title: Resistance to infection of long-term cryopreserved human aortic valve allografts.
abstract: OBJECTIVE
  To analyze the in vitro antimicrobial activity of 3 antibiotic regimens (group A, gentamicin-piperacillin-vancomycin-metronidazole-amphotericin B; group B, gentamicin-piperacillin-flucloxacillin-metronidazole-amphotericin B; and group C, meropenem-vancomycin-tobramycin-colistin-amphotericin B) used in the processing of cryopreserved human ascending aortic tissue and aortic valves against Staphylococcus epidermidis and Staphylococcus aureus. The results were additionally compared with the infection resistance of cryopreserved ascending aortic tissue against Escherichia coli and Pseudomonas aeruginosa.
  
  
  METHODS
  Each of 10 cryopreserved human allografts (CHAs) was divided into 25 pieces (separating aortic wall and valve). Eighteen segments were microbiologically tested, and 7 pieces underwent scanning electron microscopy. A bacterial solution (4 mL; optical density, 0.20 ± 0.02) was used for contamination. After incubation, the optical density of the solution was measured. CHAs underwent sonication to release viable adherent bacteria. The number of attached bacteria was quantified by the colony forming units per square centimeter of CHA surface.
  
  
  RESULTS
  Antibiotic regimen groups B and C were more efficient than group A in eradicating gram-positive organisms adherent to the aortic wall (P < .001). Group C showed enhanced resistance against E coli compared with group A or B (P < .001), whereas group B appeared to be more effective against P aeruginosa (P < .001). With reference to each antibiotic regimen, ascending aortic tissue showed significantly less bacterial contamination with staphylococcal bacteria than valve grafts (P ≤ .01).
  
  
  CONCLUSIONS
  CHAs possess antibacterial activity despite long-term storage over 5 years. Antibiotic combinations applied during CHA processing have a significant influence on their infection resistance. Ascending aortic tissue shows a significantly enhanced bacterial resistance against staphylococcal bacteria compared with aortic valves.
authors.affiliation: Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany; CrossBIT Research Center for Biocompatibility and Immunology of Medical Implants, Hannover Medical School, Hannover, Germany.
authors.forename: Viola
authors.initials: V
authors.lastname: Steffen
authors.affiliation: Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Marsch
authors.affiliation: Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany; CrossBIT Research Center for Biocompatibility and Immunology of Medical Implants, Hannover Medical School, Hannover, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Burgwitz
authors.affiliation: Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany; CrossBIT Research Center for Biocompatibility and Immunology of Medical Implants, Hannover Medical School, Hannover, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Kuehn
authors.affiliation: Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany. Electronic address: Teebken.Omke@MH-Hannover.de.
authors.forename: Omke E
authors.initials: OE
authors.lastname: Teebken
mesh_terms: D000293:Adolescent; D000328:Adult; D064591:Allografts / Q000187:drug effects / Q000382:microbiology; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D001021:Aortic Valve / Q000187:drug effects / Q000382:microbiology / Q000601:surgery*; D002648:Child; D015925:Cryopreservation / Q000379:methods*; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000517:prevention & control; D018570:Risk Assessment; D013203:Staphylococcal Infections / Q000517:prevention & control; D013211:Staphylococcus aureus / Q000187:drug effects*; D013212:Staphylococcus epidermidis / Q000187:drug effects*; D014019:Tissue Donors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: aortic valve; ascending aorta; bacterial infection; cryopreserved human allograft; infective endocarditis; prosthetic graft infection