Immunological and echocardiographic evaluation of decellularized versus cryopreserved allografts during the Ross operation

• Published in: European journal of cardio-thoracic surgery 2005-04, Vol.27 (4), p.572-578
• Main Authors: Affonso da Costa, Francisco Diniz, Dohmen, Pascal Maria, Duarte, Daniele, von Glenn, Cristina, Lopes, Sérgio Veiga, Filho, Hermínio Haggi, Affonso da Costa, Marise Brenner, Konertz, Wolfgang
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Allograft heart valve; Aortic Valve - diagnostic imaging; Aortic Valve - physiology; Aortic Valve - surgery; Biological and medical sciences; Bioprosthesis; Cardiology. Vascular system; Child; Cryopreservation; Female; Heart Valve Diseases - physiopathology; Heart Valve Diseases - surgery; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - methods; HLA Antigens - immunology; Humans; Humoral immune response; Isoantibodies - biosynthesis; Male; Medical sciences; Pneumology; Postoperative Period; Pulmonary Valve - immunology; Pulmonary Valve - pathology; Pulmonary Valve - transplantation; Short-term valve function; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Ultrasonography; Ventricular Outflow Obstruction - surgery
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2004.12.057

Objective: Compare the immunological and echocardiographic data of decellularized versus cryopreserved allografts used for RVOT reconstruction during Ross operation. Methods: From 16/01/03 thru 07/10/03, 20 Ross operations were performed using decellularized (n=11) or cryopreserved (n=9) allografts. Echocardiography was done at discharge, 1, 3, 6 and 12 months and annually thereafter. Samples for determination of antibodies against HLA class I and II were obtained preoperatively and at days 5, 10, 30, 90 and 180 postoperatively. These samples were tested by the ELISA method in LAT-M dishes (unspecific) for identification of circulating antibodies and the results expressed as mean sample values (Is=DO/cutoff). If positive, LAT-E (specific) was performed and PRA levels determined. Results: There was no mortality. Cryopreserved allografts showed marked Is values elevations for class I and II antibodies which started at the first month and remained elevated up to 6 months. In contrast, of the patients receiving decellularized allografts, seven remained negative, two patients had only marginal elevation of class I antibodies and two patients showed abnormal elevations of PRA levels. This response happened earlier than in the cryopreserved group, starting on the 5th postoperative day and has returned to baseline levels in one case. Echocardiography showed mild, but significant, elevation of gradients in cryopreserved valves but none in the decellularized. Conclusions: Decellularized allografts had normal function up to 18 months and showed important reduction of the immunogenic response when compared to cryopreserved valves.