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Fiala R, Kochová P, Kubíková T, Cimrman R, Tonar Z, Špatenka J, Fabián O, Burkert J. Mechanical and structural properties of human aortic and pulmonary allografts do not deteriorate in the first 10 years of cryopreservation and storage in nitrogen. Cell Tissue Bank 2019; 20:221-241. [PMID: 30903411 DOI: 10.1007/s10561-019-09762-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/13/2019] [Indexed: 11/22/2022]
Abstract
The aortic and pulmonary allograft heart valves (AHV) are used in the cardiac surgery for replacing the impaired semilunar valves. They are harvested from donor hearts and cryostored in tissue banks. The expiration period was set to 5 years arbitrarily. We hypothesized that their mechanical and structural properties do not deteriorate after this period. A total of 64 human AHV (31 aortic and 33 pulmonary) of different length of cryopreservation (fresh, 0-5, 5-10, over 10 years) were sampled to different tissue strips (artery, leaflet, ventriculo-arterial junction) and tested by tensile test with loading velocity 10 mm/min until tissue rupture. Neighbouring regions of tissue were processed histologically and evaluated for elastin and collagen area fraction. The results were evaluated statistically. In aortic AHV, the physical deformation response of wall samples to stress did not changed significantly neither during the process of cryopreservation nor during the first 10 years of storage. In pulmonary AHV, the ultimate strain dropped after 5 years of cryopreservation indicating that pulmonary artery was significantly less deformable at the time of rupture. On the other hand, the ultimate stress was equal during the first 10 years of cryostorage. The changes in collagen and elastin amount in the tissue samples were not associated with mechanical impairment. Neither elasticity, stiffness and solidity nor morphology of aortic and pulmonary AHV did not change reasonably with cryopreservation and in the first 10 years of cryostorage. This evidence suggests that the expiration period might be extended in the future.
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Affiliation(s)
- Radovan Fiala
- Department of Cardiovascular Surgery, Motol University Hospital, Second Faculty of Medicine, Charles University in Prague, V Úvalu 84, 150 06, Prague, Czech Republic.
| | - Petra Kochová
- Department of Cardiovascular Surgery, Motol University Hospital, Second Faculty of Medicine, Charles University in Prague, V Úvalu 84, 150 06, Prague, Czech Republic.,NTIS - New Technologies for the Information Society, Faculty of Applied Sciences, University of West Bohemia, Technická 8, Pilsen, Czech Republic
| | - Tereza Kubíková
- Department of Histology and Embryology, Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Karlovarská 48, 301 66, Pilsen, Czech Republic
| | - Robert Cimrman
- NTIS - New Technologies for the Information Society, Faculty of Applied Sciences, University of West Bohemia, Technická 8, Pilsen, Czech Republic
| | - Zbyněk Tonar
- NTIS - New Technologies for the Information Society, Faculty of Applied Sciences, University of West Bohemia, Technická 8, Pilsen, Czech Republic
| | - Jaroslav Špatenka
- Department of Cardiovascular Surgery, Motol University Hospital, Second Faculty of Medicine, Charles University in Prague, V Úvalu 84, 150 06, Prague, Czech Republic.,Department of Transplantations and Tissue Bank, Motol University Hospital, V Úvalu 84, 150 06, Prague, Czech Republic
| | - Ondřej Fabián
- Department of Pathology and Molecular Medicine, Motol University Hospital, Second Faculty of Medicine, Charles University in Prague, V Úvalu 84, 150 06, Prague, Czech Republic
| | - Jan Burkert
- Department of Cardiovascular Surgery, Motol University Hospital, Second Faculty of Medicine, Charles University in Prague, V Úvalu 84, 150 06, Prague, Czech Republic.,Department of Transplantations and Tissue Bank, Motol University Hospital, V Úvalu 84, 150 06, Prague, Czech Republic
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Song J, Xing Y, Chen X, Song Z, Teng X, Wang M, Zheng Z, Hu S. Processing of the explanted heart. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2015; 6:613-7. [PMID: 25599048 PMCID: PMC4290049 DOI: 10.4103/1947-2714.147975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Analysis of the explanted hearts from heart transplant recipients provides valuable clinical samples, which can be used to study the anatomy and pathology of the heart. PubMed database was employed as the article source of this review. This article summarized the processing methods of the explanted heart, including dissection, histopathologic examination, cryopreservation, and genetic testing. A standard processing of explanted hearts ensures the quality and reliability of samples. Analysis of explanted hearts facilitates the diagnostic assessment and therapy strategy of heart diseases.
