The RO was associated with excellent long-term survival and low incidence of reoperations up to 15 years. Male patients with AI and dilated annulus are at increased risk for late insufficiency and root dilatation. Fresh decellularized allografts presented the best results for reconstruction of the right ventricular outflow tract.
The use of decellularized allografts was safe and with good medium-term results up to 4 years. There was a tendency to lower late gradients in the SDS decellularized allografts after 12 months.
Objective: The aim of this study was to retrospectively evaluate the first eight years of activities of the Human Heart Valve Bank of Hospital de Caridade da Irmandade da Santa Casa de Curitiba (BVCHSC), analyzing aspects related to procurement, processing, storage and distribution of homologous cardiovascular grafts.Method: Initial donor screening was achieved according the national guidelines for human organ procurement, besides specific BVCHSC criteria. Hearts were obtained from multiple organ donors, non-beating heart donors and heart transplant recipients, with total ischemic times under 48 hours. Donor ages varied from neonates up to 60 years for aortic valves and 65 years for pulmonary valves. The dissected grafts had their dimensions measured and their morphology evaluated, using a classification system with category 0 (discarded), 1 (minimal morphological alterations) and 2 (perfect). The incidence and microorganisms responsible for organ contamination were determined, as was the efficiency of the decontamination solution. Aspects related to graft distribution were also analysed.
Results: From September 1996 to February 2005, 1059hearts from 19 Brazilian states were received at BVCHSC. From these, 977 (92.3%) were from brain-death donors. A total of 2105 grafts were processed and of the aortic and pulmonary grafts that were analysed, 783 were in category 2, 697 in category 1 and 186 were discarded due to morphological abnormalities. In total, 433 received grafts were contaminated and the sterilization solution was efficient in 330 cases. 571 (27.1%) grafts were rejected during some phase of the processing, mainly due to contamination and morphological abnormalities. A total of 1338 grafts were distributed to 74 health institutions and were more commonly used for aortic valve replacement (529), correction of congenital heart diseases (478) and during the Ross procedure (272).Conclusions: The activities of the BVCHSC during the initial eight years were satisfactory, fulfilling the proposed goals.Descriptors: Tissue banks. Transplantation, homologous. Cryopreservation. Tissue preservation.
399COSTA Cardiovasc Surg 2005; 20(4) , MTBA ET AL -Analysis of the inicial eight years of activities of the Human Heart Valve Bank of the Hospital de Caridade da Irmandade da Santa Casa de Misericórdia de Curitiba Braz J
The Ross operation in this cohort was associated with long-term survival similar to the general population and low incidence of reoperations. Patients with the preoperative diagnosis of AI are at increased risk for late autograft insufficiency and root dilatation. Decellularized allografts presented the best results for reconstruction of the RVOT. These results support the conclusion that the Ross operation has an important role in the treatment of middle-aged patients with aortic valve disease, especially those with pure aortic stenosis.
IntroductionCurrent guidelines state that patients with severe mitral regurgitation
should be treated in reference centers with a high reparability rate, low
mortality rate, and durable results.ObjectiveTo analyze our global experience with the treatment of organic mitral
regurgitation from various etiologies operated in a single center.MethodsWe evaluated all surgically treated patients with organic mitral
regurgitation from 2004-2017. Patients were evaluated clinically and by
echocardiography every year. We determined early and late survival rates,
valve related events and freedom from recurrent mitral regurgitation and
tricuspid regurgitation. Valve failure was defined as any mitral
regurgitation ≥ moderate degree or the need for reoperation for any
reason.ResultsOut of 133 patients with organic mitral regurgitation, 125 (93.9%) were
submitted to valve repair. Mean age was 57±15 years and 52 patients
were males. The most common etiologies were degenerative disease (73
patients) and rheumatic disease (34 patients). Early mortality was 2.4% and
late survival was 84.3% at 10 years, which are similar to the age- and
gender-matched general population. Only two patients developed severe mitral
regurgitation, and both were reoperated (95.6% at 10 years). Freedom from
mitral valve failure was 84.5% at 10 years, with no difference between
degenerative and rheumatic valves. Overall, late ≥ moderate tricuspid
regurgitation was present in 34% of the patients, being more common in the
rheumatic ones. The use of tricuspid annuloplasty abolished this
complication.ConclusionWe have demonstrated that mitral regurgitation due to organic mitral valve
disease from various etiologies can be surgically treated with a high repair
rate, low early mortality and long-term survival that are comparable to the
matched general population. Concomitant treatment of atrial fibrillation and
tricuspid valve may be important adjuncts to optimize long-term results.
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