Cryopreserved human heart valve allografts: a ten-year single centre experience
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Published on: September 21, 2021
Marijana Skific1, Mirna Golemovic2, Ivica Safradin3
1Clinical Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia. mskific@kbc-zagreb.hr.
Insights
The Croatian Cardiovascular Tissue Bank processed 103 heart valves from 75 donations, with 65 suitable for transplant. Cryopreserved heart valve allografts showed promising survival rates, especially in congenital heart disease patients.
Area of Science:
- Cardiovascular Surgery
- Tissue Banking
- Transplantation Immunology
Background:
- The Croatian Cardiovascular Tissue Bank (CTB) has been active for ten years.
- Heart valve allografts are crucial for treating various cardiac conditions.
Purpose of the Study:
- To review tissue banking activities at CTB over the past decade.
- To evaluate the clinical outcomes of cryopreserved heart valve allografts (CHAs) in different patient populations.
Main Methods:
- Analysis of heart donations referred to CTB from June 2011 to December 2021.
- Processing of donations to yield heart valves and assessment of quality for clinical use.
- Transplantation of CHAs into 36 patients across three groups: infective endocarditis, non-infectious heart disease, and congenital heart disease.
Main Results:
- Out of 75 donations, 103 valves were processed, with 65 meeting quality standards (37% discard rate).
- Infective endocarditis group: 3-year survival was 47%; freedom from re-operation was 76% for all graft-related causes and 88% for structural valve deterioration.
- Congenital heart disease group: 94% of CHAs used for right ventricular outflow tract reconstruction; 88% of patients had no graft-related complications.
- No graft reinfections were reported.
Conclusions:
- CTB activities demonstrate the potential of CHAs in cardiac surgery.
- CHAs show favorable outcomes, particularly in congenital heart disease patients.
- Demand for CHAs currently exceeds supply, highlighting the need for increased donation and processing.
Abstract:
This study provides an overview of tissue banking activities at the Croatian Cardiovascular Tissue Bank (CTB) during past ten years and presents the outcomes of cryopreserved heart valve allografts (CHAs) use in different patient groups. From June 2011 until December 2021, 75 heart donations were referred to CTB: 41 recipient of heart transplant (RHT), 32 donors after brain death (DBD) and 2 donors after circulatory death (DCD) donations. Processing resulted in 103 valves of which 65 met quality requirements for clinical use. Overall tissue discard rate was 37%. The most frequent reasons for discard were inadequate morphology (12%) in RHT donations and microbiological contamination (19%) in DBD donations. Altogether, 38 CHAs were transplanted to 36 patients. Recipients were divided in three groups; infective endocarditis (IE), non-infectious heart disease and congenital heart disease group. In the IE group, the 30-day, 1-year and 3-year survival was 71%, 53% and 47%, respectively. Freedom from re-operation due to all graft-related causes was 76% and due to structural valve deterioration 88%. There were no cases of graft reinfection. In the congenital heart disease group CHAs were predominantly (94%) used for right ventricular outflow tract reconstruction and 88% of patients recovered without graft-related complications. At present, the number of demands for CHAs at CTB considerably outweighs their availability.
