HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Schoen, F. J. Articles by Levy, R. J. Search for Related Content PubMed PubMed Citation Articles by Schoen, F. J. Articles by Levy, R. J.

J Thorac Cardiovasc Surg 1994;108:880-887
© 1994 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

Onset and progression of calcification in porcine aortic bioprosthetic valves implanted as orthotopic mitral valve replacements in juvenile sheep

Boston, Mass, Ann Arbor, Mich., and Minneapolis, Minn.

Supported in part by grant HL-38118 from the National Institutes of Health.

Received for publication Feb. 10, 1994. Accepted for publication May 31, 1994. Address for reprints: Frederick J. Schoen, MD, PhD, Department of Pathology, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115.

Abstract

The purpose of this study was to characterize the onset and progression of mineralization in porcine bioprosthetic valves implanted in sheep and to test the hypothesis that such valves simulate calcification that is observed clinically and in other experimental models. Hancock I porcine aortic bioprosthetic valves (Medtronic Heart Valve Division, Irvine, Calif.) were implanted as orthotopic mitral valve replacements in juvenile sheep, retrieved after 1 to 124 days, and analyzed as follows: gross inspection, radiography, light, transmission, and surface scanning electron microscopy, and calcium analysis by absorption spectroscopy. Mineralization increased with increasing time after implantation in both valve cusps and adjacent aortic wall. Mean cuspal calcification was 80 µg/mg in valves removed after 3 to 4 months. Nevertheless, considerable variability among valves was apparent in the level of calcification noted at specific time intervals. Virtually all aspects of the morphologic characteristics were identical to those previously noted for clinical explants and experimental specimens, both subcutaneous and circulatory. In particular, ultrastructural examination revealed that the earliest calcific deposits were associated with devitalized cuspal connective tissue cells and their fragments. Collagen calcification was sparse. Both surface scanning and transmission electron microscopy indicated a lack of endothelial or blood-derived cells on the valves at all sampling times. We conclude that porcine bioprosthetic valves implanted as mitral valves in sheep provide a useful calcification model, simulating morphologic and pathobiologic events that occur clinically and in noncirculatory models. However, sufficient specimen replicates must be done to overcome variability in calcification among valves and sampling sites. (J THORAC CARDIOVASC SURG1994;108:880-7)

This article has been cited by other articles:

				W. de Buhr, S. Pfeifer, J. Slotta-Huspenina, E. Wintermantel, G. Lutter, and W. A. Goetz Impairment of pericardial leaflet structure from balloon-expanded valved stents J. Thorac. Cardiovasc. Surg., June 1, 2012; 143(6): 1417 - 1421. [Abstract] [Full Text] [PDF]

				N. W. Guldner, F. Bastian, G. Weigel, H. Zimmermann, M. Maleika, M. Scharfschwerdt, D. Rohde, and H.-H. Sievers Nanocoating with titanium reduces iC3b- and granulocyte-activating immune response against glutaraldehyde-fixed bovine pericardium: A new technique to improve biologic heart valve prosthesis durability? J. Thorac. Cardiovasc. Surg., May 1, 2012; 143(5): 1152 - 1159. [Abstract] [Full Text] [PDF]

				X. Wei, W. Yi, W. Chen, X. Ma, W. B. Lau, H. Wang, and D. Yi Clinical Outcomes With the Epicholorohydrin-Modified Porcine Aortic Heart Valve: A 15-Year Follow-Up Ann. Thorac. Surg., May 1, 2010; 89(5): 1417 - 1424. [Abstract] [Full Text] [PDF]

				K. K. Liao, X. Li, R. John, D. M. Amatya, L. D. Joyce, S. J. Park, R. Bianco, and R. M. Bolman III Mechanical Stress: An Independent Determinant of Early Bioprosthetic Calcification in Humans Ann. Thorac. Surg., August 1, 2008; 86(2): 491 - 495. [Abstract] [Full Text] [PDF]

				P. C. Santos, L. R. Gerola, I. Casagrande, E. Buffolo, and D. T. Cheung Stentless Valves Treated by the L-Hydro Process in the Aortic Position in Sheep Asian Cardiovascular and Thoracic Annals, October 1, 2007; 15(5): 413 - 417. [Abstract] [Full Text] [PDF]

