A Review of Aortic Valve Homografts over a Six and One-half Year Period

Barratt‐Boyes, B. G.; Roche, A. F.

doi:10.1097/00000658-196909010-00016

Cited by 77 publications

(18 citation statements)

References 7 publications

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“…Sterilization by irradiation and chemical means used in the 1960s and early 1970s did not provide effective long-term durability (Kirklin et al 1994). Antibiotic decontamination procedures to treat heart valve allograft for tissue banking were developed first by Barratt-Boyes and Roche (Barratt-Boyes and Roche 1969). Various alternative antibiotic sterilization protocols with different antibiotics, concentrations, exposure times and incubation temperatures were proposed afterward (Barratt-Boyes and Roche 1969;Barratt-Boyes et al 1987;Wain et al 1977;Khanna et al 1981;Strickett et al 1983;Hu et al 1989;O'Brien et al 1995;Gall et al 1995).…”

Section: Introductionmentioning

confidence: 99%

Processing of cardiovascular allografts: effectiveness of European Homograft Bank (EHB) antimicrobial treatment (cool decontamination protocol with low concentration of antibiotics)

Tabaku¹,

Jashari²,

Carton³

et al. 2004

Cell Tissue Banking

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To assess the effectiveness of antimicrobial treatment by using cool decontamination protocol with low concentration of antibiotics during processing of cardiovascular allografts, 948 allografts processed during a 2-year period were analysed. Five hundred and fourty one donors aged <62 years were classified in: multiorgan donors (MOD) with non-transplantable hearts; recipients of cardiac transplantation (RHT); and non-beating heart cadavers with a warm ischemic time of less than 6 h (NBHD). During processing three samples for bacteriology testing were taken A (sampling before decontamination); B (sampling after decontamination); C (sampling on the final product). Samples A were positive in 348 cases (36.4%), respectively 36% for MOD, 21.6% for RHT and 78.1% for NBHD. All the allografts were immersed in a cocktail of four antibiotics at 4 degrees C. After exposure to antibiotics the rate of decontamination of those with A positive was 90.4, 92.5, 82.5% respectively for MOD, RHT, NBHD. At the end of processing, 57 allografts (6%) were positive in B and/or C, 15 allografts remained contaminated with the same bacteria as in A, 42 were contaminated during processing. The overall rate of sterility in the end of processing is 94% and for each group this is: 95.4% for MOD, 96.8% for RHT and 86.3% for NBHD. Analysis shows that there is no influence of time of exposure in AB in the rate of decontamination for MOD and RHT. The most predominant germ in contamination is Coagulase Negative Staphylococcus (CNS) (53.4% alone, 8.9% with other bacteria). 83.3% of MOD; 88.5% of RHT were contaminated with one germ, while 40.4% of NBHD were contaminated with more than one.

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Section: Introductionmentioning

confidence: 99%

Processing of cardiovascular allografts: effectiveness of European Homograft Bank (EHB) antimicrobial treatment (cool decontamination protocol with low concentration of antibiotics)

Tabaku¹,

Jashari²,

Carton³

et al. 2004

Cell Tissue Banking

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“…The use of flash-frozen valves was discontinued in 1971 because of the introduction of the nutrientpreserved fresh valve (20,3). This was considered to be a viable tissue (1) and it was thought that the graft would not only be incorporated within the host organism but that the normal structure would be maintained by the growth and proliferation of its own viable cells as collagen.…”

Section: Discussionmentioning

confidence: 99%

“…From 1968 the homograft valves were frozen and stored at -60°C until that procedure was replaced in 1971 by storage of fresh homograft valves in a nutrient antibiotic medium in the hope that the tissues could have the potential to regenerate, remain viable and be incorporated within the body's cellular structure (1,3,20).…”

Section: Introductionmentioning

confidence: 99%

An 11-Year Assessment of 93 Flash-frozen Homograft Valves in the Aortic Position

Ingegneri¹,

Wh²,

Martelli³

et al. 1979

Thorac cardiovasc Surg

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Flash-frozen homograft aortic valves were used for isolated aortic valve replacement at the National Heart Hospital between 1968 and 1971. This study of 93 patients with an average follow-up of 8.5 years complements a previous report on 30 patients but shows a higher incidence of degeneration.There was an early mortality of 4.8 % and a late mortality of 15.9 % over 11 years. Only five of the 15 late deaths were directly attributable to valve malfunction. There were no episodes of thromboembolism during the 11 year followup and only three cases of infective endocarditis. Despite the late onset of valve degeneration there is a 77 % probability of patient survival at 11 years. The use of frozen valves delayed the time of onset of degenerative changes when compared over an 11-year period with the earlier use of freeze-dried valves. The evaluation of replacement cardiac valves is thus seen to be time-dependent and needs a long follow-up and an adequate number of patients in the sample for a meaningful assessment. There was no significant difference in the long-term performance between the frozen valves sterilized in ethylene oxide or sterilized with gamma irradiation.

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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 Review of Aortic Valve Homografts over a Six and One-half Year Period

Cited by 77 publications

References 7 publications

Processing of cardiovascular allografts: effectiveness of European Homograft Bank (EHB) antimicrobial treatment (cool decontamination protocol with low concentration of antibiotics)

Processing of cardiovascular allografts: effectiveness of European Homograft Bank (EHB) antimicrobial treatment (cool decontamination protocol with low concentration of antibiotics)

An 11-Year Assessment of 93 Flash-frozen Homograft Valves in the Aortic Position

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

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