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J Thorac Cardiovasc Surg 1997;113:1014-1021
© 1997 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

MECHANISMS UNDERLYING DEGENERATION OF CRYOPRESERVED VASCULAR HOMOGRAFTS

Supported in part by Programa CIENCIA/JNICT, Fundação Calouste Gulbenkian, and the Portuguese Health Ministery.

Received for publication May 6, 1996 revisions requested July 9, 1996; revisions received Jan. 16, 1997 accepted for publication Jan. 22, 1997. Address for reprints: José Neves, MD, Instituto do Coração, 27, Av. Reinaldo dos Santos, 2795 Carnaxide, Portugal.

Abstract

Objective: To analyze the mechanism(s) underlying homograft degeneration, we designed an experimental model in which the behavior of cryopreserved autografts and homografts, as well as fresh autografts, implanted in the same animal was compared. Methods: A cryopreserved homograft was implanted in the aorta of 14 sheep. The excised aortic autologous segment was then subjected to cryopreservation, and 1 to 8 weeks later it was implanted 1 to 2 cm below the cryopreserved homograft. The intermediate segment of the native aorta, the fresh autograft, was dissected at this point. Animals were put to death at different times and the implanted segments were harvested together with a portion of native aorta. Histologic and immunohistochemical analyses, as well as cell viability assessments, were then performed on the explanted segments. Similar studies were also conducted on fragments of cryopreserved autografts and homografts before implantation. Results: With the exception of a partial loss of the endothelium, cryopreserved specimens retained cell viability and morphologic integrity before implantation. Explanted cryopreserved homografts showed profound changes affecting all strata, as well as a decline in cell viability. Lymphocyte infiltrates were found up to 12 months after implantation. Endothelium was always absent in cryopreserved homografts. However, a reendothelialization of the cryopreserved autografts was observed. After an initial period of neuronal degeneration, reenervation of the cryopreserved autograft segment occurred 6 to 12 months after the operation. Findings regarding the fresh autografts were similar to those of the cryopreserved autografts. Conclusion: Our results suggest that the immunologic reaction rather than the cryopreservation process is responsible for the degenerative process occurring in cryopreserved homografts.

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