Banking cryopreserved heart valves in Europe: assessment of a 5-year operation in an international tissue bank in Brussels

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Abstract
OBJECTIVE: The heart valve bank of the European Homograft Bank has beenset up in 1988 to meet the growing demand of cardiac surgeons for varioussized and quality controlled cryopreserved homografts. METHODS: Heart valvedonors less than 60 years of age were classified in 3 categories:multiorgan donors with non transplantable hearts, recipients of cardiactransplantation and non beating heart cadavers with a warm ischemic time ofless than 6 hours. Past history and biology were checked for transmissiblediseases. Preparation, progressive freezing and storage in liquid nitrogenvapors, and quality control were according to the standards of the BelgianMinistry of Health. RESULTS: From end January 1989 to end May 1994, 989homograft valves were cryopreserved (514 pulmonary, 475 aortic and 3mitral) whereas 962 valves were discarded. The first cause of rejectionbeing a major macroscopic lesion (41.48%). 138 hearts accepted atinspection were contaminated and 43 cases remained so after antibiotics. 38cases were positive for hepatitis B or C. Complication at distribution andthawing included 10 instances of bag rupture and 15 of transversal fracturethrough the wall of the conduit. 477 aortic, 474 pulmonary valves as wellas one mitral were implanted between May 1989 and May 1994, either for leftor right ventricular outflow tract reconstruction. In the left ventricularoutflow tract series 111 aortic and 23 pulmonary homograft valves were usedin cases of native endocarditis, prosthetic endocarditis or recurrentendocarditis after homograft implantation. 9.6% of the requests could no besatisfied. Regular follow up information was available from 382implants-40.1% only. CONCLUSIONS: The assessment of 5 years operation ofthe heart valve bank indicates: 1) the efficiency of selecting,cryopreserving and allocating quality controlled homograft valves from alarge pool of donor hearts provided by a network of hospitals; 2) thedifficulty of obtaining regular follow up information on the implants.

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