Cardiac Valve Allografts 1962–1987: Current Concepts on the Use of Aortic and Pulmonary Allografts for Heart Valve Subsitutes PDF
Preview Cardiac Valve Allografts 1962–1987: Current Concepts on the Use of Aortic and Pulmonary Allografts for Heart Valve Subsitutes
Cardiac Valve Allografts 1962-1987 Proceedings of the Symposium on Current Concepts on the Use of Aortic and Pulmonary Allografts for Heart Valve Substitutes Berlin (West), September 7-9, 1987 A. C. Yankah, R. Hetzer, D. C. Miller, D. N. Ross, J. Somerville, M. H. Yacoub (Eds.) Cardiac Valve Allografts 1962-1987 Current Concepts on the Use of Aortic and Pulmonary Allografts for Heart Valve Substitutes Steinkopff Verlag Darmstadt Springer-Verlag New YQrk A. Charles Yankah, M.D. Roland Hetzer, M.D. D. Craig Miller, M.D. Consultant Professor, Chairman and Ass. Professor of Cardiac German Heart Center Berlin Director Surgery Clinic for Cardiothoracic Clinic for Cardiothoracic Stanford University and Vascular Surgery and Vascular Surgery Dept. of Cardievascular Surgery 0-1000 Berlin (West) 65 German Heart Center Berlin Stanford Germany 0-1000 Berlin (West) 65 California 94305, Germany USA Donald Ross, M.D. Jane Somerville, M.D. Magdi H. Yacoub, M.D. Consultant Cardiac Surgeon Consultant Cardiologist Professor & Consultant Cardiac Director or Surgery National Heart Hospital Surgeon National Heart Hospital Westmoreland Street Harefield Hospital, Westmoreland Street London WIM 8BA National Heart and Brompton London WlM 8BA UK. Hospital, London UK. UK. CIP-Titelaufnahme der Deutschen Bibliothek Cardiac valve allografts: 1962-1987; current concepts on the use of aort. and pulmonary allografts for heart valve substitutes; [proceedings of the Symposium on Current Concepts on the Use of Aort. and Pulmonary Allografts for Heart Valve Substitutes, Berlin (West), September 7-9, 1987] 1 A. C. Yankah ... (eds.). - Darmstadt: Steinkopff; New York: Springer, 1988. ISBN-13: 978-3-642-72422-0 e-ISBN-13: 978-3-642-72420-6 DOl: 10.1007/978-3-642-72420-6 NE: Yankah, A. C. [Hrsg.]; Symposium on Current Concepts on the Use of Aortic and Pulmonary Allografts for Heart Valve Substitutes < 1987, Berlin, West> This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically these rights of translation, reprinting, re-use of illustrations, recitation, broadcasting, reproduction on microfIlms or in other ways, and storage in data banks. Duplication of this publication or parts thereof is only permitted under the provision of the German Copyright Law of September 9,1965, in its version of June 24, 1985, and a copyright fee must always be paid. Violations fall under the prosecution act of the German Copyright Law. Copyright © 1988 by Dr. Dietrich Steinkopff Verlag GmbH & Co. KG, Darmstadt Medical Editorial: Juliane K. Weller - Copy Editing: Deborah Marston - Production: Heinz J. Schafer Softcover reprint of the hardcover 1s t edition 1988 The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulation and therefore free for general use. Foreword It was the genius of Gordon Murray in Toronto that introduced the use of allografts into cardiac surgery in the 1950s. Soon after this on opposite sides ofthe world, Sir Brian Barratt-Boyes in Auckland, New Zealand, and Mr. Donald Ross in London, undertook to use allografts for the replacement of diseased aortic valves. Since that time the global interest in allografts has been patchy, episodic, and without a con sensus. Nonetheless, for the last 20 years at least three groups in the world have steadfastly pursued the development of new and relevant information concerning the use of allograft valves in humans. These are the centres of Sir Brian Barratt Boyes, Mr. Donald Ross, and Mark O'Brien in Brisbane. More recently, talented investigators, including Drs. Yankah, Yacoub, and others, have been developing information concerning the immunological aspects of the use of allografts, as well as their clinical use. No doubt, at present, cardiac valve allografts of one sort or another are the devices of choice for conduits and have an important place in the surgery of aortic valve replacement. Even so, in the mind of this writer at least, the future usefulness of allografts for the replacement of diseased cardiac valves and conduits between a ventricle and the pulmonary artery, remains problematic, and depends upon improvements in other devices for this purpose and upon improve ments that may be made in preparing and using allografts. The question for the future, then, is whether developments in bioprostheses and mechanical valves will eventuate in devices so superior to those currently available that there will be little or no place for the logistically and technically more difficult task of using allograft valves. Improvements may be made in the performance and behavior of allograft valves as well, of course, but it seems less likely that these will result in dramatic improvements. This book brings together the most important current work in this interesting and always changing field. Dr. Yankah and his colleagues are to be congratulated for conceiving the idea of this project and providing such an important scientific stim ulus to it. Careful study of this book will provide timely and important information for the reader. John W. Kirklin v Preface In the face of the very limited experience we had, as compared to the other centers, the German Heart Center organized this Symposium on the current concepts on the use of aortic and pulmonary allografts for heart valve substitutes in Berlin from Sept. 7-9, 1987 most egoistically, with the primary aim of learning as much as possible from the great number of experts with much larger experience and knowl edge in this field. The Symposium also marked the 25th anniversary of the first clinical use of aortic valve allograft in the subcoronary position, a pioneer work which was achieved by two prominent surgeons, Mr. Donald N. Ross, Senior Sur geon, National Heart Hospital, London, UK and Sir Brian Barratt-Boyes, Surgeon in-Chief, Green Lane Hospital, Auckland, New Zealand, who were the honorary guests at the meeting. We congratulate Dr. Gordon Murray who paved the way, experimentally and clinically in the 1950s to this success. We consider the devel opment of this particular field as exemplary for cardiac surgery on the whole, where after various technical developments and changing opinions