Pathology Of Explanted Cryopreserved Allograft Heart Valves: Comparison With Aortic Valves From Orthotopic Heart Transplants Richard N. Mitchell, MD,

Slides:

Advertisements

Similar presentations

Morphology of valve allografts (homografts) valve and pulmonary valve autografts. (A) Gross photograph of pulmonary valve allograft removed following 7.

Advertisements

Max B. Mitchell, MD The Journal of Thoracic and Cardiovascular Surgery

Bing-Yen Wang, MD, Hsiao-Huang Chang, MD, PhD, I

David D. Yuh, MD, Kimberly L. Gandy, MD, Bruce A

Wound healing around and within saphenous vein bypass grafts

Mycoplasma hominis prosthetic valve endocarditis: The value of molecular sequencing in cardiac surgery Syed T. Hussain, MD, Steven M. Gordon, MD, Carmela.

In vivo autologous recellularization of a tissue-engineered heart valve: Are bone marrow mesenchymal stem cells the best candidates? Andre Vincentelli,

A detailed histologic analysis of pulmonary arteriovenous malformations in children with cyanotic congenital heart disease Brian W. Duncan, MDa, James.

Acute Rejection, Types II & III (Vascular)

The use of technetium tc 99m annexin V for in vivo imaging of apoptosis during cardiac allograft rejection Patrick W. Vriens, MDa, Francis G. Blankenberg,

Aortic root replacement with a novel decellularized cryopreserved aortic homograft: Postoperative immunoreactivity and early results Kenton J. Zehr,

Reconstruction of pulmonary artery with porcine small intestinal submucosa in a lamb surgical model: Viability and growth potential Lorenzo Boni, MD,

Coronary artery bypass grafting with the descending branch of thelateral femoral circumflex artery used as an arterial conduit: Is arteriographicevaluation.

Biomatrix/Polymer Composite Material for Heart Valve Tissue Engineering Christof Stamm, MD, Amir Khosravi, MD, Niels Grabow, MS, Kathleen Schmohl, PhD,

Jacques A. M. van Son, MD, PhD, William D. Edwards, MD, Gordon K

Development of a “leak-proof,” knitted Dacron vascular prosthesis

Bing-Yen Wang, MD, Hsiao-Huang Chang, MD, PhD, I

Tracheal regeneration: Evidence of bone marrow mesenchymal stem cell involvement Agathe Seguin, MD, PhD, Sonia Baccari, MD, Muriel Holder-Espinasse, MD,

Decellularization reduces immunogenicity of sheep pulmonary artery vascular patches Eric J. Lehr, MD, PhD, Gina R. Rayat, PhD, Brian Chiu, MD, Thomas.

Nodular pulmonary amyloidosis

Decellularized heart valve as a scaffold for in vivo recellularization: Deleterious effects of granulocyte colony-stimulating factor Francis Juthier,

Christopher G. A. McGregor, MB, William R

Behavior of vital and killed autologous pericardium in the descending aorta of sheep David T. Cheung, PhD, Suk Jung Choo, MD, Albert C. Grobe, MS, Douglas.

Total replacement of the mitral apparatus with a stentless, chordally supported mitral valve allograft: An experimental study Herbert Vetter, MDa, Andreas.

Compound polyglactin 910/polypropylene small vessel prostheses

Adriana Luk, MD, Robert J. Cusimano, MD, Jagdish Butany, MBBS, MS

Cardiac lipoma arising from left ventricular papillary muscle: Resect or not? Young Sam Kim, MD, Kyung Hee Lee, MD, PhD, Suk Jin Choi, MD, PhD, Wan Ki.

Clifford H. Van Meter, MD (by invitation), William C

Calcification of allograft and stentless xenograft valves for right ventricular outflow tract reconstruction: An experimental study in adolescent sheep

Immunogenicity of decellularized cryopreserved allografts in pediatric cardiac surgery: comparison with standard cryopreserved allografts John A Hawkins,

Trileaflet aortic valve reconstruction with a decellularized pericardial patch in a sheep model Bart Meuris, MD, PhD, Shigeyuki Ozaki, MD, PhD, William.

