The quality of heart valve tissue for homograft transplantation

Background and aim of the study: The results of heart valve replacement sur gery may be improved by refining surgical techniques and/or developing new heart valve transplants. The aim of this study was to examine the effect of age on the presence of cholesterol clefts and lipid deposits in the cusp b ase and sinus wall of aortic homografts. Methods: Seventy-one valves were obtained at autopsy from donors (aged 15- 40 years) with no history of illness or evidence of serious illness. Trauma was the predominant cause of death among patients. The valves were examine d using an osmium-vaporization technique. Results: Osmiophilic deposits were detected in the cusp base in 28 cases (4 2%), and in the sinus wall in 49 cases (69%). Cholesterol crystals in the c usp base were found in 16 cases (24%), and sinus wall cholesterol clefts in 26 cases (38%). The model-predicted probability of cusp base lipid deposit s existing was 76% in 40-year-old donors, 36% in 30-years-olds, and 11% in 20-year-olds; the probability of cusp base cholesterol clefts existing was 45%, 21% and 8% in these age groups, respectively. The influences of immuno logical reactions, biochemical changes (centers of calcification) and accel eration of atherosclerotic processes are discussed. Conclusion: The microscopic study of heart valves demonstrated the presence of lipid deposits in subjects of an unexpectedly young age. Among our stud y material, 58% of valves obtained from donors aged 11-40 years were unsuit able for transplantation. Our results confirmed the need for macroscopic in spection of heart valves before their being transplanted.