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A novel anticalcification treatment strategy for bioprosthetic valves and review of the literature
Author(s) -
Agathos E. Andreas,
Tomos Periklis I.,
Kostomitsopoulos Nikolaos,
Koutsoukos Petros G.
Publication year - 2019
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.14151
Subject(s) - calcification , glutaraldehyde , medicine , calcium , alcohol , endocrinology , biochemistry , chemistry , pathology
Background and aim of the study Glutaraldehyde (Glut) fixed bioprosthetic valves fail due to progressive dystrophic calcification. Many treatments have been proposed to eliminate calcification but none have been entirely successful. Calcitonin (CT) and sodium bisulfite (BSF) have recently been introduced as independent anticalcification reagents. It is postulated that their combined effect, along with the addition of the detergent Tween 80 and alcohol at 37°C, may efficiently minimize tissue calcification due to aldehyde adduct formation and elimination of lipids. Material and Methods Three groups were created from porcine aortic leaflets: group I (Glut only), group II (Glut with 1% CT, 12.5% BSF, and 1.2% Tween 80 at 37°C), and group III (Glut with 1% CT, 10% BSF, 1.2% Tween 80, and 20% alcohol at 37°C). All tissues were implanted subdermally in three sets of eight (group I), six (group II), and five (group III) Wistar rats. After 4 months, the tissues were retrieved and lyophilized at −40°C at 100 mm Hg. The calcium was measured with a flat atomic absorption technique. Results The preimplantation calcium (Ca) concentration in mg Ca/gram of tissue was 1.79 ± 0.14 in group I, 1.65 ± 0.28 in group II, and 0.72 ± 0.79 in group III ( P = ns). After 4 months, the Ca concentration was 277.55 ± 32.52, 103.54 ± 5.39 ( P < .001) and 42.02 ± 15.63 ( P < .001), respectively. There was also a significant difference ( P < .001) between groups II and III. Conclusion The combination of CT and BSF along with the detergent Tween 80 and alcohol at 37°C mitigates the calcification efficiently as compared to Glut treatment only.