Rachael W. Quinn, PhD, Arthur A. Bert, MD, Gabriel L

Tomoharu Akiba, MD*, Anton E. Becker, MD

Percutaneous Tissue-Engineered Pulmonary Valved Stent Implantation

Conformational stress and anastomotic hyperplasia

Pseudoaneurysm Formation After Medtronic Freestyle Porcine Aortic Bioprosthesis Implantation: A Word of Caution Brian R. Englum, MD, Elizabeth N. Pavlisko,

The pathology of fresh and cryopreserved homograft heart valves: An analysis of forty explanted homograft valves David R. Koolbergen, MD, Mark G. Hazekamp,

Preliminary experience with porcine intestinal submucosa (CorMatrix) for valve reconstruction in congenital heart disease: Histologic evaluation of explanted.

Allograft heart valves: The role of apoptosis-mediated cell loss

Histologic abnormalities of the ascending aorta and pulmonary trunk in patients with bicuspid aortic valve disease: Clinical relevance to the ross procedure

Amir Abolhoda, Sumei Yu, J

Prevention of Calcification of Bioprosthetic Heart Valve Cusp and Aortic Wall With Ethanol and Aluminum Chloride Jocelyn N. Clark, PhD, Matthew F. Ogle,

Prolonged discordant xenograft survival and delayed xenograft rejection in a pig-to- baboon orthotopic cardiac xenograft model He Xu, MDa, Steven R. Gundry,

A self-renewing, tissue-engineered vascular graft for arterial reconstruction Kei Torikai, MD, Hajime Ichikawa, MD, PhD, Koichiro Hirakawa, MS, Goro Matsumiya,

Martin H. Chamberlain, FRCS, David P. Taggart, MD, FRCS

Differences in reendothelialization after balloon catheter removal of endothelial cells, superficial endarterectomy, and deep endarterectomy Steven G.

The influence of concordant xenografts on the humoral and cell-mediated immune responses to subsequent allografts in primates Robert E. Michler, MDa,

Successful allotransplantation of cryopreserved tracheal grafts with preservation of the pars membranacea in nonhuman primates Tomohiro Murakawa, MD,

Heparinization on pericardial substitutes can reduce adhesion and epicardial inflammation in the dog Jen-Her Lu, MD, PhD, Yen Chang, MD, Hsing-Wen Sung,

Tissue Engineering of Viable Pulmonary Arteries for Surgical Correction of Congenital Heart Defects Rainer G. Leyh, MD, PhD, Mathias Wilhelmi, MD, Philip.

Evaluation of Explanted CorMatrix Intracardiac Patches in Children With Congenital Heart Disease Jennifer S. Nelson, MD, MS, Amer Heider, MD, Ming-Sing.

Use of a bovine jugular vein graft with natural valve for right ventricular outflow tract reconstruction: A one-year animal study Yukio Ichikawa, MD,

Evidence of mitigated calcification of the Mosaic versus Hancock Standard valve xenograft in the mitral position of young sheep Patricia A. Weber, DrPH,

Glenn C. Hunter, MD, Stephen H. Smyth, MD, Marie L. Aguirre, MD, B

Percutaneous pulmonary polyurethane valved stent implantation

Impact of endothelial cell seeding on long-term patency and subendothelial proliferation in a small-caliber highly porous polytetrafluoroethylene graft

Clinical experience with CorMatrix extracellular matrix in the surgical treatment of mitral valve disease Marc W. Gerdisch, MD, FACS, FACC, Richard J.

Influence of vein valves in the development of arteriosclerosis in venoarterial grafts in the rabbit Aurelio Chaux, MDa (by invitation), Xin Min Ruan,

Inflammatory abdominal aortic aneurysms: A thirty-year review

Decellularization reduces calcification while improving both durability and 1-year functional results of pulmonary homograft valves in juvenile sheep

A. Simon, DrMeda, M. Wilhelmia, G. Steinhoff, ProfDrMedb, W

Proliferation of smooth muscle cells in acute allograft vascular rejection Jun Amano, MDa, Shigeru Ishiyama, MDb, Toshiro Nishikawa, MDb, Hiroyuki Tanaka,

