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KMID : 0438219790160010251
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Korea University Medical Journal
1979 Volume.16 No. 1 p.251 ~ p.258
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An Experimental Study on the Preservation of the Valvular Xenograft
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Abstract
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Treatment of valvular heart disease with valve replacement has been one of the most popular procedures in cardiac surgery. Although first effiort was directed toward prosthetic valve, it soon became popular that bioprosthesis, the valvular xenograft, was prefered in a majority of cases.
Valvular xenograft has some superiority to the prosthetic valve in some points of thromboembolism and hemolytic anemia, and it also has some inferiority of durability, immunologic reaction and resistance to infection.
Tremendous effiorts were made to cover the inferiority with several methods of collection, preservation, valve mounting and surgical technic of the valvular xenograft replacement.
Auther has collected 30 porcine aortic valves immediately after slaughter, aortic cuspes coapted with cotton balls to protect valve deformity after washing with normal saline solution, and has preserved each five valves in diffierent storage methods of 5 groups (75% ethanol, Dakin´s solution, 4% formaldehyde, ethylene oxide gas, and 0.65% glutaraldehyde) with one control of Ringer´s solution mixed with cephaloridine for 11 days.
. The preserved valves of each group was tested with bactriologic culture, pressure tolerance test and pathologic changes individually to obtain following results:
1. Bacteriologic culture revealed only one positive culture of Citobacter freundii in 75% Ethanol preserved group.
2. Pressure tolerance test was done with apparatus composed of Y connected manometer and pressure applicator. Tolerable limit of pressure was recorded when central leak of fluid was observed. Average pressure tolerated in each group was: Glutaraldehyde 168 mmHg, Formaldehyde 128 mmHg, Dakin 92 mmHg, E. O, gas 48 mmHg, Ethanol 26 mmHg in relation to control of Ringer´s 90 mmHg.
3. Histopathologic observation was focussed in three view points. Endthelial cell linings were well preserved only in the Glutaraldehyde and formalin preserved group, others all detached and destroyed. Collagen fibers are, also, destroyed with fracture and distorsion in all groups except Glutaraldehyde and Formaldehyde group. Elastic fibers were destructed in all groups in some degree, and least destruction was observed in Glutaraldehyde and Formaldehyde group.
According to the above observation, most effiective method of preservation of porcine heart valve was CQlutaraldehyde solution after the procedure presented by monsieur Carpentier in 1968.
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