Choosing Human Tissue Grafts
Cryopreserved human tissue (allo)grafts have been used for cardiovascular reconstruction for over 50 years. Aortic valve allografts are used primarily in cases with extensive aortic root destruction from native or prosthetic valve endocarditis. Because they provide normal hemodyamics, unlike man-made valve prostheses, they are also very useful in patients with aortic valve disease who have small aortic roots or significant left ventricular dysfunction. They are ideal for the patient who needs normal hemodyamics without long-term anticoagulation. They also provide the largest “landing zone” for a later transcatheter aortic valve replacement in a younger patient in whom a second procedure will likely be required.
Pulmonary valve allografts are typically used to replace the pulmonary valve in patients undergoing a Ross procedure or right ventricular outflow tract reconstruction for various congenital heart defects in children and adults. Vascular patch material is used in a number of complex congenital heart defects in children.
Vascular conduit grafts are the only realistic option for in-situ replacement of infected prosthetic grafts, and saphenous vein grafts are ideal for limb-salvage and during coronary artery bypass when autologous conduit is unavailable.
In these complex, often high-risk cases, tissue quality is of paramount importance and should be secondary to cost considerations. All commercial tissue processors are not the same. It is important to work with companies who have AATB Accreditation and who are able to at least provide internal and preferably peer-reviewed data to support their claims.