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Homograft valve bank: our experience in valve banking
Susan Verghese1, P Padmaja, B Sindhu
1Department of Cardiology, International Center for Cardiothoracic and Vascular Diseases, Chennai. drkmc@md3.vsnl.net.in
Insights
A cardiac homograft valve bank was established in India, processing 588 hearts and issuing 585 valves for procedures like Rastelli and Ross. The study details valve types, discard reasons, sterilization methods, and contamination trends.
Area of Science:
- Cardiovascular Surgery
- Transplantation Immunology
- Biomaterials Science
Background:
- Established a cardiac homograft valve bank with cryopreservation in July 1995 at the Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai.
- The facility aimed to provide viable cardiac valves for transplantation in Indian conditions.
Purpose of the Study:
- To report the operational experience and outcomes of a cardiac homograft valve bank over a 7.5-year period.
- To document the types of valves processed, reasons for discard, sterilization protocols, and clinical applications.
Main Methods:
- Processed 588 donor hearts between July 1995 and March 2003.
- Harvested aortic, pulmonary, and other valves, with 29.9% of hearts discarded due to various quality and safety concerns.
- Sterilized valves using an antibiotic cocktail in Hank's balanced salt solution.
Main Results:
- Issued 585 homograft valves: 247 aortic, 323 pulmonary, and 15 others.
- Identified shifts in microbial contamination: Gram-negative bacilli initially, followed by Gram-positive organisms.
- Valves were predominantly used for Rastelli procedures (48.71%) and Ross procedures (23.41%).
Conclusions:
- Successfully established a functional cardiac homograft valve bank tailored for Indian healthcare needs.
- Demonstrated the feasibility of providing a significant number of homograft valves for clinical use.
Background:
A cardiac homograft valve bank with cryopreservation facility was established at the Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai in July 1995.
Methods And Results:
During the last 7 1/2 years of its existence, from July 1995 to March 2003, 588 hearts were processed. The valves harvested were 390 aortic, 400 pulmonary and 39 others including mitral valve, aortic conduits, pericardium etc.; 176 (29.9%) hearts were discarded for various reasons which included failure to sterilize, HBV, HIV, HCV, treponema pallidum hemagglutination test positivity, atheromatous/fatty streaks, incompetent valves, and dissection mistakes. The valves were sterilized using an antibiotic cocktail of vancomycin, amikacin, streptomycin, cefotaxime and amphotericin B in Hank's balanced salt solution. Of the 585 valves issued for clinical use, 247 were aortic, 323 pulmonary and 15 others (mitral valve, pericardium, conduits). Gram negative bacilli were the predominant contaminants from the hearts during the first half (July 1995 to February 1999) and gram positive organisms were the predominant contaminants during the later half (March 1999 to March 2003) of the study period. A variety of fungal contaminants like candida, aspergillus, penicillium and other fungi were also isolated from the homograft hearts at procurement. The valves were used most commonly for Rastelli procedure/right ventricular-pulmonary artery conduit (48.71%) followed by Ross procedure (23.41%). The other procedures were aortic valve replacement (6.15%), truncus repair (5.81%), unifocalization with conduit repair (6.49%), aortoplasty (0.512%), left ventricular-pulmonary artery conduit (0.512%), pulmonary valve replacement (0.512%), aneurysm repair (0.34%), Norwood repair (0.34%), mitral valve replacement (0.17%) and other procedures (7%).
Conclusions:
We have established a viable and functioning cardiac homograft valve bank to suit Indian conditions and till date, have issued 585 homograft valves for clinical use.
