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Schmiady MO, Jashari R, Lenherr R, Regenscheit S, Hitendu D, Wendt M, Schiess S, Schweiger M, Hofmann M, Sromicki J, Flammer A, Wilhelm MJ, Cesnjevar R, Carrel T, Vogt PR, Mestres CA. How to counteract the lack of donor tissue in cardiac surgery? Initial experiences with a newly established homograft procurement program. Cell Tissue Bank 2024; 25:1-10. [PMID: 37097383 PMCID: PMC10126547 DOI: 10.1007/s10561-023-10087-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/28/2023] [Indexed: 04/26/2023]
Abstract
Homograft heart valves may have significant advantages and are preferred for the repair of congenital valve malformations, especially in young women of childbearing age, athletes and in patients with active endocarditis. A growing problem, however, is the mismatch between tissue donation and the increasing demand. The aim of this paper is to describe the initiation process of a homograft procurement program to attenuate the shortage of organs. A comprehensive description of the infrastructure and procedural steps required to initiate a cardiac and vascular tissue donation program combined with a prospective follow-up of all homografts explanted at our institution. Between January 2020 and May 2022, 28 hearts and 12 pulmonary bifurcations were harvested at our institution and delivered to the European homograft bank. Twenty-seven valves (19 pulmonary valves, 8 aortic valves) were processed and allocated for implantation. The reasons for discarding a graft were either contamination (n = 14), or morphology (n = 13) or leaflet damage (n = 2). Five homografts (3 PV, 2 AV) have been cryopreserved and stored while awaiting allocation. One pulmonary homograft with a leaflet cut was retrieved by bicuspidization technique and awaits allocation, as a highly requested small diameter graft. The implementation of a tissue donation program in cooperation with a homograft bank can be achieved with reasonable additional efforts at a transplant center with an in-house cardiac surgery department. Challenging situations with a potential risk of tissue injury during procurement include re-operation, harvesting by a non-specialist surgeon and prior central cannulation for mechanical circulatory support.
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Affiliation(s)
- Martin O Schmiady
- Clinic for Cardiac Surgery, University Heart Center, University Hospital Zurich, Rämistrasse 100, CH-8091, Zurich, Switzerland.
- Department of Congenital Cardiovascular Surgery, University Children's Hospital Zurich, Zurich, Switzerland.
- Children's Research Center, University Children's Hospital Zurich, University Zurich, Zurich, Switzerland.
| | - Ramadan Jashari
- European Homograft Bank (EHB), University Hospital St. Luc, Brussels, Belgium
| | - Renato Lenherr
- Donor Care Association, University Hospital Zurich, Zurich, Switzerland
| | | | - Dave Hitendu
- Department of Congenital Cardiovascular Surgery, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, University Zurich, Zurich, Switzerland
| | - Martin Wendt
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Zurich, Switzerland
| | - Stefanie Schiess
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Zurich, Switzerland
| | - Martin Schweiger
- Department of Congenital Cardiovascular Surgery, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, University Zurich, Zurich, Switzerland
| | - Michael Hofmann
- Clinic for Cardiac Surgery, University Heart Center, University Hospital Zurich, Rämistrasse 100, CH-8091, Zurich, Switzerland
| | - Juri Sromicki
- Clinic for Cardiac Surgery, University Heart Center, University Hospital Zurich, Rämistrasse 100, CH-8091, Zurich, Switzerland
| | - Andreas Flammer
- Clinic for Cardiology, University Heart Centre, University Hospital Zurich, Zurich, Switzerland
| | - Markus J Wilhelm
- Clinic for Cardiac Surgery, University Heart Center, University Hospital Zurich, Rämistrasse 100, CH-8091, Zurich, Switzerland
| | - Robert Cesnjevar
- Department of Congenital Cardiovascular Surgery, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, University Zurich, Zurich, Switzerland
| | - Thierry Carrel
- Clinic for Cardiac Surgery, University Heart Center, University Hospital Zurich, Rämistrasse 100, CH-8091, Zurich, Switzerland
| | - Paul R Vogt
- Clinic for Cardiac Surgery, University Heart Center, University Hospital Zurich, Rämistrasse 100, CH-8091, Zurich, Switzerland
| | - Carlos A Mestres
- Clinic for Cardiac Surgery, University Heart Center, University Hospital Zurich, Rämistrasse 100, CH-8091, Zurich, Switzerland
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Jashari R, Bouzet V, Alcaraz Blanco MJ, Oleffe A, Lecocq E, Mastrobuoni S. Vascular allografts for clinical application in Europe: assessment of 30 years of experience with vascular tissue banking in Brussels. Cell Tissue Bank 2023; 24:613-625. [PMID: 36595150 PMCID: PMC9809507 DOI: 10.1007/s10561-022-10063-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/06/2022] [Indexed: 01/04/2023]
Abstract
Vascular tissue banking has been carried out in Brussels for over 30 years in compliance with EU and Swiss tissue banking regulations. A total of 2.765 vascular tissue donations were performed in Belgian, French, Netherlands and Suisse transplant centres: 547(20%), 1.013(37%) and 1.205(43%) during the first, second and third periods, respectively. 85% and 18% increase in donations during the second and third decades compared to previous one, were remarkable. Of the 7.066 evaluated vascular tissues, 2.407(227, 921 and 1.259) were discarded (34.1%), whereas 4.659(523, 1.861 and 2.275) accepted (65.9%) during the respective period. Of the 92 donated veins, 44(47.8%) were discarded and 48(52.2%) accepted. Allografts available for clinical application were stored in vapours of liquid nitrogen. A total of 4.636 allografts were delivered and transplanted for cases of infection (58%), critical limb ischaemia (16%) and congenital cardiac surgery (15%). Thirty veins were implanted. The progressive increases in donations of 20%, 37% and 43% and in transplantations of 20.8%, 34.6% and 45% during the first, second and third periods, respectively, were remarkable. Complications were reported after transplantation and these included acute rejection of two femoral arteries one month after transplantation. We conclude that the donation and transplantation of cryopreserved vascular allografts was stable with a progressive increase over time. Allografts were used predominantly for the treatment of infection, limb salvage for critical ischaemia and for neonates and infants with congenital cardiac malformation. Immune related rejection was observed. This should be a subject of future investigation.
