Risk factors for rejection for morphological reasons of heart valves for transplantation
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Risk factors for rejection for morphological reasons of heart valves for transplantation Marja J. van Wijk • Antoon van den Bogaerdt Arlinke G. Bokhorst
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Received: 31 May 2011 / Accepted: 4 July 2011 / Published online: 10 July 2011 Ó Springer Science+Business Media B.V. 2011
Abstract The study aim was to identify risk factors for morphological rejection of aortic and pulmonary valves for transplantation that could be used to optimize donor selection. The files of all Dutch heart valve donors, donating in a 2.5 years period, whose hearts were processed at Heart Valve Bank Rotterdam, were reviewed for all factors that could be relevant for valve rejection and related to outcome of morphological assessment of the valves. Valves were retrieved from 813 deceased Dutch donors, 24.1% also donating organs. For 797 aortic and 767 pulmonary valves, who met retrieval criteria, morphological assessment was done. 69.5% of aortic and 37.5% of pulmonary valves were considered unsuitable for transplantation at morphological assessment. Backward stepwise multivariate logistic regression analysis, showed age, cardiac cause of death, cerebrovascular accident as cause of death or in medical history, and number of cardiovascular risk factors in a donor to be independent risk factors for morphological rejection of aortic valves. Age, sex, weight [100 kg and ruptured aortic aneurysm as cause of death were independent risk factors for morphological rejection of pulmonary valves. Being an M. J. van Wijk (&) A. G. Bokhorst BISLIFE Foundation, PO Box 309, 2300 AH Leiden, The Netherlands e-mail: [email protected] A. van den Bogaerdt Heart Valve Bank Rotterdan, Erasmus Medical Center, Rotterdam, The Netherlands
organ donor was an independent predictor of morphological approval of aortic and pulmonary valves, while hypertension was an independent predictor for morphological approval of aortic valves. Thus, independent factors were identified that are associated with morphological rejection of aortic and pulmonary valves for transplantation, and that could be used to optimize donor selection by preventing unnecessary retrievals, limiting costs, while improving yield per donor with minimal compromise for availability. Keywords Heart valves Transplantation Homograft Risk factors Morphology
Introduction Human heart valves have been used for transplantation since the 1960s (Ross 1962) and are used today mainly to correct complex congenital heart disease and valve defects (Reinhartz et al. 2006) or to replace infected valve prostheses or native valves with endocarditis (Grinda et al. 2005). These heart valves for transplantation are retrieved from post-mortem tissue and organ donors and sometimes from heart transplant or artificial heart recipients, who donate the diseased heart for valve donation. Unfortunately, the demand for certain types and sizes of homograft valves still exceeds the availability, especially of pulmonary and large size aortic valves. After retrieval of the heart valves several steps are taken to ensure the qua
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