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Cryopreservation of cardiac homografts
S Verghese1, P Sudha, P Padmaja
1Department of Microbiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai.
Insights
Establishing a cardiac homograft valve bank involved processing 169 donor hearts. Cryopreservation protocols were analyzed, with recommendations for improving cardiac homograft viability and safety.
Area of Science:
- Cardiovascular Surgery
- Tissue Banking
- Cryobiology
Background:
- A homograft valve bank was established at the Institute of Cardiovascular Diseases in July 1995.
- From July 1995 to February 1999, 169 donor hearts were processed, primarily for aortic and pulmonary valves.
Purpose of the Study:
- To establish and evaluate the initial operations of a homograft valve bank.
- To analyze the efficacy of cryopreservation protocols for cardiac homografts.
Main Methods:
- Donor hearts were procured post mortem.
- Aortic and pulmonary valves were dissected and immersed in antibiotics/antifungals for 48-72 hours before cryopreservation.
- Sterilization, culture, and cryopreservation methods were employed.
Main Results:
- 169 donor hearts were processed, yielding aortic and pulmonary valves.
- Significant discard rates were observed: 35.57% of aortic and 30.21% of pulmonary valves due to contamination or positivity.
- 153 homografts were released for use.
Conclusions:
- The study highlights challenges in homograft procurement and preservation, including contamination and sterilization failures.
- Recommendations are made for improving cryopreservation by emphasizing timeliness, appropriate media, specific drugs, and necessary safeguards.
- Optimizing these protocols is crucial for increasing the availability and safety of cardiac homografts.
Abstract:
A homograft valve bank for cryopreservation of cardiac homografts was established at the Institute of Cardiovascular Diseases in July 1995. From July 1995 to February 1999, 169 donor hearts were processed. All except four hearts were procured post mortem. Aortic valves (149) and pulmonary valves (139) were the common homografts dissected out for use. The valves were immersed in a cocktail of five broad spectrum antibiotics and antifungals for an average of 48 to 72 hours before cryopreservation. Fifty-three (35.57%) aortic and 42 (30.21%) pulmonary valves had to be discarded for various reasons like fungal contamination, failure to sterilise, HBsAg positivity etc.; 153 homografts have been released for use so far. Analysing the usual methods of procurement, sterilisation protocol, culture and cryopreservation used for cardiac homografts at this centre, this paper recommends observance of timeliness, use of appropriate media for preservation of heart parts, administration of specific drugs and safeguards necessary for cryopreservation procedure.