A method of sterilizing and preserving fresh allograft heart valves

Lockey, Eunice; Ai-Janabi, Nawal; Gonzalez‐Lavin, Lorenzo; Ross, Donald N.

doi:10.1136/thx.27.4.398

Cited by 57 publications

(25 citation statements)

References 10 publications

(7 reference statements)

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“…Antibiotic decontamination of the allografts was introduced by Bryan Barrat-Boyes in 1969 ( BarratBoyes et al 1969). Different protocols were proposed and modified in the years 1970 (Lockey et al 1972;Yacoub et al 1973;Waterworth et al 1974;Wain et al 1977). In 1983 Strtickett with her collaborators (Strickett et al 1983) introduced the low concentration antibiotic cocktail of different antibiotics in low temperature conditions (+48C).…”

Section: Discussionmentioning

confidence: 99%

Decontamination of heart valve and arterial allografts in the European Homograft Bank (EHB): comparison of two different antibiotic cocktails in low temperature conditions

Jashari

Tabaku

Hoeck

et al. 2007

Cell Tissue Banking

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The aim of the study was to compare the efficiency of two different antibiotic cocktails in the cardiovascular allograft decontamination. Low temperature, low-concentration antibiotic cocktail with Cefoxitin, Lincomycin, Polymixin B and Vancomycin was decontamination protocol in EHB for many years. The modified cocktail doesn't contain Cefoxitin. The study had two steps. First step: cardiovascular allografts from 80 donors are incubated in classical (group 1) or modified cocktail (group 2). Second step: 184 and 182 allografts of group 1 and group 2 are incubated in the modified and classical antibiotic cocktail, respectively. The bacteriological examination is performed in three steps: A-transport solution, B-decontamination solution and C-cryopreservation solution. During the first step 23.75% of the tissues were initially contaminated mainly with Staphylococcus (78.95%). 93.75% of the allografts of group 1 and 100% of group 2 were sterile after incubation (p = 0.058). 25.54% and 30.77% of group 1 and 2, respectively were contaminated in A-examination during the second step. Staphylococci were isolated in 82.98% and 69.64% in group 1 and 2, respectively. About 4.35% of group 1 and 5.5% of group 2 were contaminated in A, B, and C whereas 5.4% of group 1 and 4.4% of group 2 were contaminated in B or C after being sterile in A. Finally 9.78% of the tissues were rejected and 90.22% cryopreserved in the modified, whereas 9.89% rejected and 90.11% accepted in the classical group (p = 0.1). The difference was non-significant in the level of decontamination between the two cocktails. Contamination of some tissues with low growing, low-pathogen germs that appeared in B or C examination, couldn't be explained. This issue needs complementary investigation.

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Section: Discussionmentioning

confidence: 99%

Decontamination of heart valve and arterial allografts in the European Homograft Bank (EHB): comparison of two different antibiotic cocktails in low temperature conditions

Jashari

Tabaku

Hoeck

et al. 2007

Cell Tissue Banking

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“…Sterilization procedures have also been shown to affect negatively the two factors thought to influence long-term survival: fibroblast viability and host ingrowth into and onto the implants. [16][17][18][19][20] Many different formulas have been advocated since 1968 to overcome these problems . [20][21][22] The potential for microorganisms in tracheal grafts because of atmospheric communication necessitates antibiotic treatment.…”

Section: Discussionmentioning

confidence: 99%

“…[16][17][18][19][20] Many different formulas have been advocated since 1968 to overcome these problems . [20][21][22] The potential for microorganisms in tracheal grafts because of atmospheric communication necessitates antibiotic treatment. We sterilized the grafts in an antibiotic nutrient medium considered efficacious at our institution.23 Antibiotic sterilization for twelve to sixteen hours was found to be adequate as evidenced by culture and sensitivity results of the preserved grafts.…”

Section: Discussionmentioning

confidence: 99%

Tracheal Homograft as Aortic Conduit: Early Phase Results

Muralidharan

Laub

et al. 1990

Vascular Surgery

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The aim of this study was to evaluate the performance of tracheal homografts as aortic conduits. Fourteen tracheal grafts freshly procured from rats were preserved by the following two methods: cryopreservation (n = 6) and treatment with glutaraldehyde 0.2 % (n = 8). The explanted tracheae were stored for ten to twenty days prior to implantation. They were subsequently implanted into the infrarenal aorta of the recipient rats. The average length replaced was 1 to 1.5 cm. The grafts were then evaluated after a period of one (n = 6, 2 cryopreserved, 4 gluteraldehyde), two (n = 4, 2 cryopreserved, 2 glutaraldehyde), and three (n = 4, 2 cryopreserved, 2 gluteraldehyde) weeks for their performance, morphology, and histopathology. The rats did well postoperatively with adequate distal perfusion. Two of the 6 rats with cryopreserved grafts had reduced flow as evidenced by lack of pulsation in the aorta distal to the graft, and histologic examination revealed incompletely occluding thrombus adherent to the luminal surface. The remaining cyropreserved and glutaraldehyde-fixed grafts had good flow and did not show any radiologic evidence of narrowing at the site of anastomosis or in the region of the graft. Histopathologic examination showed that the glutaraldehyde-treated homografts had better morphology, intact cartilage, and no or mild inflammatory response. The cryopreserved tracheal homografts showed degenerative changes in the cartilage. The inflammatory response was moderate, and the mucosa was either ruptured or absent. In the 2 that had reduced flow, there was marked cartilage necrosis and inflammatory response with thrombus formation in the lumen. This early phase study shows that tracheal homografts functioned well as conduits in the aortic position and gluaraldehydetreated homografts have better morphology than cryopreserved homografts.

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“…Antibiotic sterilized homograft valves have been used since 1968 (Stinson et al, 1968;Barratt-Boyes and Roche, 1969;Yacoub and Kittle, 1970;Lockey et al, 1972) and are considered by the authors to be one of the best available valve substitutes. Fungal endocarditis following homograft valve replacement remains an important cause of mortality and morbidity.…”

Section: Introductionmentioning

confidence: 99%

The role of chemotherapy in the management of fungal endocaridits following homograft valve replacement

Wain

Ahmed

Thompson

et al. 1979

Postgraduate Medical Journal

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SummaryInitial intensive combined chemotherapy, with late re-operation when indicated, appears to give better results than immediate excision of the infected valve.The combination chemotherapy used in this series was amphotericin B (up to 100 mg/patient/day) and flucytosine (up to 12g/patient/day). Serious side effects attributed to this chemotherapy were extremely rare. Candida infections were the most common and the Aspergillus infections were uniformly fatal. Embolectomies and excisions of large mycotic aneurysms were generally successful. Re-operation for late valve malfunction was common and yielded satisfactory results.

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A method of sterilizing and preserving fresh allograft heart valves

Cited by 57 publications

References 10 publications

Decontamination of heart valve and arterial allografts in the European Homograft Bank (EHB): comparison of two different antibiotic cocktails in low temperature conditions

Decontamination of heart valve and arterial allografts in the European Homograft Bank (EHB): comparison of two different antibiotic cocktails in low temperature conditions

Tracheal Homograft as Aortic Conduit: Early Phase Results

The role of chemotherapy in the management of fungal endocaridits following homograft valve replacement

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