protocols of the homograft bank system. All grafts from NHBD had been antibiotically sterilized for 3 days beforehand. Morphological observations were made using light and electron microscopy and, in order to characterize the endothelial cell viability, a non-radioactive cell proliferation assay was used. The PGI2 secretion of the remaining endothelium was defined as the 6-keto-prostaglandin Fl a metabolite by an enzyme immunoassay. Observations in the scanning electron microscope revealed that, after cryopreservation, homografts show an almost confluent endothelium when processed within 24 h after harvest from HBD, but lack endothelial cells when obtained from NHBD. Cryopreserved grafts from NHBD exhibited an altered tissue structure with edema and vacuolization within the spongiosa of the leaflets as well as irreversible cell damage when examined under the light and transmission electron microscope. That the metabolic activity of HBD homografts was maintained was confirmed by proven PGI2 secretion (6150+/-1200 pg/3 ml M199 after cryopreservation), whereas specimens from NHBD showed a reduced (1950+/-730 pg/3 ml M199) and, after cryopreservation, almost no release (P < 0.0001). Homografts from HBD stored for 1 week at 4-degrees-C in nutrient medium displayed the highest endothelial cell viability compared to all remaining groups. It can therefore be suggested that even after cryopreservation homograft valves from HBD show a high tissue viability and.integrity. Nevertheless, due to the immunological potential of these cells, endothelial cell viability of HBD homografts should be considered carefully when used for cardiac valve replacement. It remains to be seen to what extent the immunological response to allografts influences long-term tissue durability.

引用

页码：425 / 430

页数：6

共 18 条

[1]

Angell W.W., Shumway N.E., Kosek J.C., A five-year study of viable aortic valve homografts, J Thorac Cardiovasc Surg, 64, pp. 329-339, (1972)

[2]

Angell W.W., Oury J.H., Lamberti J.J., Koziol J., Durability of the viable aortic allograft, J Thorac Cardiovasc Surg, 98, pp. 48-56, (1989)

[3]

Armiger L.C., Thomson R.W., Strickett M.G., Barratt-Boyes B.G., Morphology of heart valves preserved by liquid nitrogen freezing, Thorax, 40, pp. 778-786, (1985)

[4]

Barratt-Boyes R.G., Roche M.B., Subramanyan R., Pemberton J.R., Whitlock R.M., Long-term follow-up of patients with the antibiotic-sterilized aortic homograft valve inserted freehand in the aortic position, Circulation, 75, pp. 768-777, (1987)

[5]

Bodnar E., Matsuki O., Parker R., Ross D.N., Viable and nonviable aortic homografts in the subcoronary position: A comparative study, Ann Thorac Surg, 47, pp. 799-805, (1989)

[6]

Campalani G., Chalmers J., Weaver E., Aortic valve replacement with frozen irradiated homografts: An 18-year experience, Eur J Cardio-Thorac Surg, 3, pp. 558-561, (1989)

[7]

Cochran R.P., Kunzelman K.S., Cryopreservation does not alter antigenic expression of aortic allografts, J Surg Res, 46, pp. 597-599, (1989)

[8]

Crescenzo D.G., Hilbert S.L., Messier R.H., Domkowski P.W., Bar-Rick M.K., Lange P.L., Ferrans V.J., Wallace R.B., Hopkins R.A., Human cryopreserved homografts: Electron microscopic analysis of cellular injury, Ann Thorac Surg, 55, pp. 25-31, (1993)

[9]

Daly R.C., Orszulak T.A., Schaff H.V., Mc Govern E., Wallace R.B., Long-term results of aortic valve replacement with nonviable homografts, Circulation, 84, pp. 81-88, (1991)

[10]

Gonzalez-Lavin L., Bianchi J., Graf D., Amini S., Cl G., Degenerative changes in fresh aortic root homografts in a canine model: Evidence of an immunologic influence, Transplant Proc, 20, pp. 815-819, (1988)

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