Cryopreserved homograft pericardium patch

This study examines the midterm experience with a new decellularized allogeneic patch for congenital cardiac reconstructions. Annuloplasty of cryopreserved pulmonary homograft with delrin. Early failure of the shelhigh pulmonary valve conduit in. Cryopreserved homografts in the pulmonary position. The timing of interventions has a significant impact on short and longterm outcomes. During a median followup of 6 months range, 147 months, no reinfections occurred and primary patency was 89%. Patients often present with a systemic infection that is made worse by embolic complications, such as strokes, along with pathophysiologic sequelae of acute valvular dysfunction.

Backgroundfew studies have explored the longterm function of cryopreserved homograft valves used for reconstruction of the right ventricular tract rvot in patients with congenital heart disease. Transesophageal echocardiography is utilized to help assess adequacy of repair. Mechanical compliance and immunological compatibility of. Doublevalve endocarditis homograft and patch repair the. Reconstruction of the pulmonary artery is undertaken next, utilizing a patch of cryopreserved pulmonary artery homograft. Furthermore, the most commonly used conduit, the cryopreserved homograft, is a scarce resource, availability of small size is limited. Pericardium is employed in cardiac surgery to repair congenital heart defects or to perform valve reconstruction. The use of arterial homograft is indicated especially in case of prosthetic graft infections after bypass surgery. Use of the aortic homograft in the reconstruction of. This operation is useful in children with multilevel. Pericardial patch an overview sciencedirect topics. Cryopreserved hepatocytes are shipped in the vapor phase of liquid nitrogen contained in a nonhazardous container called a dry ln 2 vapor shipper or dewar. An alternative to pericardium patch is to use the homograft to reconstruct the aortic root.

We used one patch trimmed into an oval shape to reconstruct the aortomitral continuity and the dome of the left atrium, instead of using two separate patches. Since 1984, in cooperation with a national network of tissue banks and organ procurement organizations, cryolifes cryopreserved human tissue continues to provide cardiac surgeons with a variety of preserved implantable tissues, such as aortic valves, pulmonary valves, and patch materials. Decellularized homografts are donated human heart valves which have been modified via. In addition, pericardium of animal origin pig, cow is the elective material to fabricate bioprosthetic valves to be employed in surgical replacement of insufficient andor stenotic valves. Some have reported development of significant aortic valve regurgitation. We present the histopathologic findings of human explants of cardiocel that were used in operations for congenital heart disease in children. Incubation of cryopreserved pulmonary homograft, ch walls. Acute rejection of a cryopreserved arterial homograft. Use of the aortic homograft in the reconstruction of complex. For this reason, the pericardium is usually regarded as an attachment to the heart. Sgph00 cryopatch sg pulmonary human cardiac trunk and branch patches the.

A valved segment of the homograft vfvh is separated from a nonvalved segment nvfvh. The aortic annulus was severely destroyed by the infection. A cryopreserved homograft was ordered from a european or german homograft. The cryopreserved homograft has been used as an alternative to the artificial vascular graft or composite valved conduit. Relative binding of fibrinogen fg to graft tissues in static conditions. Pulmonary arterioplasty with decellularized allogeneic patches. A variety of materials were used for the hood including the attached anterior mitral leaflet of an aortic homograft, an additional piece of homograft, pericardium, or synthetic material, such as dacron du pont co or goretex w.

This graft was disinfected using an antibiotic regimen, cryogenically preserved and then is maintained at temperatures between 40c to 80c until used for application. All of the tissues supplied by coloplast and manufactured by rti biologics are selected in compliance with stringent specifications governing donor selection and serological testing in order to minimize the risk of transmitting infectious diseases. The aortictoright atrium fistula was closed with an autologous pericardium patch. Orthotopic aortic reconstruction with intraoperatively prepared xenopericardial roll grafts without omentopexy was performed as the initial operation to treat aortic infection or as a rescue operation to treat graft infection. Pathology of explanted cryopreserved allograft heart valves. Unusual mechanism of myocardial infarction in prosthetic.

All proximal extensions were placed as patches and none as tubular grafts. Congenital reconstructions repair of the rvot tissue size catalog number sg pulmonary hemiartery proximal base 30mm min. Bovine pericardium has served for many years as a popular option as a biomaterial patch for cea. Bacterial adherence to graft tissues in static and flow.

From the 46 remaining children, 18 were operated by only atriopulmonary access. Cryolife exercises right to acquire photofix bovine. We report the case of a patient who experienced the loss of a cryopreserved femoral artery caused by an acute rejection. Factors in the early failure of cryopreserved homograft pulmonary. Reoperative replacement of the homograft aortic root. However, its use has been limited due to the lack of availability of donors and concern about longterm durability 5,9. Jonas md, karthik ramakrishnan md 1,2 1department of cardiovascular surgery, childrens national hospital, washington dc 2department of pediatrics and surgery, the george washington university school of. Among late survivors, 5 74% patients have their original homograft in place and 98 54% have valves. The authors report on the use of the ascending aorta cryopreserved homograft in reconstructing the tracheobronchial tree of. The patch technique also allows the surgeon to enlarge both annuli and. The pericardium channel of hand jueyin originates from the chest.

