Abstract
Established in 2008, the National Cardiovascular Homograft Bank (NCHB) has been instrumental in creating an available supply of cardiovascular tissues for implantation in Singapore. This article introduces its collaboration with Singapore General Hospital Skin Bank Unit. The procedure of homograft recovery, processing, cryopreservation and quality assurance are presented. Since its establishment, the NCHB has followed the guidelines set by the Ministry of Health Singapore and the American Association of Tissue Banks. A total of 57 homografts had been recovered and 40 homografts were determined to be suitable for clinical use. The most significant reasons for non-clinical use are positive microbiological culture or unsuitable graft condition. Crucial findings prompted reviews and implementation of new procedures to improve the safety of homograft recipients. These include (1) a change in antibiotic decontamination regime from penicillin and streptomycin to amikacin and vancomycin after a review and (2) mandating histopathogical examination since the discovery of cardiac sarcoidosis in a previously undiagnosed donor. Further, the NCHB also routinely performs dengue virus screening, for donors suspected of dengue infection. Cultural factors which affect the donation rate are also briefly explored. By 2010, 31 homografts had been implanted into recipients with congenital or acquired heart valve conditions. More than half of these recipients were children. Post-operative outcomes had been encouraging, with no report of adverse events attributed to implanted homografts.
Highlights
Human heart valves have been used in surgical procedures for the past 50 years
Due to the poor clinical durability and cell viability of chemically-treated homografts, this had led to a wane in interest in the use of such homografts for implantation (Gall et al 1995), until low-dose antibiotic decontamination followed by cryopreservation and storage of homografts in liquid nitrogen was introduced
We present our methods of donor selection, recovery, processing, storage and quality assurance of the cardiovascular homografts
Summary
Human heart valves have been used in surgical procedures for the past 50 years. Gordon Murray from Toronto reported the use of the first fresh aortic valve in 1956 (Murray 1956). In Singapore, the first human heart valve was implanted by Donald Ross and Ong Kim Kiat in 1985 (personal communication—Dr Ong Kim Kiat). The first human heart valves were disinfected using chemical agents such as formaldehyde, glutaldehyde, beta propriolactone, ethylene oxide or high dose of antibiotics. Due to the poor clinical durability and cell viability of chemically-treated homografts, this had led to a wane in interest in the use of such homografts for implantation (Gall et al 1995), until low-dose antibiotic decontamination followed by cryopreservation and storage of homografts in liquid nitrogen was introduced
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