Structural integrity of collagen and elastin in SynerGraft® decellularized-cryopreserved human heart valves.

SynerGraft® (SG) decellularized-cryopreserved cardiac valve allografts have been developed to provide a valve replacement option that has reduced antigenicity, retained structural integrity, and the ability to be stored long-term until needed for implantation. However, it is critical to ensure that both the SG processing and cryopreservation of these allografts do not detrimentally affect the extracellular matrix architecture within the tissue. This study evaluates the effects of SG decellularization and subsequent cryopreservation on the extracellular matrix integrity of allograft heart valves.

Performance of the CryoValve SG human decellularized pulmonary valve in 342 patients relative to the conventional CryoValve at a mean follow-up of four years.

Objective: This study compared clinical outcomes of patients receiving CryoValve SG decellularized pulmonary valves with those of patients receiving conventionally processed CryoValve pulmonary valves.

Methods: All consecutive patients undergoing Ross procedures and right ventricular outflow tract reconstructions with SG valves at 7 institutions (February 2000-November 2005) were assessed retrospectively (193 Ross procedures, 149 right ventricular outflow tract reconstructions). Patient, procedural, and outcome data were compared with those from 1246 conventional implants (665 Ross procedures, 581 right ventricular outflow tract reconstructions).

Ross operation: 16-year experience.

Objective: We performed a review of a consecutive series of 487 patients undergoing the Ross operation to identify surgical techniques and clinical parameters that affect outcome.

Methods: We performed a prospective review of consecutive patients from August 1986 through June 2002 and follow-up through August 2004. Patient age was 2 days to 62 years (median, 24 years), and 197 patients were less than 18 years of age.

Pulmonary autografts in patients with severe left ventricular dysfunction.

Background: Performing a Ross operation in patients with severe left ventricular dysfunction is controversial. The objective in this retrospective study was to determine the outcome of 15 patients with aortic valve disease (11 had aortic insufficiency and 4 had aortic insufficiency and aortic stenosis) associated with reduced left ventricular function (ejection fraction < 40%) treated with a pulmonary autograft.

Methods: We identified 15 patients with severe left ventricular dysfunction from 226 consecutive pulmonary autograft procedures done between age 18 and 50 years from 1986 to 2001.

Effect of prior aortic valve intervention on results of the Ross operation.

Background And Aim Of The Study: Patient-related factors, aortic insufficiency, bicuspid aortic valve, aortic annulus dilatation, ascending aortic dilatation or aneurysm, and aortic valve endocarditis have been suggested as affecting the results of the Ross operation. The study aim was to assess the impact of prior aortic valve intervention on early and late results of a Ross operation.

Methods: A total of 399 patients who underwent surgery between August 1986 and September 2000 were reviewed retrospectively.

Prognosis after aortic root replacement with cryopreserved allografts in adults.

Background: Aortic root replacement with cryopreserved allografts is associated with excellent hemodynamics, little endocarditis, low thromboembolic event rates, and no need for anticoagulation. There is, however, concern regarding the long-term durability of this valve substitute, especially in younger patients. Meta-analysis and microsimulation were used to calculate age-specific long-term prognosis after allograft aortic root replacement based on current evidence.

Is tissue-engineered heart valve replacement clinically applicable?

Tissue engineering of a heart valve has progressed dramatically in three different arenas: a biodegradable stented valve seeded with autogenous cells, decellularized allograft and xenograft valves that are seeded with autogenous cells, and decellularized allograft and xenograft valves that repopulate by adaptive remodeling in vivo. Preclinical evaluation and implants in sheep have been accomplished in each of these arenas, and clinical use of this emerging technology is occurring in the latter two. The clinical use of decellularized allografts that repopulate in vivo is expanding; however, its impact on allograft durability remains unknown.