Five patients had their homograft explanted and replaced with an rvot outflow patch or other nonhomograft valved conduit. Cryopreserved skin allograft description this allograft was processed from donated human skin, resulting from the generous gift of an individual or hisher family. Cryopreserved homograft pericardium patch group, 15 cases, their rvot were enlarged with cryopreserved homograft pericardium patches. Imaging ahmed glaucoma tubes with a pericardial graft and tissue glue or partialthickness scleral flap and sutures the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Over 20 years experience with aortic homograft in aortic. Cryolife is the market leader in vascular allografts with over 49 published clinical studies, dedicated representatives, and professional educational programs that train fellows and residents. Factors influencing the survival of cryopreserved homografts. Cryopreserved allograft tissue used in the norwood procedure for infants with hypoplastic left heart syndrome hlhs has the potential to cause marked immunologic sensitization which may complicate potential future heart transplantation, if required. The coronary buttons were directly reimplanted on the homograft with continuous sutures. To determine the life span of cryopreserved homografts. Treatment of aortic and peripheral prosthetic graft.

Advantages of aortic root replacement using the cryopreserved aortic homograft include avoidance of anticoagulation, excellent hemodynamics, and the wide range of available conduit sizes. Braz j cardiovasc surg the use and midiumterm evaluation. The main disadvantage of a cryopreserved aortic allograft is its timelimited durability. Use of the aortic homograft in the reconstruction of complex tracheobronchial tree injuries by a. Its advantages include excellent hemodynamics, no need for anticoagulation, and resistance to infection 48. There are excellent hemodynamic characteristics in homograft eg.

The authors determine the safety and effectiveness of pericardial patch grafts in glaucoma implant surgery. Xenopericardial roll graft replacement for infectious. It is also used for pulmonary valve replacement in. Modified yasui operation using cryopreserved femoral vein. A 3dayold neonate underwent a yasui operation for a type b interrupted aortic arch with a ventricular septal defect vsd and a subaortic obstruction. A rectangular bovine pericardial patch was used to reinforce the annular suture line for the aortic homograft. Backgroundfew studies have explored the longterm function of cryopreserved homograft valves used for reconstruction of the right ventricular tract rvot in patients with congenital heart disease methods and resultsamong 205 patients receiving cryopreserved homografts for reconstruction of the rvot between november 1985 and april 1999, the outcome of 220 homografts in 183 operative. In 8 cases, this led to the abandonment of the patch technique with a. Microscopic analysis and histology were performed to evaluate bacterial adhesion to matrix. Ricketts atlanta, georgia and valhalla, new york backgroundpurpose.

Which graft material is the optimal graft material for the treatment of infected aortic aneurysms and aortic graft infections is still a matter of controversy. Cryolife is accredited by the american association of tissue banks aatb and meets all fda and state tissue processing requirements. Selfmade pericardial tube graft the annals of thoracic surgery. Dec 16, 2014 the use of arterial homograft is indicated especially in case of prosthetic graft infections after bypass surgery. Six explants were identified from 140 patients undergoing cardiocel implants from october 2012 to march 2015.

The use and midiumterm evaluation of decellularized. Proximal extensions of autologous pericardium or homograft material were added. Bovine pericardium was used for the treatment of prosthetic graft infections in 19 patients. Mechanical compliance and immunological compatibility of fixative. Pericardial patch grafts in glaucoma implant surgery. The patient required retransplantation six months later for reasons unassociated with the repair. Patch reconstruction using pericardium or synthetic material decreases the incidence of stenosis. However, there remain patients for whom a homograft or an autograft is the most appropri ate prosthetic choice, but for one of many possible reasons, the pulmonary valve is not useable.

This tissue can be therefore treated as a safe homograft for cardiac surgery. Aortic valve replacement using conventional cryopreserved homografts is currently. The monocusp valve frequently progresses with early calcification that causes pulmonary valve regurgitation which is usually well tolerated, and symptoms develop gradually. From july 1995 to february 1999, 169 donor hearts were. The distal aorta is now anastomosed to the new aortic root. A european study on decellularized homografts for pulmonary valve. The authors report on the use of the ascending aorta cryopreserved homograft in reconstructing the tracheobronchial tree of three children. Imaging ahmed glaucoma tubes with a pericardial graft and. Extended aortic root replacement1,2 combined the techniques of aortoventriculoplasty3,4 and total aortic root replacement5 using the aortic homograft. Fg binding is calculated as a fluorescence signal relative to the autofluorescence of each graft tissue. Bovine pericardium patches due to its characteristics of easy handling, suturability and hemostasis compared with synthetic patches, the bovine pericardial patches have became an excellent alternative for a wide spectrum of clinical uses. Navia jl aortic root replacement with cryopreserved homograft.

