Prevention of bioprosthetic heart valve calcification by ethanol preincubation. Efficacy and mechanisms.
Prevention of bioprosthetic heart valve calcification by ethanol preincubation. Efficacy and mechanisms.
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DOI：
10.1161/01.cir.95.2.479
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发表时间：
1997-01
期刊：
影响因子：
37.8
通讯作者：
N. Vyavahare;D. Hirsch;E. Lerner;J. Baskin;F. Schoen;R. Bianco;H. Kruth;R. Zand;R. Levy
中科院分区：
文献类型：
--
作者：
N. Vyavahare;D. Hirsch;E. Lerner;J. Baskin;F. Schoen;R. Bianco;H. Kruth;R. Zand;R. Levy
背景由戊二醛交联的猪主动脉瓣或牛心包制成的生物人工心脏瓣膜的瓣尖钙化经常导致这些装置的临床失效。我们研究了乙醇预处理戊二醛交联猪主动脉瓣作为一种新的方法，以防止瓣尖钙化。这种方法的假设认为，乙醇预处理抑制钙化导致蛋白质结构的改变和脂质提取。方法和结果结果表明，在大鼠皮下植入物中，80.0%乙醇可完全抑制戊二醛预处理的猪生物人工主动脉瓣尖的钙化（60天乙醇预处理的钙水平，与对照钙水平相比为1.87 +/- 0.29微克/mg组织，236.00 +/- 6.10微克/毫克组织）和绵羊二尖瓣置换术（乙醇预处理的钙水平，5.22 +/- 2.94微克/毫克组织;对照钙水平，32.50 +/- 11.50微克/毫克组织）。乙醇抑制的机制可以通过几个观察结果来解释：乙醇预处理导致纯化I型胶原和戊二醛交联猪主动脉瓣叶的红外光谱中观察到的酰胺I带发生不可逆的改变。乙醇预处理还导致瓣叶胆固醇和磷脂几乎完全浸提。结论：戊二醛交联猪主动脉瓣生物瓣膜的乙醇预处理代表了一种高度有效和基于机械的方法，可以预防钙化生物心脏瓣膜衰竭。
BACKGROUND Calcification of the cusps of bioprosthetic heart valves fabricated from either glutaraldehyde cross-linked porcine aortic valves or bovine pericardium frequently causes the clinical failure of these devices. Our investigations studied ethanol pretreatment of glutaraldehyde cross-linked porcine aortic valves as a new approach to prevent cuspal calcification. The hypothesis governing this approach holds that ethanol pretreatment inhibits calcification resulting from protein structural alterations and lipid extraction. METHODS AND RESULTS Results demonstrated complete inhibition of calcification of glutaraldehyde-pretreated porcine bioprosthetic aortic valve cusps by 80.0% ethanol in rat subdermal implants (60-day ethanol-pretreated calcium level, 1.87 +/- 0.29 micrograms/mg tissue compared with control calcium level, 236.00 +/- 6.10 micrograms/mg tissue) and in sheep mitral valve replacements (ethanol-pretreated calcium level, 5.22 +/- 2.94 micrograms/mg tissue; control calcium level, 32.50 +/- 11.50 micrograms/mg tissue). The mechanism of ethanol inhibition may be explained by several observations: ethanol pretreatment resulted in an irreversible alteration in the amide I band noted in the infrared spectra for both purified type I collagen and glutaraldehyde cross-linked porcine aortic leaflets. Ethanol pretreatment also resulted in nearly complete extraction of leaflet cholesterol and phospholipid. CONCLUSIONS Ethanol pretreatment of glutaraldehyde cross-linked porcine aortic valve bioprostheses represents a highly efficacious and mechanistically based approach and may prevent calcific bioprosthetic heart valve failure.