title: Processing of ovine cardiac valve allografts: 3. Implantation following antimicrobial treatment and preservation.
abstract: It is known that a satisfactory clinical outcome can follow the implantation of cardiac valve allografts in spite of the loss of living cells in the tissue. If viable cells are not required for long term graft function, then effective disinfection of the tissue might become possible. In an earlier paper in this series we reported that peracetic acid (PAA) is an effective antimicrobial agent for the treatment of valve allografts; it was lethal to the cells but at a concentration of 0.21% had little effect on the mechanical properties or extracellular morphology of the valve leaflets. It was also found that PAA-treatment could be combined with storage in 85% glycerol at 4 degrees C, or cryopreservation with 10% Me(2)SO, without substantial further impairment of microscopic structure or mechanical properties. In this paper we describe the implantation of processed ovine aortic valves in the descending thoracic aorta of sheep. The experimental groups included control untreated valves and valves that had been treated with antibiotics or PAA and either cryopreserved, or stored in 85% glycerol. The recipient sheep showed good clinical appearances until the experiment was terminated at six months. The explanted grafts were examined by standard morphological and mechanical testing methods. The PAA-treated valves were clearly recognisable as valves: the leaflets had fair to medium morphology in both the unpreserved and the cryopreserved groups. All leaflets had a superficial overgrowth of cells. Microsatellite analysis for allelic differences were performed on samples of donor and recipient tissues using three markers of tissue source. Only one valve, which had been treated with PAA, revealed allelic differences between donor and recipient. It is suggested that DNA-fragments may have remained after the destruction of donor cells and six months of implantation: the overgrowing cells were almost certainly of recipient origin. We conclude that our experiments, in which PAA-treatment was combined with preservation, are sufficiently encouraging to justify further studies to refine the technique, but in our opinion they are not sufficient to justify a clinical trial at this time.
authors.affiliation: Santa Cruz Hospital, Lisbon, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Neves
authors.forename: M
authors.initials: M
authors.lastname: Abecassis
authors.forename: T
authors.initials: T
authors.lastname: Santiago
authors.forename: T
authors.initials: T
authors.lastname: Ramos
authors.forename: J
authors.initials: J
authors.lastname: Melo
authors.forename: E
authors.initials: E
authors.lastname: Gruys
authors.forename: C
authors.initials: C
authors.lastname: Hulskamp-Koch
authors.forename: A
authors.initials: A
authors.lastname: Ultee
authors.forename: E L C
authors.initials: EL
authors.lastname: Verkaar
authors.forename: J A
authors.initials: JA
authors.lastname: Lenstra
authors.forename: Y A
authors.initials: YA
authors.lastname: Goffin
authors.forename: A
authors.initials: A
authors.lastname: Vanderkelen
authors.forename: B
authors.initials: B
authors.lastname: Van Hoeck
authors.forename: C J
authors.initials: CJ
authors.lastname: Hunt
authors.forename: D E
authors.initials: DE
authors.lastname: Pegg