Early calcific degeneration of the St. Jude Medical Epic aortic bioprosthesis

Izzat, Mohammad Bashar; Sabbagh, Nada; Aljasem, Hazem

doi:10.1002/ccr3.2664

Cited by 1 publication

(1 citation statement)

References 5 publications

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“…Naso et al ( 13 ) have more recently provided evidence, based on an adapted M86 ELISA, of native and contemporary bioprosthetic valve construct tissues, including from the porcine, valve-based, Epic and bovine pericardial Mitroflow tissue valves, not only highlighting the presence of α-Gal in both native bovine and porcine tissue but, importantly, its diminution following commercial processing. The apparent elimination of this epitope in the Epic valve is, however, offset by its reported early mineralization ( 14 ). Furthermore, Moczar et al ( 15 ) provided evidence of IgG and complement in 20/22 failed Mitroflow valves, despite the 75% reduction in α-Gal epitope reported by Naso et al While we would concede that the presence of α-Gal, capable of eliciting a host response, may indeed contribute to ensuing pathology of the implanted tissue, it likely does not represent the quintessential xeno-antigen and its depletion should not be held as the sole benchmark for determining xeno-reactivity.…”

Section: Distraction Division and Decellularizationmentioning

confidence: 97%

Residual Bioprosthetic Valve Immunogenicity: Forgotten, Not Lost

Human

Bezuidenhout

Aïkawa

et al. 2022

Front. Cardiovasc. Med.

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Despite early realization of the need to control inherent immunogenicity of bioprosthetic replacement heart valves and thereby mitigate the ensuing host response and its associated pathology, including dystrophic calcification, the problem remains unresolved to this day. Concerns over mechanical stiffness associated with prerequisite high cross-link density to effect abrogation of this response, together with the insinuated role of leaching glutaraldehyde monomer in subsequent dystrophic mineralization, have understandably introduced compromises. These have become so entrenched as a benchmark standard that residual immunogenicity of the extracellular matrix has seemingly been relegated to a very subordinate role. Instead, focus has shifted toward the removal of cellular compartment antigens renowned for their implication in the failure of vascularized organ xenotransplants. While decellularization certainly offers advantages, this review aims to refocus attention on the unresolved matter of the host response to the extracellular matrix. Furthermore, by implicating remnant immune and inflammatory processes to bioprosthetic valve pathology, including pannus overgrowth and mineralization, the validity of a preeminent focus on decellularization, in the context of inefficient antigen and possible residual microbial remnant removal, is questioned.

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Section: Distraction Division and Decellularizationmentioning

confidence: 97%