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The Journal of Thoracic and Cardiovascular Surgery, Vol 94, 812-823, Copyright © 1987 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
MF O'Brien, EG Stafford, MA Gardner, PG Pohlner and DC McGiffin
We examined the long-term clinical function and fate of allograft aortic
valves, preserved by two differing methods, for aortic valve replacement:
(1) fresh allografts stored at 4 degrees C refrigeration (group I) and (2)
viable allografts cryopreserved in liquid nitrogen at -196 degrees C (group
II). A total of 316 aortic valve replacement operations were performed, 124
in group I (December 1969 to May 1975) and 192 in group II (June 1975 to
December 1986). Concomitant surgical procedures (eg, coronary artery bypass
grafting and mitral valve replacement) were necessary in 120 operations.
The overall immediate 30 day mortality was 6.0% (confident limits 4.6% to
7.7%), and the survival rates were 83% at 4 years and 60% at 15 years.
Endocarditis and technical factors concerning reoperation showed no
difference between the two groups according to parametric estimates and
hazard function analyses. However, there was a marked difference in
reoperation for valve degeneration: 23 patients in group I and 0 patients
in group II. The freedom from reoperation for valve degeneration at 10
years was 89% for group I and 100% for group II, and at 15 years it was 59%
for group I. The hazard function for group I reflected the late rising risk
of degeneration. The freedom from thromboembolism of both groups (aortic
valve replacement with or without bypass grafting) was 97% at 10 years and
96% at 15 years. Group II explanted valves (operation for technical
malalignment reasons) has consistently shown evidence of persisting
viability on tissue culture, on metabolic studies, and on histologic
appearances. Chromosomal studies have shown the donor origin of these
cells. The superior results with the cryopreserved valve is considered to
be due to persisting viability, which appears to be the key to durability.
ARTICLES
A comparison of aortic valve replacement with viable cryopreserved and fresh allograft valves, with a note on chromosomal studies
Department of Cardiac Surgery, Prince Charles Hospital, Chermside, Brisbane, Australia.
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R. N. Mitchell, R. A. Jonas, and F. J. Schoen Pathology Of Explanted Cryopreserved Allograft Heart Valves: Comparison With Aortic Valves From Orthotopic Heart Transplants J. Thorac. Cardiovasc. Surg., January 1, 1998; 115(1): 118 - 127. [Abstract] [Full Text] [PDF]
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Y. C. Song, L. Y. Yao, J. M. Kneebone, and F. M. Lupinetti EFFECT OF CRYOPRESERVATION AND HISTOCOMPATIBILITY ON TYPE I PROCOLLAGEN GENE EXPRESSION IN AORTIC VALVE GRAFTS J. Thorac. Cardiovasc. Surg., September 1, 1997; 114(3): 421 - 427. [Abstract] [Full Text]
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F. Santini, C. Dyke, S. Edwards, G. Stavri, M. Feccia, H. Khan, E. Birks, and M. H. Yacoub PULMONARY AUTOGRAFT VERSUS HOMOGRAFT REPLACEMENT OF THE AORTIC VALVE: A PROSPECTIVE RANDOMIZED TRIAL J. Thorac. Cardiovasc. Surg., May 1, 1997; 113(5): 894 - 900. [Abstract] [Full Text]
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M. Komeda, J. R. Glasson, A. F. Bolger, G. T. Daughters II, N. B. Ingels Jr., and D. C. Miller PAPILLARY MUSCLE-LEFT VENTRICULAR WALL "COMPLEX" J. Thorac. Cardiovasc. Surg., February 1, 1997; 113(2): 292 - 301. [Abstract] [Full Text]
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K. Inutsuka, K. Kawahara, T. Takachi, K. Okabayashi, T. Shiraishi, and T. Shirakusa Reconstruction of Trachea and Carina With Immediate or Cryopreserved Allografts in Dogs Ann. Thorac. Surg., November 1, 1996; 62(5): 1480 - 1484. [Abstract] [Full Text]
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J. A. Dearani, T. A. Orszulak, R. C. Daly, M. R. Phillips, F. A. Miller, G. K. Danielson, and H. V. Schaff Comparison of Techniques for Implantation of Aortic Valve Allografts Ann. Thorac. Surg., October 1, 1996; 62(4): 1069 - 1075. [Abstract] [Full Text]
