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J Thorac Cardiovasc Surg 2007;134:1025-1032
© 2007 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Biofilm formation on pyrolytic carbon heart valves: Influence of surface free energy, roughness, and bacterial species

^a Department of Thoracic and Cardiovascular Surgery, Rouen University Hospital Charles Nicolle, Rouen, France
^b Groupe de Recherche des Antimicrobiens et Micro-organismes, Rouen University Hospital Charles Nicolle, Rouen, France
^c Institut Fédératif de Recherche Multidisciplinaire sur les Peptides, Rouen University Hospital Charles Nicolle, Rouen, France
^d Unité Mixte de Recherche, Centre National de Recherche Scientifique, Rouen University, Faculty of Sciences, Mont Saint Aignan, France
^e Centre Régional pour l’Innovation et le Transfert de Technologies, Analyses et Surface, Louviers, France.

Received for publication December 28, 2006; revisions received May 4, 2007; accepted for publication June 20, 2007.

^_* Address for reprints: Pierre-Yves Litzler, MD, Department of Thoracic and Cardiovascular Surgery, Charles Nicolle University Hospital, 1, rue de Germont, 76000 Rouen, France. (Email: pierre-yves.litzler{at}chu-rouen.fr).

Objective: The aim of this study was to analyze the interaction of surface free energy and roughness characteristics of different pyrolytic carbon heart valves with three bacterial species on biofilm formation.

Methods: Three pyrolytic carbon heart valves (St Jude Medical [St Jude Medical Inc, Minneapolis, Minn], Sulzer Carbomedics [CarboMedics Inc, Austin, Tex], and MedicalCV [Medical Incorporated, Inver Grove Heights, Minn]) were tested. Roughness was measured by interferential microscopy and surface free energy by contact angle technique. To obtain a biofilm, prostheses were inserted into a bioreactor with Staphylococcus aureus P209, Staphylococcus epidermidis RP62A, or Pseudomonas aeruginosa PAO1. Adhesion was quantified by counting sessile bacteria. Morphologic characteristics of biofilms were evaluated with scanning electron microscopy.

Results: Roughness analysis revealed significant differences between the MedicalCV (35.18 ± 4.43 nm) valve and St Jude Medical (11.03 ± 3.11 nm; P < .0001) and Sulzer Carbomedics (8.80 ± 1.10 nm; P < .0001) valves. Analysis of surface free energy revealed a higher level for the MedicalCV valve (41.03 mJ · m^–2) than for both the Sulzer Carbomedics (38.93 mJ · m^–2) and St Jude Medical (31.51 mJ · m^–2) models. These results showed a correlation between surface free energy and bacterial adhesion for S epidermidis and P aeruginosa species. Regardless of the support, we observed significant adhesion differences for the three bacterial species. S aureus was the most adherent species, S epidermidis was the least, and P aeruginosa was intermediate.

Conclusions: Our results suggest that adhesion of S epidermidis and P aeruginosa are dependent on pyrolytic carbon surface free energy and roughness, although S aureus adhesion appears to be independent of these factors. Improvement of pyrolytic carbon physicochemical properties thus could lead to a reduction in valvular prosthetic infections.