Download Homografts - Rotes Kreuz

Homografts
for the treatment of heart valve disease
Ass. Prof. Dr. Martin
Andreas
Department of Cardiac Surgery
Medical University of Vienna
Alfred Kocher, Claudia Oeser, Nina Worel, Peter Brühl,
Andreas Zuckermann, Günther Laufer
Medical University Vienna
Harvesting Facilities in Austria
§  Österreichisches Rotes Kreuz, Landesverband OÖ,
Blutzentrale Linz
§  Types of donors: multi-organ donors, non-heart beating donors
§  Procurement outside the center
§  Authorization for the processing, storage and distribution of
heart valves
§  Univ. Klinik für Chirurgie, Klinische Abteilung für
Herzchirurgie, Homograft-Entnahmeeinrichtung Wien
§  Types of donors: living donors, multi-organ donors
§  Procurement inside the center
§  Currently no authorization for the processing, storage and
distribution of heart valves
Medical University Vienna
Implanted homografts at the AKH Wien
Implantation of mainly “Cryolife homografts“ (2008 – 2014)
Implantation of “Bislife homografts“ and homografts from the
“Blutzentrale Linz“ (2014 – 2015)
Implantation of homografts from the “Homograft-Entnahmeeinrichtung
Wien“ (summer 2015 till today)
Medical University Vienna
Homograft performance in Vienna
Freedom from reoperation
Green:
Blue:
Vienna
Cryolife
p=0.016
Medical University Vienna
Clinical indications for
homograft implantation
Adult cardiac surgery
§  Ross procedure
§  Aortic valve replacement for endocarditis
Pediatric cardiac surgery
§  RVOT reconstruction (Fallot, ..)
§  Norwood
§  …
Medical University Vienna
Aortic Valve Disease Surgical Treatment Options
§  Standard mechanic / biologic valves
§  New surgical prosthesis (sutureless/rapid deployment)
§  Transfemoral / transapical TAVI
Pediatric and young adults -> optimal prosthesis?
§  Aortic Homografts
§  Ross procedure
§  Bioregenerative aortic valve replacement (ARISEProject)
Medical University Vienna
Standard aortic homograft
Medical University Vienna
Medical University Vienna
Medical University Vienna
Ross Procedure
Medical University Vienna
Medical University Vienna
Medical University Vienna
Medical University Vienna
Medical University Vienna
Medical University Vienna
Medical University Vienna
Medical University Vienna
Medical University Vienna
Medical University Vienna
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Medical University Vienna
Medical University Vienna
Medical University Vienna
0.0
0.2
0.4
0.6
0.8
1.0
Survival
0
5
10
15
20
A Single-Center Experience With the Ross Procedure Over 20 Years. Andreas M, Seebacher G, Reida E,
Wiedemann D, Pees C, Rosenhek R, Heinze G, Moritz A, Kocher A, Laufer G. Ann Thorac Surg. 2013 Oct
Medical University Vienna
Survival
Ross
Mech
The Ross procedure offers excellent survival compared with mechanical aortic valve replacement in a real-world
setting. Andreas M, Wiedemann D, Seebacher G, Rath C, Aref T, Rosenhek R, Heinze G, Eigenbauer E, Simon P,
Ruetzler K, Hiesmayr JM, Moritz A, Laufer G, Kocher A. Eur J Cardiothorac Surg. 2014 Feb 4.
Medical University Vienna
Risks of the Ross procedure
§  Dilatation of the autograft
§  Stenosis of the pulmonary homograft
§  Complex surgery
§  Systemic reaction to the homograft?
Medical University Vienna
Medical University Vienna
Case: Heart transplantation after Ross
procedure
§  Patient with congential aortic valve stenosis and dilative
cardiomyopathy
§  Ross procedure 1998
§  Heart transplantation 2015
§  Severe antibody mediated graft failure
§  Homograft Donor HLA-A02, Recipient HLA-A01
§  PRA prä TX: 0%, but anti A02 antibodies
-> PRA 83% post HTX
Medical University Vienna
Sensitized Patients
§  Increasing number
§  Risk factors: blood transfusion,
pregnancy, previous surgery
§  PRA show potential risk
§  Potential prospective crossmatch
§  Transplant may have a booster effect
on memory cells
Medical University Vienna
Bioregenerative AVR – The Future?
Future Innovations will make the difference!!
palliative therapy
curative therapy
Decellularized Homografts (ARISE Study)
Medical University Vienna
Bioregenerative AVR – The Future?
Ruzmetov M et al. Decellularized versus standard cryopreserved valve allografts
for right ventricular outflow tract reconstruction: a single-institution comparison.
J Thorac Cardiovasc Surg. 2012 Mar;143(3):543-9
Medical University Vienna
Decellularized Fresh Homografts for Pulmonary Valve Replacement: A Decade of Clinical
Experience; Samir Sarikouch, Alexander Horke, Igor Tudorache, Philipp Beerbaum, Mechthild
Westhoff- Bleck, Dietmar Boethig, Oleg Repin, Liviu Maniuc, Anatol Ciubotaru, Axel Haverich
and Serghei Cebotari (EACTS 2015)
Medical University Vienna
Decellularized Fresh Homografts for Pulmonary Valve Replacement: A Decade of Clinical
Experience; Samir Sarikouch, Alexander Horke, Igor Tudorache, Philipp Beerbaum, Mechthild
Westhoff- Bleck, Dietmar Boethig, Oleg Repin, Liviu Maniuc, Anatol Ciubotaru, Axel Haverich
and Serghei Cebotari (EACTS 2015)
Medical University Vienna
Decellularized Fresh Homografts for Pulmonary Valve Replacement: A Decade of Clinical
Experience; Samir Sarikouch, Alexander Horke, Igor Tudorache, Philipp Beerbaum, Mechthild
Westhoff- Bleck, Dietmar Boethig, Oleg Repin, Liviu Maniuc, Anatol Ciubotaru, Axel Haverich
and Serghei Cebotari (EACTS 2015)
Medical University Vienna
SAVR for Aortic Valve Disease
1828 Friedrich Wöhler:
First Urea synthesis
Inspiration for Bioregeneration:
Homunculus
Valve Therapy of the future will be
Bioregenerative Replacement!!!
Medical University Vienna
Corlife Dezellularization
Medical University Vienna
Medical University Vienna
Medical University Vienna
Medical University Vienna
Medical University Vienna
Conclusion
§  Homografts play a major role in specialized procedures in
cardiac surgery
§  Legal requirements for graft harvesting and tissue banking are
demanding
§  Decellularization process may broaden the clinical spectrum
§  A palliative therapy may be changed to a curative therapy
Medical University Vienna
Medical University Vienna
Martin Andreas, MD, MBA, PhD
Department of Cardiac Surgery
Währinger Gürtel 18-20, 1090 Vienna
[email protected]
+43-1-40400-69660