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Affiliation(s)
- Ramadan Jashari
- European Homograft Bank (EHB), Cliniques Universitaires St. Luc (UCL), Av. Emmanuel Mounier 49, Tour Rosalind Franklin (Entrée F), Route 703, 2E Étage, 1200 Brussels, Belgium
| | - Vanessa Bouzet
- European Homograft Bank (EHB), Cliniques Universitaires St. Luc (UCL), Av. Emmanuel Mounier 49, Tour Rosalind Franklin (Entrée F), Route 703, 2E Étage, 1200 Brussels, Belgium
| | - Maria-Josee Alcaraz Blanco
- European Homograft Bank (EHB), Cliniques Universitaires St. Luc (UCL), Av. Emmanuel Mounier 49, Tour Rosalind Franklin (Entrée F), Route 703, 2E Étage, 1200 Brussels, Belgium
| | - Alison Oleffe
- European Homograft Bank (EHB), Cliniques Universitaires St. Luc (UCL), Av. Emmanuel Mounier 49, Tour Rosalind Franklin (Entrée F), Route 703, 2E Étage, 1200 Brussels, Belgium
| | - Emilie Lecocq
- European Homograft Bank (EHB), Cliniques Universitaires St. Luc (UCL), Av. Emmanuel Mounier 49, Tour Rosalind Franklin (Entrée F), Route 703, 2E Étage, 1200 Brussels, Belgium
| | - Stefano Mastrobuoni
- European Homograft Bank (EHB), Cliniques Universitaires St. Luc (UCL), Av. Emmanuel Mounier 49, Tour Rosalind Franklin (Entrée F), Route 703, 2E Étage, 1200 Brussels, Belgium
- Department of Cardiac Surgery, Hospital Saint Luc, UCL, Brussels, Belgium
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Jashari R. Transplantation of cryopreserved human heart valves in Europe: 30 years of banking in Brussels and future perspectives. Cell Tissue Bank 2021. [PMID: 33532987 DOI: 10.1007/s10561-021-09902-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/20/2021] [Indexed: 11/27/2022]
Abstract
For over 30 years, our TE has processed, controlled for quality and distributed cryopreserved allograft valves for human application. We present a review of this activity and future perspectives of cardiovascular tissue banking. The donor age and medical/behavioral history are in compliance with the regulations of the EUMS. Allograft morphology and function are evaluated in a class A cleanroom. Tests for viral/bacterial infection, histological control of structure/infection/malignancy and control-rate cryopreservation are performed. A total of 7562 hearts were sent to our TE, whereas 7290 valves (pulmonary, aortic and mitral) were transplanted. The donations increased over time: 1934, 2566 and 3062 hearts were donated during the first, second and third decades (increases of 32.7 and 19.3% during the second and third decades). Likewise, there was a significant increase in transplantations with 2050, 2550 and 2690 valves implanted during the first, second and third decades (24.4 and 5.5% increase during the second and third decades). A total of 4475 pulmonary (61.4%), 2760 aortic (37.9%) and 55 mitral valves (0.7%) were transplanted. Outstanding long-term results in adults and evidence of immune-related deterioration of allografts in neonates and infants were demonstrated. Decellularization was suggested as a solution. One hundred pulmonary and 180 aortic valves were sent for transplantation after decellularization for the ESPOIR and ARISE clinical trials and beyond. The donation and transplantation activity increased progressively. Although cryopreserved valves represent the best substitute for diseased valves, accelerated failure appears after implantation in neonates and infants. The implementation of new technologies, such as decellularization, as a standard procedure for treatment of allograft valves will offer further improvements in allograft quality and increase of durability.