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Affiliation(s)
- Jiangping Song
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yong Xing
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xiao Chen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Zhizhao Song
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xiao Teng
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Mangyuan Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Zhe Zheng
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Shengshou Hu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Kumar PA, McGrath T, Griffin BP, Gonzalez-Stawinski GV, Alfirevic A, Arora H, Wallace LK. Aortic valve homograft: a rare cause of left ventricular outflow tract obstruction. Anesth Analg 2009; 109:361-3. [PMID: 19608803 DOI: 10.1213/ane.0b013e3181ac1c09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Priya A Kumar
- Department of Anesthesiology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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Schenke-Layland K, Stock UA, Nsair A, Xie J, Angelis E, Fonseca CG, Larbig R, Mahajan A, Shivkumar K, Fishbein MC, MacLellan WR. Cardiomyopathy is associated with structural remodelling of heart valve extracellular matrix. Eur Heart J 2009; 30:2254-65. [PMID: 19561339 DOI: 10.1093/eurheartj/ehp267] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS To increase the supply, many countries harvest allograft valves from explanted hearts of transplant recipients with ischaemic (ICM) or dilated cardiomyopathy (DCM). This study determines the structural integrity of valves from cardiomyopathic hearts. METHODS AND RESULTS Extracellular matrix (ECM) was examined in human valves obtained from normal, ICM, and DCM hearts. To confirm if ECM changes were directly related to the cardiomyopathy, we developed a porcine model of chronic ICM. Histology and immunohistostaining, as well as non-invasive multiphoton and second harmonic generation (SHG) imaging revealed marked disruption of ECM structures in human valves from ICM and DCM hearts. The ECM was unaffected in valves from normal and acute ICM pigs, whereas chronic ICM specimens showed ECM alterations similar to those seen in ICM and DCM patients. Proteins and proteinases implicated in ECM remodelling, including Tenascin C, TGFbeta1, Cathepsin B, MMP2, were upregulated in human ICM and DCM, and porcine chronic ICM specimens. CONCLUSION Valves from cardiomyopathic hearts showed significant ECM deterioration with a disrupted collagen and elastic fibre network. It will be important to determine the impact of this ECM damage on valve durability and calcification in vivo if allografts are to be used from these donors.
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Affiliation(s)
- Katja Schenke-Layland
- Department of Medicine/Cardiology, Cardiovascular Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Carrel T. Aortic valve and/or aortic root replacement using an aortic homograft. Multimed Man Cardiothorac Surg 2009; 2009:mmcts.2009.003905. [PMID: 24413404 DOI: 10.1510/mmcts.2009.003905] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Aortic valve replacement using the homograft valve has a special place in the cardiac surgical practice although it has never been widely used, in part due to the lack of tissue donors but also due to the perceived difficulty of the procedure compared with aortic valve replacement using prosthetic devices and concerns regarding homograft valve failure. The principal indication for aortic valve replacement using a homograft aortic valve is for active aortic valve endocarditis (native or prosthetic) with or without perivalvular tissue destruction (abscess cavity, fistula, detachment of the anterior mitral valve leaflet from the aortic annulus). Since the homograft tissue is pliable and adaptable, it can be used to repair defects in complex cases with root destruction. A second interesting application of homograft aortic valve is in the treatment of small aortic root (in which replacement with a small prosthetic valve would produce an unacceptable orifice ratio and ultimately affect long-term outcome) and left ventricular outflow tract obstruction when the homograft aortic valve can be combined to the Konno procedure. Homograft aortic valve can be used in these cases without sacrifying the pulmonary valve to be used as aortic valve substitute (for instance in adolescents and young adults who do not want to undergo a 'two-valve' procedure like the Ross-Konno procedure). The most frequent operation technique is the cylindrical aortic root replacement, performed in a similar way than the classical Bentall procedure. This technique is the most easiest one and performed more frequently than the subcoronary implantation, which is substantially more demanding. Results from centres that have significant experience with homograft valve surgery report equivalent survival data. The University of Alabama had an 87% survival at 5 years in a 10-year period from 1981 to 1991. Of those who underwent isolated aortic valve replacement with a homograft, there was 99% survival at 30 days and 94% survival at 8 years. In the Mayo Clinic series, 82% were alive at 8 years. Like all tissue valves, homograft aortic valves may fail. An understanding of the mechanisms of homograft valve failure and the way in which these mechanisms interact has important surgical implications. Homograft aortic valves may develop progressive regurgitation as a result of a change in the mechanical properties of the leaflets over time.
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Affiliation(s)
- Thierry Carrel
- Clinic for Cardiovascular Surgery, University Hospital Bern, 3010 Bern, Switzerland
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