Calcific degeneration as the main cause of porcine bioprosthetic valve failure

Milano, Aldo Domenico; Bortolotti, Uberto; Talenti, Enrico; Valfré, Carlo; Arbustini, Eloisa; Valente, Marialuisa; Mazzucco, Alessandro; Gallucci, Vincenzo; Thiene, Gaetano

doi:10.1016/0002-9149(84)90638-6

Cited by 179 publications

(63 citation statements)

References 22 publications

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“…1,2,23 Various modifications of most models have been introduced throughout the years: particularly new valve designs and the use of calcium-retarding agents to process the tissue, preventing such sequelae. These innovations have yielded a generation of bioprostheses with substantially improved durability.…”

Section: Discussionmentioning

confidence: 99%

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The Mosaic Mitral Valve Bioprosthesis: A Long-Term Clinical and Hemodynamic Follow-Up

Celiento¹,

Blasi²,

Martino³

et al. 2016

Texas Heart Institute Journal

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We reviewed the cases of 100 patients (mean age, 73 ± 10 yr; 64 men) who had mitral valve replacement with a Medtronic Mosaic porcine bioprosthesis from 1995 through 2011. The mean New York Heart Association (NYHA) class was 3 ± 0.7, and 52 patients were in atrial fibrillation. Prosthetic sizes were chiefly 27 mm (50 patients) and 29 mm (40 patients). Follow-up ended in December 2012 and is 97% complete, with a cumulative duration of 611 patient-years (mean duration, 6 ± 4.6 yr; maximum, 17.7 yr). The early mortality rate was 10% (6% in elective patients); late deaths occurred in 31 patients (5 valve-related). Actuarial survival rates at 5, 10, and 15 years were 74% ± 5%, 50% ± 6%, and 37% ± 8%. The mean NYHA class in survivors was 1.4 ± 0.6 (P <0.0001). Thromboembolic episodes occurred in 4 patients, with an actuarial freedom at 15 years of 91% ± 5%. No cases of endocarditis were observed. Four patients needed reoperation, 2 for structural failure, and 1 each for perivalvular leakage and valve thrombosis. Actuarial freedom from structural failure and from reoperation, respectively, was 93% ± 5% and 91% ± 5% at 15 years. Echocardiographic follow-up in 24 patients with 27-mm prostheses showed a mean gradient of 5 ± 1.7 mmHg and an effective orifice area of 1.57 ± 0.3 cm2; in 16 patients with 29-mm prostheses, the mean gradient was 4.5 ± 1.9 mmHg, and the effective orifice area, 1.63 ± 0.4 cm2. During nearly 17 years of follow-up, the Mosaic bioprosthesis has shown good overall clinical and hemodynamic performance after mitral valve replacement.

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Section: Discussionmentioning

confidence: 99%

“…1,2 Since that time, the use of calcium-retarding agents to mitigate the severity of cusp mineralization has given longer durability to most commercially available tissue valves. [3][4][5] The Mosaic ® bioprosthesis (MB) (Medtronic, Inc.; Minneapolis, Minn) is a 3rd-generation porcine valve that became clinically available in 1994.…”

mentioning

confidence: 99%

The Mosaic Mitral Valve Bioprosthesis: A Long-Term Clinical and Hemodynamic Follow-Up

Celiento¹,

Blasi²,

Martino³

et al. 2016

Texas Heart Institute Journal

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“…A disfunção prematura de uma bioprótese pode estar relacionada à resposta biológica do hospedeiro e ao estresse mecânico não fisiológico, causado pela falta de flexibilidade do suporte ("stent") que segura as comissuras, levando a fragmentação das fibras colágenas e calcificação dos folhetos (3)(4)(5) .…”

Section: Comentáriosunclassified

“…As válvulas mecânicas estão associadas a fenômenos tromboembólicos e disfunções protéticas, necessitando de anticoagulação oral prolongada, que interfere negativamente na qualidade de vida do paciente (1) . As biopróteses convencionais apresentam degeneração tecidual e desempenho hemodinâmico prejudicado, devido ao aumento do estresse mecânico e à redução do orifício valvular efetivo, causados pela presença de um suporte rígido ("stent") (2)(3)(4)(5) . Válvulas biológicas convencionais, pequenas, implantadas na posição aórtica, podem produzir gradientes significativos, às vezes, necessitando de reoperação (6) .…”

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Técnica simplificada de implante de bioprótese aórtica sem suporte ("stentless")

Pinheiro¹,

Fagundes²,

Ramos³

et al. 2000

Rev Bras Cir Cardiovasc

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“…[1][2][3][4] In adults, valve replacement is necessary, on average, 10-12 years postimplantation. Calcification is especially problematic in children, who often require valve replacement 2-5 years postimplantation.…”

Section: Introductionmentioning

confidence: 99%

Identification of specific calcium-binding noncollagenous proteins associated with glutaraldehyde-preserved bovine pericardium in the rat subdermal model

Gura

Wright

Veis

et al. 1997

J. Biomed. Mater. Res.

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Calcification of glutaraldehyde-preserved bioprosthetic heart valves (BHVs) results in their clinical failure. The mechanism of this pathologic calcification is not well defined. Since serum proteins are known to be taken up in mineralized tissue, we hypothesized that serum proteins derived from several calcium-binding noncollagenous proteins (NCPs) of bone and teeth also may be associated with pathologically mineralized BHVs. Using a rat subdermal model of BHV calcification, glutaraldehyde-preserved bovine pericardium (GPBP) was implanted for 1, 3, 14, and 60 days, and then subjected to an extraction procedure designed to isolate only NCPs tightly bound to the mineral phase. Gel electrophoresis and Coomassie Brilliant Blue staining demonstrated that these proteins became associated with GPBP over time, paralleling reported calcium uptake by the tissue. Stains-All staining demonstrated a marked accumulation of highly acidic, phosphorylated NCPs associated with 60-day GPBP extracts. Some of these proteins were detected in rat serum but were absent from extracts of GPBP incubated in rat serum in vitro. Western blotting with antibodies to three NCPs found in bone and teeth-bone acidic glycoprotein 75 (BAG 75), osteopontin, and SPARC-demonstrated that these NCPs were tightly bound to the mineral phase of calcified GPBP. A fourth NCP, bone sialoprotein II (BSP II) was barely detectable. Thus each identified NCP showed a different pattern of GPBP association relative to mineral deposition, suggesting unique roles for each in pathologic calcification. SPARC increased within 3 days of GPBP implantation but decreased by 2 weeks. BAG 75 and osteopontin uptake was detected in the initial mineral deposits and increased mineralization proceeded. BSP II never increased significantly over the entire-period. Further studies, which should include immunohistochemistry, will be important for delineating the source, location, and function of these three NCPs and for identifying others that also may be involved in this pathological process. Most important, the new insights into the mechanism of pathologic calcification described here present exciting opportunities for novel approaches to BHV calcification prevention.

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Calcific degeneration as the main cause of porcine bioprosthetic valve failure

Cited by 179 publications

References 22 publications

The Mosaic Mitral Valve Bioprosthesis: A Long-Term Clinical and Hemodynamic Follow-Up

The Mosaic Mitral Valve Bioprosthesis: A Long-Term Clinical and Hemodynamic Follow-Up

Técnica simplificada de implante de bioprótese aórtica sem suporte ("stentless")

Identification of specific calcium-binding noncollagenous proteins associated with glutaraldehyde-preserved bovine pericardium in the rat subdermal model

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