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Kraft L, Ribeiro VST, de Nazareno Wollmann LCF, Suss PH, Tuon FF. Determination of antibiotics and detergent residues in decellularized tissue-engineered heart valves using LC-MS/MS. Cell Tissue Bank 2020; 21:573-584. [PMID: 32809090 DOI: 10.1007/s10561-020-09856-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/08/2020] [Indexed: 11/24/2022]
Abstract
Residual chemicals that are presented during tissue processing in human tissue banks can be a risk for the allograft recipient. Determine the residual concentrations of the antibiotics and detergent used in the process of human decellularized tissue-engineered heart valves stored in isotonic saline solution up to 18 months. A total of 24 human decellularized allografts were stored in sterile sodium chloride and analyzed immediately after the decellularization process (0 months) and after storage for 6, 12, and 18 months, which includes the use of sodium dodecyl sulfate (SDS) and antibiotics (cefoxitin, vancomycin hydrochloride, lincomycin hydrochloride, polymyxin B sulfate). These valves were used for suitability tests, the zone of inhibition evaluation, and direct contact cytotoxicity assay. The stock solution from 32 valves was used for LC-MS/MS analysis of antibiotics and SDS. Tissue samples from decellularized valves showed a zone of inhibition formation for S. aureus and B. subtilis, suggesting the presence of an inhibitory molecule in the tissue. Cytotoxicity tests were negative. Polymyxin B, vancomycin, and SDS were detected and quantified in human decellularized aortic and pulmonary allografts during all periods of the study. There were no traces of residual cefoxitin and lincomycin in the tissue stock solution. We found residual concentrations of the antibiotics and detergent used in the process of human decellularized tissue-engineered heart valves stored in isotonic saline solution up to 18 months.
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Affiliation(s)
- Leticia Kraft
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil
| | - Victoria Stadler Tasca Ribeiro
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil
| | | | - Paula Hansen Suss
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil
| | - Felipe Francisco Tuon
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil. .,Human Tissue Bank, Pontifícia Universidade Católica do Paraná, Curitiba, PR, 80215-901, Brazil.
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de By TMMH, McDonald C, Süßner S, Davies J, Heng WL, Jashari R, Bogers AJJC, Petit P. Validation of microbiological testing in cardiovascular tissue banks: results of a quality round trial. Eur J Cardiothorac Surg 2018; 52:895-900. [PMID: 28605496 DOI: 10.1093/ejcts/ezx178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 03/23/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Surgeons needing human cardiovascular tissue for implantation in their patients are confronted with cardiovascular tissue banks that use different methods to identify and decontaminate micro-organisms. To elucidate these differences, we compared the quality of processing methods in 20 tissue banks and 1 reference laboratory. We did this to validate the results for accepting or rejecting tissue. We included the decontamination methods used and the influence of antibiotic cocktails and residues with results and controls. The minor details of the processes were not included. METHODS To compare the outcomes of microbiological testing and decontamination methods of heart valve allografts in cardiovascular tissue banks, an international quality round was organized. Twenty cardiovascular tissue banks participated in this quality round. The quality round method was validated first and consisted of sending purposely contaminated human heart valve tissue samples with known micro-organisms to the participants. The participants identified the micro-organisms using their local decontamination methods. RESULTS Seventeen of the 20 participants correctly identified the micro-organisms; if these samples were heart valves to be released for implantation, 3 of the 20 participants would have decided to accept their result for release. Decontamination was shown not to be effective in 13 tissue banks because of growth of the organisms after decontamination. Articles in the literature revealed that antibiotics are effective at 36°C and not, or less so, at 2-8°C. The decontamination procedure, if it is validated, will ensure that the tissue contains no known micro-organisms. CONCLUSIONS This study demonstrates that the quality round method of sending contaminated tissues and assessing the results of the microbiological cultures is an effective way of validating the processes of tissue banks. Only when harmonization, based on validated methods, has been achieved, will surgeons be able to fully rely on the methods used and have confidence in the consistent sterility of the tissue grafts. Tissue banks should validate their methods so that all stakeholders can trust the outcomes.
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Affiliation(s)
| | - Carl McDonald
- National Bacteriology Laboratory, NHS Blood and Transplant, Colindale, UK
| | - Susanne Süßner
- Austrian Red Cross, Blood Transfusion Service for Upper Austria, Linz, Austria
| | - Jill Davies
- Oxford Radcliffe Hospitals, NHS Trust, Oxford, UK
| | - Wee Ling Heng
- National Cardiovascular Homograft Bank, SingHealth Transplant Tissue Centre, Singapore
| | - Ramadan Jashari
- European Homograft Bank (EHB), St Jean Clinique, Brussels, Belgium
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| | - Pieter Petit
- Foundation of European Tissue Banks, Berlin, Germany
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