Clark Jocelyn N, Ogle Matthew F, Ashworth Paul, Bianco Richard W, Levy Robert J
Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104-4318, USA.
Ann Thorac Surg. 2005 Mar;79(3):897-904. doi: 10.1016/j.athoracsur.2004.08.084.
Calcification is frequently associated with device failure of bioprostheses fabricated from either glutaraldehyde pretreated porcine aortic valves or bovine pericardium. It was hypothesized that differential pretreatment with ethanol-aluminum chloride will prove safe and efficacious for inhibiting the calcification of both the porcine aortic valve bioprosthetic cusp and the aortic wall.
Glutaraldehyde-fixed porcine aortic valves were subjected to differential aluminum chloride (AlCl3) and ethanol pretreatment; aortic wall segments were treated exclusively with AlCl3 (0.1 moles/L) for 45 minutes, 6 hours, or 8 hours (groups 3A, B, and C, respectively), followed by valve cusp incubations in ethanol (80%, pH 7.4). Nontreated control bioprosthetic valves were either stent-mounted porcine aortic valve bioprostheses (Carpentier-Edwards, group 1) (Edwards, Santa Anna, CA) or St. Jude Toronto SPV valves (St. Jude Medical, St. Paul, MN) (group 2). Mitral valve replacements were carried out in juvenile sheep for 150 days.
Calcium in cusps from group 3A was 2.84 +/- 0.62 mg calcium/g tissue versus control, 22.79 +/- 8.46 mg calcium/g tissue, p = 0.04. Valves pretreated with AlCl3 for 45 minutes, 6 hours, and 8 hours had significantly lower levels of calcium in the aortic wall compared to controls (40.38 +/- 5.66, 26.77 +/- 4.02, and 28.94 +/- 8.25 mg calcium/g tissue for groups 3A, 3B, and 3C, respectively, vs 95.47 +/- 17.14 mg calcium/g tissue for group 1, p < 0.001, and 133.42 +/- 3.96 mg calcium/g tissue for group 2, p < 0.001).
Differentially applied ethanol and aluminum chloride pretreatment significantly inhibited calcification of both the glutaraldehyde-fixed porcine aortic valve bioprosthetic cusp and the aortic wall.
钙化常与由戊二醛预处理的猪主动脉瓣或牛心包制成的生物假体装置故障相关。据推测，用乙醇 - 氯化铝进行差异预处理将被证明对抑制猪主动脉瓣生物假体瓣叶和主动脉壁的钙化是安全有效的。
对戊二醛固定的猪主动脉瓣进行差异氯化铝（AlCl3）和乙醇预处理；主动脉壁段仅用AlCl3（0.1摩尔/升）处理45分钟、6小时或8小时（分别为3A、3B和3C组），然后将瓣叶在乙醇（80%，pH 7.4）中孵育。未处理的对照生物假体瓣膜为支架安装的猪主动脉瓣生物假体（Carpentier - Edwards，第1组）（爱德华兹公司，加利福尼亚州圣安娜）或圣犹大多伦多SPV瓣膜（圣犹大医疗公司，明尼苏达州圣保罗）（第2组）。在幼年绵羊中进行二尖瓣置换手术，为期150天。
3A组瓣叶中的钙含量为2.84±0.62毫克钙/克组织，而对照组为22.79±8.46毫克钙/克组织，p = 0.04。与对照组相比，用AlCl3预处理45分钟、6小时和8小时的瓣膜在主动脉壁中的钙含量显著较低（3A、3B和3C组分别为40.38±5.66、26.77±4.02和28.94±8.25毫克钙/克组织，第1组为95.47±17.14毫克钙/克组织，p < 0.001，第2组为133.42±3.96毫克钙/克组织，p < 0.001）。
差异应用乙醇和氯化铝预处理显著抑制了戊二醛固定的猪主动脉瓣生物假体瓣叶和主动脉壁的钙化。
