Abstract
Cardiovascular allografts are usually disinfected using antibiotics, but protocols vary significantly between tissue banks. It is likely that different disinfection protocols will not have the same level of efficacy; they may also have varying effects on the structural integrity of the tissue, which could lead to significant differences in terms of clinical outcome in recipients. Ideally, a disinfection protocol should achieve the greatest bioburden reduction with the lowest possible impact on tissue integrity. We conducted a systematic review of methods applied to disinfect cardiovascular tissues. The use of multiple broad spectrum antibiotics in conjunction with an antifungal agent resulted in the greatest reduction in bioburden. Antibiotic incubation periods were limited to less than 24 h, and most protocols incubated tissues at 4 °C, however one study demonstrated a greater reduction of microbial load at 37 °C. None of the reviewed studies looked at the impact of these disinfection protocols on the risk of infection or any other clinical outcome in recipients.Electronic supplementary materialThe online version of this article (doi:10.1007/s10561-016-9570-9) contains supplementary material, which is available to authorized users.
Highlights
Prior to the advent of tissue preservation, transplantation of cardiac valves had to occur shortly after recovery to reduce the incidence of contamination and tissue damage
The search was applied to electronic databases MEDLINE and EMBASE from 1988 to July 2, 2014 using the following headings and text words: ‘‘heart valve,’’ ‘‘cardiac valve,’’ ‘‘aortic valve,’’ ‘‘pulmonary valve,’’ ‘‘allograft,’’ ‘‘anti-bacterial,’’ ‘‘anti-fungal,’’ ‘‘sterilization,’’ and ‘‘tissue banking.’’ The search included publications in English and excluded animal studies, case reports and conference abstracts
A total of 4353 citations were reviewed after duplicates were removed and three additional citations were identified by a separate search of references (Fig. 1)
Summary
Prior to the advent of tissue preservation, transplantation of cardiac valves had to occur shortly after recovery to reduce the incidence of contamination and tissue damage. Advances in cardiovascular preservation have allowed for the creation of heart valve banks worldwide. J. Mohr Canadian Blood Services, 270 John Savage Ave., Dartmouth, NS B3B 0H7, Canada. R. Ayeni Department of Surgery, McMaster University, 293 Wellington St. N, Suite 110, Hamilton, ON L8L 8E7, Canada
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