Anticalcification Treatments of Bioprosthetic Heart Valves: In Vivo Studies in Sheep

Studies performed by other investigators have shown that a number of preimplantation processes inhibit the calcification of pieces of porcine aortic valves and of bovine parietal pericardium subcutaneously implanted in rats. To evaluate biological reactivity with these biomaterials functioning in an intracardiac position, mitral and tricuspid valve replacements were performed in young sheep to assess the effects of the following preimplantation processes: (1) surfactants, including sodium dodecyl sulfate, polysorbate-80, Triton X-100 and N-lauryl sarcosine; (2) covalently bound aminohydroxypropane diphosphonic acid; (3) toluidine blue; and (4) incorporation of polyacrylamide into valvular tissues. Quantitative calcium analyses showed that only the surfactants substantially reduced calcification, and only in porcine aortic valvular bioprostheses. However, morphological studies showed that some of these agents also induced alterations that decreased the durability of the valves. Toluidine blue decreased calcification to a degree that was statistically significant, but not biologically important. Polyacrylamide incorporation and diphosphonate binding increased calcification. Thus, data regarding anticalcification treatments obtained from subcutaneous implantation studies in small animal models should be cautiously interpreted and validated by studies with intracardiac valvular implantation in large animals.