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PREPARATION IS HALF THE BATTLE: TECHNIQUE FOR PROCUREMENT AND IMPLANTATION OF FRESH “LIVING” HOMOGRAFT (PARTIAL HEART TRANSPLANT)
Sujata Subramanian, MD, Neil M. Venardos, Richard Owens, Chesney Castleberry, Carlos M. Mery.
Dell Children's Medical Center, Austin, TX, USA.
DROPBOX VIDEO
Objective: Over the last 2 years, a novel technique using “living” tissue from hearts not otherwise suitable for transplant has been used to replace semilunar valves in children (“partial heart transplant”). The theoretical advantage of fresh tissue relates to the growth of the valves concurrent with the patient, thereby ideally reducing the need for future interventions. Procurement of aortic and pulmonary homograft roots from a donor heart is not a routine procedure. We present a video describing a successful procurement and subsequent implantation of a fresh “living” aortic root homograft.
Methods: An 11-month-old child with d-transposition of the great arteries, ventricular septal defect and left ventricular outflow tract obstruction (LVOTO) underwent full repair with LVOT resection as a neonate; he subsequently required additional LVOTO resection at 7 months of age. Within 3 months of the second operation, the combined velocity across the LVOT had increased from 2 to >5 m/s. Additionally, the neo-aortic valve was bicuspid, dysplastic and stenotic, and the neo-pulmonary valve was insufficient, making it unsuitable for a “reverse” Ross procedure. A fresh “living” aortic root replacement (partial heart transplant) was performed.
Result: The video describes the pre-operative preparation for procurement (including practice in pig hearts), and the technique for root procurement and root replacement.
Conclusion: Even though homograft root implantation is analogous to other valve replacement techniques familiar to congenital heart surgeons, direct procurement of the roots for implantation is not a commonly performed technique.
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