Clinical pulmonary autograft valves: Pathologic evidence of adaptive remodeling in the aortic site Elena Rabkin-Aikawa, MD, PhD, Masanori Aikawa, MD,

Postimplantation morphologic changes of glutaraldehyde-fixed porcine aortic roots and risk of aneurysm and rupture Tirone E. David, MD, Susan Armstrong,

Thoracoabdominal aortic aneurysm in Cogan’s syndrome

Prevention of perioperative vascular prosthetic infection with a novel triple antimicrobial- bonded arterial graft Ibrahim Aboshady, MD, Issam Raad, MD,

Successful Single-Lung Transplantation for Multicentric Castleman Disease Yuki Morimura, MD, Fengshi Chen, MD, PhD, Tomoaki Kinjo, MD, Aya Miyagawa-Hayashino,

Vascular Effects of Cyclosporin A and Acute Rejection in Canine Heart Transplantation Denis Bouchard, MD, Marc-Antoine Despatis, MD, Josie Buluran, BSc,

Patrick I. McConnell, MD, Narutoshi Hibino, MD

Steven R. Meyer, MD, Jeevan Nagendran, BSc, Leena S. Desai, Gina R

Presentation transcript:

Pathology Of Explanted Cryopreserved Allograft Heart Valves: Comparison With Aortic Valves From Orthotopic Heart Transplants Richard N. Mitchell, MD, PhD a, Richard A. Jonas, MDb, Frederick J. Schoen, MD, PhD a The Journal of Thoracic and Cardiovascular Surgery Volume 115, Issue 1, Pages 118-127 (January 1998) DOI: 10.1016/S0022-5223(98)70450-7 Copyright © 1998 Mosby, Inc. Terms and Conditions

Figure 1 Unimplanted valve and short-term explant: photomicrographs of valve cusps. A, Unimplanted valve. B, Valve removed at autopsy 2 days after implantation. Insets show corresponding low-power photomicrographs. Although the explanted valve retains a layered architecture, its interstitial cellularity is substantially diminished, and the outflow surface is flattened and less rippled than normal, suggesting early stretching of collagen toward a configuration characteristic of diastole. (Hematoxylin and eosin stain, original magnification 175×; insets 90×.) The Journal of Thoracic and Cardiovascular Surgery 1998 115, 118-127DOI: (10.1016/S0022-5223(98)70450-7) Copyright © 1998 Mosby, Inc. Terms and Conditions

Figure 2 Long-term explants, gross photographs, and radiographs. A, Pulmonic valve allograft and pulmonary artery conduit removed after 9 years for root stenosis from a child with repaired congenital heart disease. B, Radiograph of valve and conduit shown in A. Despite diffuse nodular mineralization of the pulmonary artery conduit wall, the cusps were soft, pliable, and noncalcified. C, Aortic allograft valve removed for aortic stenosis 4.7 years after the operation. D, Radiograph of valve shown in C; nodular cuspal calcification is evident. E, Aortic valve allograft removed after 3 years for aortic insufficiency resulting from cuspal prolapse. No calcification was noted. The Journal of Thoracic and Cardiovascular Surgery 1998 115, 118-127DOI: (10.1016/S0022-5223(98)70450-7) Copyright © 1998 Mosby, Inc. Terms and Conditions

Figure 3 Long-term explants: photomicrographs of cusps and aortic wall. A, Cusp from right-sided valve explanted after 7 years. B, Aortic valve explanted after 5 years. Insets show low-power view of the same valves. A and B show overall flattening and loss of normal layered architecture, as well as loss of endothelial and deep interstitial cells. In A, a cuspal hematoma/thrombus is present at the lower (inflow) surface (arrow). C and D, Aortic valve explanted after 3 years. In C, the remnant layered architecture is highlighted by the staining for elastin (arrow). In C and D there is patchy cuspal interstitial cellularity. A representative stained cell nucleus is highlighted by an arrow in D. E, Aortic wall remnant of valve shown in B, demonstrating replacement of normal aortic wall architecture by fibrosis. F, Nodular calcification of aortic wall portion of right-sided pulmonic valve and pulmonary artery allograft, with prominent calcification along the residual pulmonary artery elastin (arrow). G, Cuspal calcific nodules (arrows). A, B, D, and E, Hematoxylin and eosin stain; F and G, Stained with von Kossa's reagent (calcium phosphates are black). Magnifications: A, B, inset D, E, and F, original magnifications 175×; inset A, B, C, and D, 90×. C, Stained with Movat pentachrome stain (elastin black). The Journal of Thoracic and Cardiovascular Surgery 1998 115, 118-127DOI: (10.1016/S0022-5223(98)70450-7) Copyright © 1998 Mosby, Inc. Terms and Conditions

