Use of Fresh Decellularized Allografts for Pulmonary Valve Replacement May Reduce the Reoperation Rate in Children and Young Adults

Abstract

Background-Degeneration of xenografts or homografts is a major cause for reoperation in young patients after pulmonary valve replacement. We present the early results of fresh decellularized pulmonary homografts (DPH) implantation compared with glutaraldehyde-fixed bovine jugular vein (BJV) and cryopreserved homografts (CH). Methods and Results-Thirty-eight patients with DPH in pulmonary position were consecutively evaluated during the follow-up (up to 5 years) including medical examination, echocardiography, and MRI. These patients were matched according to age and pathology and compared with BJV (nϭ38) and CH (nϭ38) recipients. In contrast to BJV and CH groups, echocardiography revealed no increase of transvalvular gradient, cusp thickening, or aneurysmatic dilatation in DPH patients. Over time, DPH valve annulus diameters converge toward normal z-values. Five-year freedom from explantation was 100% for DPH and 86Ϯ8% and 88Ϯ7% for BJV and CH conduits, respectively. Additionally, MRI investigations in 17 DPH patients with follow-up time Ͼ2 years were compared with MRI data of 20 BJV recipients. Both patient groups (DPH and BJV) were at comparable ages (mean, 12.7Ϯ6.1 versus 13.0Ϯ3.0 years) and have comparable follow-up time (3.7Ϯ1.0 versus 2.7Ϯ0.9 years). In DPH patients, the mean transvalvular gradient was significantly (Pϭ0.001) lower (11 mm Hg) compared with the BJV group (23.2 mm Hg). Regurgitation fraction was 14Ϯ3% and 4Ϯ5% in DPH and BJV groups, respectively. In 3 DPH recipients, moderate regurgitation was documented after surgery and remained unchanged in follow-up. Conclusions-In contrast to conventional homografts and xenografts, decellularized fresh allograft valves showed improved freedom from explantation, provided low gradients in follow-up, and exhibited adaptive growth. (Circulation. 2011; 124[suppl 1]:S115-S123.)

Decellularization of human donor aortic and pulmonary valved conduits using low concentration sodium dodecyl sulfate

“…The process has, however, been reported to reduce MHC immunoreactivity markedly, indicating reduction in membrane proteins (Elkins et al ., 2001b). The process described by da Costa et al (2010) uses 0.1% ( w / v ) SDS and washing in isotonic Ringer lactate, but does not mention the use of nuclease and the process described by the Haverich group (Cebotari et al ., 2011; Neumann et al ., 2014) incorporates a harsher detergent treatment (0.5% w / v SDS plus 0.5% w / v sodium deoxycholate) but again does not appear to incorporate a nuclease treatment (Cebotari et al ., 2011). Despite the fact that these decellularized human donor cardiac valves have been implanted into patients now for several years, details of the DNA levels in these decellularized human donor valve allografts is lacking.…”

“…Up to 6 years’ follow‐up, SDS decellularized pulmonary allografts were associated with greater freedom from reoperations compared to conventional cryopreserved allografts (da Costa et al ., 2014). In Germany, the Haverich group have reported on the early results of fresh pulmonary allografts decellularized using 0.5% ( w / v ) sodium deoxycholate and 0.5% ( w / v ) SDS in children and young adults (Cebotari et al ., 2011; Neumann et al ., 2014). In comparison to glutaraldehyde‐fixed bovine jugular vein and cryopreserved allografts, the decellularized fresh allografts showed improved performance (Cebotari et al ., 2011).…”

Searching for the optimal heart valve

“…J. 2013,8,[286][287] www.biotechnology-journal.com allografts to diminish degeneration and reduce the need for repeated surgery. Since 1968 standard frozen cryopreservation (SFC) has been employed, which includes valve storage in vapour-phase of liquid nitrogen [9].…”

“…The first one is the engineering of heart valves applying regenerative medicine principles. Following complex decellularization while maintaining the crucial extracellular matrix (ECM) integrity, the valves of porcine [7] or human origin [8] are implanted in children and young adults. Oversizing the valve at implant (diameter is larger than actually required) allows some enlargement.…”

Tissue Engineering of the Atrioventricular Valve: Decellularized Matrix in Ovine Mitral Allograft Model

“…Так, пятилетние результаты их клинического использования показали способность протезов к росту вместе с организмом реципиента и отсутствие необходимости в повторных вмешатель-ствах [7,8,25].…”