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A. K. Agnihotri, D. C. McGiffin, A. J. Galbraith, and M. F. O'Brien THE PREVALENCE OF INFECTIVE ENDOCARDITIS AFTER AORTIC VALVE REPLACEMENT J. Thorac. Cardiovasc. Surg., December 1, 1995; 110(6): 1708 - 1724. [Abstract] [Full Text]
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K. Gall, S. Smith, C. Willmette, M. Wong, and M. O'Brien Allograft heart valve sterilization: A six-year in-depth analysis of a twenty-five-year experience with low-dose antibiotics J. Thorac. Cardiovasc. Surg., September 1, 1995; 110(3): 680 - 687. [Abstract] [Full Text]
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M. Yacoub, N. R. H. Rasmi, T. M. Sundt, O. Lund, E. Boyland, R. Radley-Smith, A. Khaghani, and A. Mitchell Fourteen-year experience with homovital homografts for aortic valve replacement J. Thorac. Cardiovasc. Surg., July 1, 1995; 110(1): 186 - 194. [Abstract] [Full Text]
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M. G. Hazekamp, D. R. Koolbergen, J. Braun, H. Sugihara, C. J. Cornelisse, Y. A. Goffin, and H. A. Huysmans In situ hybridization: A new technique to determine the origin of fibroblasts in cryopreserved aortic homograft valve explants J. Thorac. Cardiovasc. Surg., July 1, 1995; 110(1): 248 - 257. [Abstract] [Full Text]
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K. Bando, G. K. Danielson, H. V. Schaff, D. D. Mair, P. R. Julsrud, and F. J. Puga Outcome of pulmonary and aortic homografts for right ventricular outflow tract reconstruction J. Thorac. Cardiovasc. Surg., March 1, 1995; 109(3): 509 - 518. [Abstract] [Full Text]
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K. J. Lockie, J. Fisher, N. P. Juster, G. A. Davies, and K. Watterson Biomechanics of glutaraldehyde-treated porcine aortic roots and valvesAn investigation of the effect of predilation of the elastic aortic root J. Thorac. Cardiovasc. Surg., December 1, 1994; 108(6): 1037 - 1042. [Abstract] [Full Text]
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D. C. McGiffin Invited letter concerning: Leaflet viability and the durability of the allograft aortic valve J. Thorac. Cardiovasc. Surg., November 1, 1994; 108(5): 988 - 990. [Full Text]
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S. Nakayama, T. Ban, and Y. Okamoto Fetal bovine serum is not necessary for the cryopreservation of aortic valve tissues J. Thorac. Cardiovasc. Surg., September 1, 1994; 108(3): 583 - 586. [Abstract] [Full Text]
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S. J. Lang, M. S. Giordano, C. Cardon-Cardo, B. D.Summers, L. Staiano-Coico, and D. P. Hajjar Biochemical and cellular characterization of cardiac valve tissue after cryopreservation or antibiotic preservation J. Thorac. Cardiovasc. Surg., July 1, 1994; 108(1): 63 - 67. [Abstract] [Full Text]
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G. Gerosa, D. N. Ross, P. E. Brucke, A. Dziatkowiak, S. Mohammad, D. Norman, J. Davies, A. Sbarbati, and D. Casarotto Aortic valve replacement with pulmonary homograftsEarly experience J. Thorac. Cardiovasc. Surg., February 1, 1994; 107(2): 424 - 437. [Abstract] [Full Text]
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B.G. Barratt-Boyes, G.W. Christie, and P.J. Raudkivi The stentless bioprosthesis: surgical challenges and implications for long-term durability Eur. J. Cardiothorac. Surg., January 1, 1992; 6(suppl_1): S39 - S43. [Abstract] [PDF]
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 G. W. Laub, S. Muralidharan, C. Daliosio, A. Perritt, Jiang Gu, J. Fernandez, S. Pollock, M. S. Adkins, and L. B. McGrath Cryopreserved Trachea--A New Arterial Conduit: Early Hemodynamic and Radiographic Performance Vascular and Endovascular Surgery, October 1, 1991; 25(8): 642 - 649. [Abstract] [PDF]
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T. J. Donovan, S. T. Ruby, and K. G. M. Brockbank Cryopreserved Venous Allografts Pretreated with Cyclosporine Revisited Vascular and Endovascular Surgery, January 1, 1991; 25(1): 34 - 41. [Abstract] [PDF]
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