Heart valve replacement with bio-valves for congenital heart defects

Constrictions in the outflow tract of the right ventricle (RVOT, right ventricular outflow tract), in the pulmonary artery valve (pulmonary valve) and in Ross operations to replace the main aortic valve (aortic valve) may necessitate the use of valve-bearing homografts. These homografts are human heart valves obtained during heart transplants or from cadaveric donors.  Despite good compatibility of the homografts, they are subject to a gradual ageing process, which leads to a slow functional impairment of the homograft and ultimately makes a new operation (re-operation) necessary. Another reason for re-operations is the lack of growth potential of the homografts, which is particularly problematic in children.

In order to reduce the number of re-operations, so-called decellularised homografts are used at the Children's Heart Centre Vienna. These are specially pre-treated homografts that are produced in co-operation with the company Corlife (www.corlife.eu). The homografts are obtained by the Viennese medical team as part of heart transplant operations. While the patient receives their new heart, the heart valves of the otherwise damaged explanted "old" heart, which are usually in good condition, are "cleaned" by a special treatment of cells from the transplanted patient. As a result, only the "scaffold" of the homograft valves remains. After implantation of this homograft, the patient's own cells can colonise this scaffold during the operations mentioned at the beginning; in the best case, the homograft is completely covered by the patient's own cells and thus integrated into the heart. A schematic representation of this can be found in Fig. 1.

The advantages and safety of decellularised homografts have been investigated in several studies over the last 10 years. The outstanding result was that the re-operation rates for decellularised homografts were significantly lower than for "normal" homografts. In the largest study, the re-operation rate after 5 years was 0% for decellularised homografts and 13% for "normal homografts" (1). The original data of this study are shown in Fig. 2. The remaining complication rates were comparable between the two homograft types. 

For further information, consultations and surgical planning, please contact our cardiac surgery team.

Literatur:

(1) Cebotari S, Tudorache I, Ciubotaru A, Boethig D, Sarikouch S, Goerler A, Lichtenberg A, Cheptanaru E, Barnaciuc S, Cazacu A, Maliga O, Repin O, Maniuc L, Breymann T, Haverich A. Use of fresh decellularized allografts for pulmonary valve replacement may reduce the reoperation rate in children and young adults: early report.  Circulation. 2011(13);124:S115-23.