Figure 4 Long-term explants; ultrastructure. A, Cellular remnants (open arrows) with focal microcalcification (solid arrow) are present diffusely throughout the cuspal connective tissue matrix, despite the absence of cellular staining on routine histologic stains. B, Dense residual collagen (c) and cell remnants (arrow) in long-term explant. The collagen has some degradation of structure and marked flattening characteristic of the diastolic configuration; wavy crimp typical of a relaxed normal valve is absent. Stained with uranyl acetate and lead citrate. Double-headed arrow in lower left = 3 μm. Original magnification 10,000×. The Journal of Thoracic and Cardiovascular Surgery 1998 115, 118-127DOI: (10.1016/S0022-5223(98)70450-7) Copyright © 1998 Mosby, Inc. Terms and Conditions

Figure 5 Photomicrographs of cusps from valves from orthotopic heart transplants. A, Aortic valve removed from patient dying of fulminant acute myocardial rejection 7.5 months after the operation. This patient had had 12 treatable rejection episodes over 7 months; the last augmentation of immunosuppression was with methylprednisolone sodium succinate (Solu-Medrol) 16 days before death. B, Aortic valve removed from patient dying of graft coronary arteriosclerosis 4 years after heart transplantation; last augmentation of immunosuppression was with methylprednisolone 4 months before death. Both valves show the expected layered architecture outflow surface rippling characteristic of the normal valve in the relaxed state, as well as a normal complement of interstitial and endothelial cells. (Hematoxylin and eosin, original magnifications 90×.) The Journal of Thoracic and Cardiovascular Surgery 1998 115, 118-127DOI: (10.1016/S0022-5223(98)70450-7) Copyright © 1998 Mosby, Inc. Terms and Conditions

Figure 6 Immunohistochemical staining results. A, Von Willebrand's factor staining of unimplanted cusp demonstrating sparse preservation of endothelial cells. B, CD45RO immunohistochemical staining of unimplanted valve demonstrating a mild diffuse infiltrate of mononuclear inflammatory cells (T-lymphocytes and macrophages). C, Immunohistochemical staining of valve cusp shown in Fig. 2, C and D for vimentin showing positivity of interstitial cells near the inflow surface, suggesting that these are mesenchymal cells derived from recipient pannus formation. D, T-cell (CD45RO) staining of valve removed from heart transplant patient who died of a technical complication 2 days after the operation. E, T-cell (CD45RO) staining of aortic valve from heart transplant patient dying 2.5 months after the operation of complications of perioperative myocardial ischemic injury. F, T-cell (CD45RO) staining of aortic valve of heart transplant from patient who required retransplantation 6.5 months after transplantation for graft coronary arteriosclerosis. G, T-cell (CD45RO) staining of aortic valve from heart transplant patient who died 7.5 months after the operation of fulminant acute myocardial rejection (also shown in Fig. 5, A). H, T-cell (CD45RO) staining of myocardium from heart whose aortic valve is represented in G. These immunohistochemical studies demonstrate that T-cells are sparse in aortic valves of heart transplants in the early postoperative period and although present in greater density thereafter do not appear to correlate with myocardial infiltrates in acute myocardial rejection. Despite the presence of T-cell infiltrates in the valve from a heart necessitating retransplantation for graft arteriosclerosis (F), there is no evidence of intimal proliferation characteristic of the coronary arterial lesion (see Fig. 5, B). (All original magnifications 175×.) The Journal of Thoracic and Cardiovascular Surgery 1998 115, 118-127DOI: (10.1016/S0022-5223(98)70450-7) Copyright © 1998 Mosby, Inc. Terms and Conditions