In Vitro Calcification of Bioprosthetic Heart Valves: Investigation of Test Fluids

Kiesendahl, Nicole; Schmitz, Christoph; Berg, Andreas; Menne, Matthias; Schmitz‐Rode, Thomas; Steinseifer, Ulrich

doi:10.1007/s10439-019-02347-5

Cited by 8 publications

(25 citation statements)

References 22 publications

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“…26,33 Therefore, several attempts towards an accelerated in vitro model were undertaken in order to provide a cost-and time-saving method for the analysis of calcification processes. 1,3,10,13,14,16 Due to the problem of superficial or spontaneous precipitation, which occurred in the fluids former applied, we performed a preliminary fluid study on the development of a nearphysiological calcification fluid. 13 The desired fluid should not precipitate spontaneously and should neither promote nor inhibit calcification.…”

Section: Introductionmentioning

confidence: 99%

“…1,3,10,13,14,16 Due to the problem of superficial or spontaneous precipitation, which occurred in the fluids former applied, we performed a preliminary fluid study on the development of a nearphysiological calcification fluid. 13 The desired fluid should not precipitate spontaneously and should neither promote nor inhibit calcification. Eleven different fluid compositions were tested without contact to potentially calcifying materials, firstly to investigate their potential for homogeneous nucleation and thus spontaneous precipitation.…”

Section: Introductionmentioning

confidence: 99%

“…Eleven different fluid compositions were tested without contact to potentially calcifying materials, firstly to investigate their potential for homogeneous nucleation and thus spontaneous precipitation. 13 For the development of a suitable in vitro test method for the calcification potential of bioprosthetic heart valves, both forms of nucleation, homogeneously and heterogeneously, are important factors. The heterogeneous nucleation represents the material-induced calcification, a relevant parameter for the comparison of different valve materials, which can occur intrinsically within the materials' matrix and on its surface.…”

Section: Introductionmentioning

confidence: 99%

“…In the present study, we now investigated the heterogeneous calcification tendency of the non-spontaneous precipitating fluids in contact with potentially calcifying materials under dynamic conditions. Additionally, we now investigated two spontaneously precipitating fluids of our preliminary fluid study 13 under dynamic material-contact in order to compare the crystalline structure of substratesurface-induced calcifications vs. spontaneously precipitated deposits with the crystal structures of calcifications found in vivo. The most common calcium phosphate phase, which occurs in vivo, is hydroxyapatite (HAP).…”

Section: Introductionmentioning

confidence: 99%

“…3,12,13,18 In the present study, we conducted two reference tests. The first one focused on the comparison of the precipitation behavior of four different fluids (two non-sponta-neously precipitating fluids, one fluid with low spontaneous precipitation tendency producing OCP as main crystal phase and one spontaneously precipitating fluid producing HAP) 13 under dynamic contact with bovine pericardium patches that have been pretreated in the same way by the manufacturer. The calcification analysis included the initiation, progression, and generation of crystal phases of calciumphosphate and the localization of the calcifications (superficial or intrinsic).…”

Section: Introductionmentioning

confidence: 99%

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In Vitro Calcification of Bioprosthetic Heart Valves: Test Fluid Validation on Prosthetic Material Samples

et al. 2020

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Calcification is a major failure mode of bioprosthetic heart valves. So far, cost and time saving in vitro analyses of calcification potentials are unreliable, mostly due to superficial or spontaneous precipitation of the applied fluids. In this study, we developed a near-physiological non-spontaneously precipitating fluid for an accelerated in vitro calcification assessment, and validated it by analyzing the calcification potential of two prosthetic materials within two reference-tests. The first test focused on the comparison of four calcification fluids under dynamic contact with n=12 commercial bovine pericardium patches. The second one focused on the validation of the most appropriate fluid by analyzing the calcification potential of pericardium vs. polyurethane. The patches were mounted in separate test compartments and treated simultaneously with the respective fluids at an accelerated test frequency. Calcification propensity and progression were detected macroscopically and microscopically. Structural analyses of all deposits indicated hydroxyapatite by X-ray powder diffraction, which is also most commonly observed in vivo. Histological examination by von Kossa staining showed matrix internal and superficial calcifications, depending on the fluid composition. The present study reveals promising results towards the development of a meaningful, cost and time saving in vitro analysis of the calcification potential of bioprosthetic heart valves.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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In Vitro Calcification of Bioprosthetic Heart Valves: Test Fluid Validation on Prosthetic Material Samples

et al. 2020

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Characteristic calcification behavior of five surgical aortic valve bioprostheses models: An in vitro study

Sadat,

Lojenburg,

Scharfschwerdt

et al. 2024

Health Science Reports

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Background and AimsThe durability of surgical aortic valve bioprostheses (SAV) is limited by the calcification of the leaflets, which results in degeneration. In clinical routine, there seems to be substantial variability in the degeneration of specific SAV models. Our study aims to establish an in vitro calcification model for prosthetic valves, characterizing the calcification behavior of different SAVs.MethodsFive commercially available SAV models (Epic™ Supra, Freestyle®, Intuity®, Perimount®, and Trifecta™) were perfused with double‐distilled water and physiological buffer with a defined calcium concentration (CaCl2 = 1.5 mM) at 37°C over 32.9 million cycles in a Hi‐Cycle tester which corresponds to approximately 1 patient‐year (calcified group). Untreated prosthetic valves served as the negative control group (noncalcified group). Calcium titration, scanning electron microscopy (SEM), histological examination, and tissue thickness measurements were performed to evaluate noncalcified and calcified SAVs (n = 10).ResultsTreatment in the Hi‐Cycle tester with calcification buffer maintained significantly higher calcium absorption of SAVs compared to the control group (p < 0.001). Additionally, hydroxyapatite crystals were found in the calcified SAV in SEM. Porcine valves rarely demonstrated punctual calcification pattern, while bovine pericardial valves presented distinct planar calcification pattern in histological examination. Further, calcification content differed significantly depending on the SAV model, with the highest calcium content in Trifecta (213 µg/cm2) and the lowest in Epic Supra (8 µg/cm2) (p < 0.001).ConclusionData from our study revealed significant differences in leaflet calcification for the various aortic valve bioprostheses models. Further studies are necessary to investigate whether these findings can mimic the clinical data of the implanted prostheses.

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The evolution of polyurethane heart valve replacements: How chemistry translates to the clinic

Crago

Lee

Farajikhah

et al. 2022

Materials Today Communications

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In Vitro Calcification of Bioprosthetic Heart Valves: Investigation of Test Fluids

Cited by 8 publications

References 22 publications

In Vitro Calcification of Bioprosthetic Heart Valves: Test Fluid Validation on Prosthetic Material Samples

In Vitro Calcification of Bioprosthetic Heart Valves: Test Fluid Validation on Prosthetic Material Samples

Characteristic calcification behavior of five surgical aortic valve bioprostheses models: An in vitro study

The evolution of polyurethane heart valve replacements: How chemistry translates to the clinic

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