It was the genius of Gordon Murray in Toronto that introduced the use of allografts into cardiac surgery in the 1950s. Soon after this on opposite sides ofthe world, Sir Brian Barratt-Boyes in Auckland, New Zealand, and Mr. Donald Ross in London, undertook to use allografts for the replacement of diseased aortic valves. Since that time the global interest in allografts has been patchy, episodic, and without a con sensus. Nonetheless, for the last 20 years at least three groups in the world have steadfastly pursued the development of new and relevant information concerning the use of allograft valves in humans. These are the centres of Sir Brian Barratt Boyes, Mr. Donald Ross, and Mark O'Brien in Brisbane. More recently, talented investigators, including Drs. Yankah, Yacoub, and others, have been developing information concerning the immunological aspects of the use of allografts, as well as their clinical use. No doubt, at present, cardiac valve allografts of one sort or another are the devices of choice for conduits and have an important place in the surgery of aortic valve replacement. Even so, in the mind of this writer at least, the future usefulness of allografts for the replacement of diseased cardiac valves and conduits between a ventricle and the pulmonary artery, remains problematic, and depends upon improvements in other devices for this purpose and upon improve ments that may be made in preparing and using allografts.
Sprache
Verlagsort
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Dateigröße
ISBN-13
978-3-642-72420-6 (9783642724206)
DOI
10.1007/978-3-642-72420-6
Schweitzer Klassifikation
Honorary guest lecture.- Evolution of the biological concept in cardiac surgery: A Pilgrim's Process.- Procurement and preservation techniques.- Allogeneic valve procurement in cardiac transplantation.- Antibiotic sterilisation in the preparation of homovital homograft valves: Is it necessary?.- Procurement and viability of cardiac valve allografts.- Cryobiology of tissues.- Cryopreservation of aortic valve homografts.- Factors affecting the viability of cryopreserved allograft heart valves.- Endothelial and fibroblast viability assays for tissue allografts.- Discussion.- Contributions for discussion: Problems of homograft procurement.- Heart valve procurement in Berlin.- Transplantation immunology of heart valve allografts.- Basic principles of transplantation immunology.- Cryopreserved and fresh valved aortic homograft conduits in a chronic sheep model: Haemodynamic, angiographic and histological comparisons.- Homograft valve calcification: Evidence for an immunological influence.- Pathology of human explanted aortic valve homografts: A comparative morphological study with porcine aortic valve expiants.- Antigenicity and fate of cellular components of heart valve allografts.- Immunohistopathology of cardiac valve allograft expiants.- Applications and limitations of histocompatibility in clinical cardiac valve allograft surgery.- Discussion.- Allograft surgery of the aortic root and the ascending aorta: Transplantation techniques.- The anatomy of the outflow tracts of the heart and of aortic and pulmonary allografts.- Selection of allograft valve size.- "Fresh" free-hand, non-viable allografts for aortic valve replacement: Operative techniques and 15-year results.- Modified techniques for subcoronary insertion of allografts.- Allograft aortic root replacement.-Extended aortic root replacement in 12 patients with complex left ventricular outflow tract obstruction.- Aortic root replacement with a cardiac allograft: The infected aortic root.- Indications and surgical technique of aortic valve replacement with the autologous pulmonary valve.- Reconstruction of the right ventricular outflow tract (RVOT) with allografts: Transplantation techniques.- The morphology of tricuspid atresia, pulmonary atresia and truncus arteriosus.- Population-based requirements for allograft valve surgery in children.- The pulmonary allograft for right ventricular outflow tract reconstruction.- Pulmonary valve allograft reconstruction of the right ventricular outflow tract.- Technique of inlay allografts into the RVOT to prevent pulmonary insufficiency.- Allografts in the treatment of absent pulmonary valve syndrome and complex tetralogy of Fallot.- Technique of allograft repair of tetralogy of Fallot with pulmonary atresia.- The use of aortic allografts in the primary repair of truncus arteriosus in early infancy and replacement of previous conduits.- Long-term results of antibiotic-treated (4 °C) allograft valves and valved conduits.- Allografts in the Rastelli procedure: Techniques.- Allograft conduit for Fontan procedure.- Late results of homograft function used for right ventricular outflow obstruction.- Pulmonary autografts, viable and non-viable aortic allografts in the subcoronary position: A comparative study.- Long-term results of antibiotic-treated aortic allografts in subcoronary position.- Survival of aortic allografts containing living cells.- Intermediate and long-term results of cryopreserved allografts.- Short-term results after allograft transplantation in the pulmonary position following previous repair of tetralogy of Fallot.-Intermediate-term results of cryopreserved allograft and xenograft valved ventricle to pulmonary artery conduits.- Functional evaluation of allografts by non-invasive techniques.- Cryopreserved viable allograft aortic valves.- Short-term follow-up of cryopreserved allograft valves and valved conduits from the CryoLife clinical registry.- Discussion.- Contribution for discussion: A mathematical model of aortic valve vibration.- Honorary guest lecture.- 25 years' clinical experience of allograft surgery - A time for reflection.- Current concepts on the use of aortic and pulmonary allografts.- Panel discussion.- Summary.- Closing remarks.- Author index.
