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J Thorac Cardiovasc Surg 1998;116:609-616
© 1998 Mosby, Inc.
SURGERY FOR ADULT CARDIOVASCULAR DISEASE |
Kiel and Hannover, Germany, and Linz, Austria
From the Department of Cardiovascular Surgery,a University Hospital, "Christian Albrechts Universität zu Kiel," Germany; Department of Cardiothoracic and Vascular Surgery,b Medizinische Hochschule Hannover, Germany; and the Department of Surgery,c General Hospital, Linz, Austria.
Received for publication Aug 19, 1997. Revisions requested Oct 1, 1997; revisions received June 5, 1998. Accepted for publication June 8, 1998. Address for reprints: André R. Simon, MD, Klinik für Herz-, Thorax- und Gefässchirurgie, Medizinische Hochschule Hannover, Carl Neuberg Str, 30623 Hannover, Germany.
Objective: For reasons that are still unclear, biologic heart valve prostheses undergo degeneration after implantation. We studied the possible role of the immune system in this process.
Methods: We examined the expression of immunologically relevant molecules by human cardiac valve endothelium in situ and in vitro and studied re-endothelialization of implanted allogeneic and xenogeneic valvular surfaces using explanted bioprostheses and valves obtained from donor hearts at cardiac retransplantation.
Results: We demonstrate that human cardiac valve endothelial cells express molecules capable of initiating immune responses and might therefore play a role in the degeneration of viable cardiac valve prostheses. Also, we show evidence of re-endothelialization on the surfaces of xenografts and allografts but not on valves obtained from previously transplanted hearts.
Conclusion: Inasmuch as valves from previously transplanted hearts seem to be free from degeneration, we conclude that reduction of the immunogenicity of allograft valve prostheses by HLA matching or immunosuppressive treatment might further improve long-term results after allograft valve replacement.
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