in preservation tech niques and immunological aspects, the original method has survived with greater and better understanding, with more precise indications and the possibility of reli able comparison. The symposium as its theme suggests, was exclusively devoted to the use of cardiac valve allografts in the sub coronary and pulmonary positions. The use of allografts in the mitral and tricuspid positions was cautiously discussed but not in detail. The Berlin symposium which took place during the 750th anniversary of the city of Berlin, brought together cardiologists, cryobiologists, engineers, pathologists, prac titioners and surgeons from Austria, Australia, Belgium, People's Republic of China, France, the Federal Republic of Germany, German Democratic Republic, Hungary, Italy, Netherlands, Portugal, Poland, Spain, Taiwan, R.O.C., United Kingdom, USA who listened to the 41 presentations and a panel discussion over 2 days and partic ipated actively in the lively discussions. The live video transmission of subcoronary transplantation of aortic allograft from the operating room of the German Heart Center to the International Congress Cen ter Berlin where the faculty of experts answered questions from the audience and elaborated on the surgical techniques, was accepted as an interesting new way of scientific communication. Opportunity was given to surgeons who were interested in using allograft valves for valve replacement, on their return home, to practice the transplantation techniques under the supervision of allograft experts, during the special laboratory session pro vided by the organizers. Now that the interest in allograft surgery is growing, the problems of procuring adequate donor allografts of different sizes arise. Currently, our major source of allograft valve harvesting is from the recipients' hearts at the time of cardiac transplantation. We have now performed 93 heart transplantations since April 1986 here in Berlin. This shows the number of valves we could have at our disposal. Organized regional procurement centers in collabo ration with organ transplant centers, intensive ease and trauma units might help in developing regional or hospital-based allograft valve banks. VII It was most appropriate to start the Symposium with Mr. Donald N. Ross, London and let it end with Sir Brian Barratt-Boyes who have contributed continuously and scientifically to the "state of the art". The faculty members were very cooperative with the collection of the manuscripts. The editing of this book has been a chal lenging and memorable experience without constraints and we are very happy being able to present the proceedings within such a short time after the symposium. We would also like to thank the members of the editorial board for their cooperation. Finally, but not least, we are greatly indebted to the City of Berlin, Mrs. Roder and her hard-working team and all the sponsors who provided the funds to make this symposium possible. This book entails the work of cryobiologists, immunologists, pathologists, cardiol ogists and surgeons who are experts on cardiac valve allografts and it was a great pleasure to host the Berlin Symposium, and we hope that the reader will get more valuable information out of the proceedings for the benefit of his patients. Berlin, December 1987 Roland Hetzer A. Charles Yankah VIII To our families and loved ones, whose religious understanding of the demands of our surgical and scientific lives made this book possible. IX Mr. Donald N. Ross Sir Brian G. Barratt-Boyes Senior Surgeon Surgeon-in-chief National Heart Hospital Green Lane Hospital London, U.K. Auckland, New Zealand The two pioneer surgeons who independently and successfully inserted the first aortic allografts in the subcoronary position in June and August 1962. x Contents Foreword J. W. Kirklin . ............... ...... .... ...... ... ... .... ..... ..... ................ ... ...... .... ..... .......... ...... V Preface R. Hetzer, A. C. Yankah ................................................................................... VII Faculty, contributors and invited discussants ....... .... ... ... .... .... .... ... ....... ... ... .... ... XV Honorary guest lecture Evolution of the biological concept in cardiac surgery: A Pilgrim's Process D. N. Ross ........................................................................................................ . Procurement and preservation techniques I Allogeneic valve procurement in cardiac transplantation S. SchUler, A. C. Yankah, R. Hetzer ................................................................. 13 Antibiotic sterilisation in the preparation of homovital homograft valves: Is it necessary?: L. Gonzalez-Lavin, L. McGrath, M. Alvarez, D. Graf .................................... 17 Procurement and viability of cardiac valve allografts A. C. Yankah, R. Hetzer ................................................................................... 23 Cryobiology of tissues S. R. May, J. G. Baust ....................................................................................... 27 Cryopreservation of aortic valve homografts J. K. Kirklin, J. W. Kirklin, A. D. Pacifico, S. J. Phillips ................................ 35 Factors affecting the viability of cryopreserved allograft heart valves A. E. Heacox, R. T. McNally, K. G. M. Brockbank ......................................... 37 Endothelial and fibroblast viability assays for tissue allografts H. L. Bank, M. K. Schmehl, K. G. M. Brockbank ........................................... 43 Discussion . ...... ........ ....... ..... ...... ..... .......... .... ...... ...... ......... ..... ........ ........ .... ........ 49 Contributions for discussion: Problems of homograft procurement A. L. Moulton .................................................................................................... 52 Heart valve procurement in Berlin F. Keller, A. C. Yankah, S. SchUler, R. Klan, G. Offermann, H. Warnecke, R. Hetzer .... ..... ............ .... ...... ..... .... ...... ...... .... ........... ...... .................. ... ... .... ...... 55 Transplantation immunology of heart valve allografts Basic principles of transplantation immunology W. Miiller-Ruchholtz ......................................................................................... 59 XI
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