The quality of heart valve tissue for homograft transplantation

The results of heart valve replacement surgery may be improved by refining surgical techniques and/or developing new heart valve transplants. The aim of this study was to examine the effect of age on the presence of cholesterol clefts and lipid deposits in the cusp base and sinus wall of aortic homografts.

Seventy-one valves were obtained at autopsy from donors (aged 15- 40 years) with no history of illness or evidence of serious illness. Trauma was the predominant cause of death among patients. The valves were examined using an osmium-vaporization technique.

Osmiophilic deposits were detected in the cusp base in 28 cases (42%), and in the sinus wall in 49 cases (69%). Cholesterol crystals in the cusp base were found in 16 cases (24%), and sinus wall cholesterol clefts in 26 cases (38%). The model-predicted probability of cusp base lipid deposits existing was 76% in 40-year-old donors, 36% in 30-years-olds, and 11% in 20-year-olds; the probability of cusp base cholesterol clefts existing was 45%, 21% and 8% in these age groups, respectively. The influences of immunological reactions, biochemical changes (centers of calcification) and acceleration of atherosclerotic processes are discussed.

The microscopic study of heart valves demonstrated the presence of lipid deposits in subjects of an unexpectedly young age. Among our study material, 58% of valves obtained from donors aged 11-40 years were unsuitable for transplantation. Our results confirmed the need for macroscopic inspection of heart valves before their being transplanted.