Document Detail

Prevention of bioprosthetic heart valve calcification by ethanol preincubation. Efficacy and mechanisms.
MedLine Citation:
PMID:  9008467     Owner:  NLM     Status:  MEDLINE    
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.
N Vyavahare; D Hirsch; E Lerner; J Z Baskin; F J Schoen; R Bianco; H S Kruth; R Zand; R J Levy
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Circulation     Volume:  95     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1997 Jan 
Date Detail:
Created Date:  1997-02-27     Completed Date:  1997-02-27     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  479-88     Citation Subset:  AIM; IM    
Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor 48109-0576, USA.
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MeSH Terms
Calcinosis / prevention & control*
Collagen / chemistry
Cross-Linking Reagents / pharmacology
Dose-Response Relationship, Drug
Ethanol / pharmacology*
Glutaral / pharmacology
Heart Valve Prosthesis*
Lipids / isolation & purification
Mitral Valve / surgery
Molecular Conformation
Osmolar Concentration
Prostheses and Implants
Skin / surgery
Grant Support
Reg. No./Substance:
0/Cross-Linking Reagents; 0/Lipids; 111-30-8/Glutaral; 64-17-5/Ethanol; 9007-34-5/Collagen
Comment In:
Circulation. 1997 Nov 18;96(10):3790-2   [PMID:  9396495 ]
Circulation. 1997 Jan 21;95(2):297-8   [PMID:  9008435 ]
Circulation. 1997 Nov 18;96(10):3792-3   [PMID:  9396496 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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