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J Thorac Cardiovasc Surg 1998;115:260-261
© 1998 Mosby, Inc.

LETTERS TO THE EDITOR

Role of lipid in calcification of porcine pulmonary and aortic valves

Reply to the Editor:

We acknowledge the comments by Chanda, Kuribayashi, and Abe and are pleased that they have followed up on our suggestion that lipids may be partly responsible for the calcification of glutaraldehyde-treated porcine aortic valves. However, we are not surprised that fatty tissue adherent to cross-linked valves disappeared from the implanted cusps. As the authors are well aware, glutaraldehyde cross links primarily the amine sites on proteins. No such sites exist on lipids or cholesterol, and, accordingly, "fatty tissues" are unlikely to be stabilized by glutaraldehyde. It is also well known that subcutaneous implantation of cross-linked tissues into the rat model stimulates a foreign body response with its associated macrophage infiltration. It is therefore probable that these macrophages "cleaned up" any unstabilized foreign material at the periphery of the implanted cusps. Our contention, therefore, is that this rat experiment did little to confirm or refute the role of intrinsic lipids in the calcification of implanted bioprosthetic valve cusps.

We do agree with Chanda, Kuribayashi, and Abe, however, that the role of lipids in inducing calcification may be secondary to other, more potent agents, such as the presence of glutaraldehyde or uncross-linked collagen. There is increasing evidence that 0.625% glutaraldehyde does not completely fix tissues and the residual antigenicity may trigger a foreign body response and lead to calcification of the offending material. Calcification of implanted biomaterials is most likely a multifactorial phenomenon, and the presence of lipids is likely one of the many contributing factors. Our findings, therefore, suggest that the role of lipids and their relative importance in mediating calcification should not be ignored, but explored further.

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This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Dunmore-Buyze, J. Articles by Boughner, D. R. Search for Related Content PubMed Articles by Dunmore-Buyze, J. Articles by Boughner, D. R.