Cryopreserved human allografts homografts for the management. Cryolife acquired the distribution rights and purchase option. Adhesion of staphylococcus aureus, staphylococcus epidermidis, and streptococcus sanguinis to bovine pericardium bp patch, bovine jugular vein bjv, and cryopreserved homograft ch tissues was quantified under static and shear stress conditions. Longterm morphological changes in a cryopreserved pulmonary valve homograft. Streptococcus sanguinis to bovine pericardium bp patch, bovine jugular vein bjv, and cryopreserved homograft ch tissues was quanti. Several techniques exist for decellularisation with the majority based on detergent or enzymatic protocols which aim to eliminate all donor cells while preserving the mechanical properties of the remaining matrix. Orthotopic aortic reconstruction with intraoperatively prepared xenopericardial roll grafts without omentopexy was performed as the initial operation to treat aortic infection or as a rescue operation to treat graft.

Evidence for rejection of homograft cardiac valves in infants see comments. Following prolonged haemostasis including a carbrol patch the sternum was closed in a routine fashion. Reoperative cryopreserved root and ascending aorta. For more information ctsnet aatb pulmonary allograft cryopatch sg pulmonary human cardiac hemiartery patch the ideal patch for. The pericardium is opened, and a pericardial patch is harvested for later construction of the rvot with a homograft. It is the responsibility of the transplant facility or clinician to maintain the tissue intended for transplantation in the appropriate recommended storage conditions prior to transplant. The patient is then heparinized, and at the initiation of cpb the pulmonary arteries are snared to prevent pulmonary overcirculation. He was urgently taken to the operating room, and an aortic root replacement with cryopreserved homograft was performed, associated with autologous pericardium patch closure of aortic to right. The management of infections of the cardiac structuresspecifically native heart valvesremains a difficult clinical challenge. Cardiocel is a bovine pericardium that is subjected to a novel anticalcification tissueengineering process. Mechanical integrity of human pericardium after cryopreservation procedure. Cry, a leading medical device and tissue processing company focused on cardiac surgery, announced today that it has exercised its right to acquire the photofix bovine pericardium patch photofix from genesee biomedical, inc. Fg binding is calculated as a fluorescence signal relative to the.

Patient name aviator id form 1a hospitalization date. Annuloplasty of cryopreserved pulmonary homograft with. Decellularized homografts are donated human heart valves which have been modified via tissue engineering. The repair of complex tracheobron chial tree injuries often is associated with complications including stenosis and excessive granulation tissue forma tion. Factors affecting longevity of homograft valves used in right. Use of an allograft patch in repair of hypoplastic left. The cryopreserved homograft has emerged as the pulmonary conduit of choice for the repair of many congenital heart defects. Aortic root replacement with homograft valved conduit. Mechanical integrity of human pericardium after cryopreservation. Store this cryopreserved allograft at 40c or colder.

Cryopreserved pulmonary homograft postimplant changes. Aortic root replacement with cryopreserved homograft was performed using interrupted monofilament sutures. Oct 27, 2015 which graft material is the optimal graft material for the treatment of infected aortic aneurysms and aortic graft infections is still a matter of controversy. The repair of complex tracheobronchial tree injuries often is associated with complications including stenosis and excessive granulation tissue formation. Homograft aorta proved useful material for salvaging the dehisced lung transplant bronchial anastomosis. The purpose of this study was to assess the antihla antibody response to allograft patches used in the initial repair of. The homograft patch provided a satisfactory repair without malacia. A homograft valve bank for cryopreservation of cardiac homografts was established at the institute of cardiovascular diseases in july 1995.

Use of an allograft patch in repair of hypoplastic left heart. Microscopic analysis and histology were performed to evaluate bacterial adhesion to matrix components. The patch was completely explanted and replaced with glutaraldehydetreated homograft pericardium. In particular, we used utl tests to reveal any potential alteration of the biomechanical characteristics of the tissue. The purpose of this study was to assess the antihla antibody response to allograft. Factors affecting longevity of homograft valves used in. Histologic evaluation of explanted tissueengineered. Closure of the atrial septal defect completes the arterial switch repair. The distal end of vfvh is then anastomosed to the distal end of the divided pulmonary bifurcation figure 1c. Cryopreserved homografts often demonstrate substantial valve regurgitation early after implantation, thereby negating in some patients the benefits of having a competent valve in the pulmonary outflow. This homograft had to be explanted 1 month after implantation because of an acute aneurysmal deterioration. It is also used for pulmonary valve replacement in the ross procedure. However, there remain patients for whom a homograft or an autograft is the most appropri ate prosthetic choice, but for one of many possible reasons, the pulmonary valve is. Cryopreserved hepatocytes thermo fisher scientific us.