Allograft valves harvesting and preservation technique for enhanced performance.

Abstract

Allograft valves offer significant advantages in valve replacement; however, their limited availability from cadaveric or brain-dead donors presents a considerable challenge. This study aims to share our experience in harvesting and preserving Allograft valves from heart transplant recipients, addressing this shortage and streamlining the process. Allograft valves were harvested from patients who underwent heart transplants at our center from October 2007 to October 2022. After sampling of the allograft for quality control, allograft valves were cryopreserved and thawed before implantation. Allograft valves were used in 60 patients who had pulmonary valve replacement (PVR) in or after repaired Tetralogy of Fallot (TOF). Patient data were collected and statistically analyzed. The age of donors was 39.0 ± 186.0 years while the median age of recipients was 5.1 years (interquartile range, 1.5-12.1). After a median follow-up of 2.6 years (interquartile range, 1.0-6.9), the freedom from all-cause mortality was 94.0%, 89.5%, and 89.5% at 5, 10, and 15 years, respectively. Adverse clinical outcomes, occurred in 24 patients (40.0%), while freedom is 64.9%, 53.4%, and 31.7% for 5, 10, and 15 years. Allograft valves bicuspidized (odds ratio, 75.085; 95% confidence interval, 10.100-558.202, P < 0.001) and early postoperative regurgitation (odds ratio, 9.946; 95% confidence interval, 1.034-95.706, P = 0.047) were considered independent risk factors for adverse clinical outcomes. Our study presents our approach to harvesting and preserving allograft valves from heart transplant recipients, demonstrating favorable short to mid-term outcomes when utilized in allograft valves for patients with or after repaired TOF. We recommend vigilant monitoring of early postoperative regurgitation, as it may signal a poor prognosis, and we strongly advise against bicuspidized the implanted allograft valves.