				R. A. Manji, L. F. Zhu, N. K. Nijjar, D. C. Rayner, G. S. Korbutt, T. A. Churchill, R. V. Rajotte, A. Koshal, and D. B. Ross Glutaraldehyde-Fixed Bioprosthetic Heart Valve Conduits Calcify and Fail From Xenograft Rejection Circulation, July 25, 2006; 114(4): 318 - 327. [Abstract] [Full Text] [PDF]

				W. Flameng, B. Meuris, J. Yperman, G. De Visscher, P. Herijgers, and E. Verbeken Factors influencing calcification of cardiac bioprostheses in adolescent sheep J. Thorac. Cardiovasc. Surg., July 1, 2006; 132(1): 89 - 98. [Abstract] [Full Text] [PDF]

				V. J. Nina, P. M. Pomerantzeff, I. S. Casagrande, D. T. Cheung, C. M. Brandao, and S. A. Oliveira Comparative Study of the L-Hydro Process and Glutaraldehyde Preservation Asian Cardiovascular and Thoracic Annals, September 1, 2005; 13(3): 203 - 207. [Abstract] [Full Text] [PDF]

				J. N. Clark, M. F. Ogle, P. Ashworth, R. W. Bianco, and R. J. Levy Prevention of Calcification of Bioprosthetic Heart Valve Cusp and Aortic Wall With Ethanol and Aluminum Chloride Ann. Thorac. Surg., March 1, 2005; 79(3): 897 - 904. [Abstract] [Full Text] [PDF]

				F. J. Schoen and R. J. Levy Calcification of Tissue Heart Valve Substitutes: Progress Toward Understanding and Prevention Ann. Thorac. Surg., March 1, 2005; 79(3): 1072 - 1080. [Abstract] [Full Text] [PDF]

				R. G. Leyh, M. Wilhelmi, P. Rebe, S. Fischer, T. Kofidis, A. Haverich, and H. Mertsching In vivo repopulation of xenogeneic and allogeneic acellular valve matrix conduits in the pulmonary circulation Ann. Thorac. Surg., May 1, 2003; 75(5): 1457 - 1463. [Abstract] [Full Text] [PDF]

				M. F. Ogle, S. J. Kelly, R. W. Bianco, and R. J. Levy Calcification resistance with aluminum-ethanol treated porcine aortic valve bioprostheses in juvenile sheep Ann. Thorac. Surg., April 1, 2003; 75(4): 1267 - 1273. [Abstract] [Full Text] [PDF]

				T. Karita, K. Imachi, T. Taguchi, M. Akashi, K. Sato, and J. Tanaka In Vitro Calcification Model (2): Apatite Formation on Segmented Polyurethane Thin Films by Using an Alternate Soaking Process: The Effect of Adsorbed Serum Proteins on Calcification Journal of Bioactive and Compatible Polymers, May 1, 2000; 15(3): 230 - 244. [Abstract] [PDF]

				T. Karita, K. Imachi, T. Taguchi, A. Kishida, and M. Akashi In Vitro Calcification Model--Part 1: Apatite Formation on Segmented Polyurethane Containing Silicone Using an Alternate Soaking Process Journal of Bioactive and Compatible Polymers, January 1, 2000; 15(1): 72 - 84. [Abstract] [PDF]

				R. N. Mitchell, R. A. Jonas, and F. J. Schoen Pathology Of Explanted Cryopreserved Allograft Heart Valves: Comparison With Aortic Valves From Orthotopic Heart Transplants J. Thorac. Cardiovasc. Surg., January 1, 1998; 115(1): 118 - 127. [Abstract] [Full Text] [PDF]

				N. Vyavahare, D. Hirsch, E. Lerner, J. Z. Baskin, F. J. Schoen, R. Bianco, H. S. Kruth, R. Zand, and R. J. Levy Prevention of Bioprosthetic Heart Valve Calcification by Ethanol Preincubation: Efficacy and Mechanisms Circulation, January 21, 1997; 95(2): 479 - 488. [Abstract] [Full Text]