Análise das atividades dos oito anos iniciais do Banco de Valvas Cardíacas Humanas do Hospital de Caridade da Irmandade da Santa Casa de Misericórdia de Curitiba

Abstract

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

Evaluation of humoral immune response to donor HLA after implantation of cellularized versus decellularized human heart valve allografts

“…Another protocol, using sodium dodecyl sulfate (SDS) in the presence of protease inhibitors, was successful for heart valve decellularization (24). Costa et al (25, 26) demonstrated that decellularized allografts are less immunogenic than cryopreserved allografts and had normal and stable hemodynamic performance up to 18 months post‐operatively. They compared the immunological and echocardiographic data of decellularized (AutoTissue Ltd™, Berlin, Germany) vs cryopreserved allografts used for right ventricular outflow tract (RVOT) reconstruction during Ross operation.…”

“…The allografts were obtained from donation after cardiac death and were prepared by the Human Cardiac Valve Bank of Santa Casa of Misericordia of Curitiba (BVCHSC). The cryopreservation was done according to previously published methods (26). The valves were prepared following standard protocols and decellularized by a proprietary process (28).…”

Troca valvar aórtica com diferentes próteses: existem diferenças nos resultados da fase hospitalar?

“…Our options are improving, especially with the possibility of using crioprecipitate valves, with better storage, and sterilization, and quality control, and also with the establishment of human heart valve banks, as demonstrated by Costa et al [22].…”

<![CDATA[<B>Ten years experience of aortic valve replacement with aortic homograft root replacement</B>]]>

“…The scarcity of homologous aortic valves is common in many centers that use homografts and this may be the most important limitation for their use. As a result, several researchers recommend that their use should be restricted to patients that would have better results, such as infectious endocarditis cases, women in child-bearing ages, cases in which anticoagulants are totally contraindicated, athletes that need a prosthesis with excellent hemodynamic performance or patients with a small aortic ring [1,7,11].…”

“…The details of the procurement, processing, storage and distribution of the grafts have been described previously [7]. The grafts were decontaminated in a RPMI 1640 nutrient solution, with low antibiotic concentration (240 µg/mL of cefoxitin, 120 µg/mL of lincomycin, 50 µg/mL of vancomycin and 100 µg/mL of polymyxin B) for 24-48 hours at 4 ºC.…”