α-氨基油酸生物瓣膜抗钙化技术的改进

Refinement of the alpha aminooleic acid bioprosthetic valve anticalcification technique.

作者信息

Gott J P, Girardot M N, Girardot J M, Hall J D, Whitlark J D, Horsley W S, Dorsey L M, Levy R J, Chen W, Schoen F J, Guyton R A

机构信息

Carlyle Fraser Heart Center, Crawford Long Hospital of Emory University, Emory University School of Medicine, Atlanta, Georgia 30365, USA.

出版信息

Ann Thorac Surg. 1997 Jul;64(1):50-8. doi: 10.1016/s0003-4975(97)00118-5.

DOI:10.1016/s0003-4975(97)00118-5

PMID:9236334

Abstract

BACKGROUND

Aminooleic acid treatment has been demonstrated to prevent porcine valve calcification and to protect valvular hemodynamic function. Initial enthusiasm was tempered by histologic studies of these AOA valves, which showed cuspal hematomas, structural loosening, and surface roughening. This prompted a systematic review of the AOA treatment process. Unsolubilized particles of alpha aminooleic acid present in the treatment solution were identified as the cause of mechanical abrasion of valve cusps during processing. These particles were eliminated with a revamped protocol, which included filtration of the AOA solution before valve preparation.

METHODS

Porcine aortic valve cusps treated with this modified AOA protocol (AOA II) were studied in a rat subdermal implant model of mineralization. A juvenile sheep trial was then used to confirm the antimineralization effects of AOA II on glutaraldehyde-fixed porcine aortic roots in a circulatory model of accelerated calcification.

RESULTS

Retrieved AOA II-treated cusps from the subdermal model were markedly less calcified than control cusps (AOA II, 1 +/- 0, 17 +/- 4, 23 +/- 6, and 17 +/- 10 versus control, 189 +/- 14, 251 +/- 16, 250 +/- 14, and 265 +/- 10 mg calcium/mg sample at 4, 8, 12, and 16 weeks, respectively; p < 0.0001). Morphologic examination of the AOA II cusps of the valves retrieved from the sheep demonstrated freedom from the structural loosening, surface roughening, and hematoma formation that had limited the utility of the original AOA preparation technique. Cusps from AOA II-treated porcine roots had significantly less calcium than control cusps (AOA II, 5.5 +/- 3.0 mg/g; control, 91.2 +/- 19.5 mg/g; p = 0.0004). The aortic walls had similar levels of calcification (AOA II, 156 +/- 73 mg/g; control, 159 +/- 10 mg/g; p = not significant).

CONCLUSIONS

These data suggest that the modified AOA technique warrants further evaluation as an antimineralization treatment for glutaraldehyde-fixed porcine bioprostheses.

摘要

背景

氨基油酸处理已被证明可预防猪瓣膜钙化并保护瓣膜血流动力学功能。对这些氨基油酸处理过的瓣膜进行组织学研究后，最初的热情有所降温，这些研究显示瓣叶血肿、结构松弛和表面粗糙。这促使对氨基油酸处理过程进行系统回顾。处理溶液中存在的未溶解的α - 氨基油酸颗粒被确定为处理过程中瓣膜瓣叶机械磨损的原因。通过改进方案消除了这些颗粒，该方案包括在瓣膜制备前对氨基油酸溶液进行过滤。

方法

在大鼠皮下植入矿化模型中研究用这种改良的氨基油酸方案（AOA II）处理的猪主动脉瓣叶。然后进行幼羊试验，以在加速钙化的循环模型中确认AOA II对戊二醛固定的猪主动脉根部的抗矿化作用。

结果

从皮下模型中取出的经AOA II处理的瓣叶钙化程度明显低于对照瓣叶（AOA II在4、8、12和16周时分别为1±0、17±4、23±6和1±10mg钙/mg样本，而对照分别为189±14、251±16、250±14和265±10mg钙/mg样本；p<0.0001）。对从羊身上取出的瓣膜的AOA II瓣叶进行形态学检查，结果显示其没有结构松弛、表面粗糙和血肿形成，而这些问题限制了原始AOA制备技术的应用。经AOA II处理的猪根部瓣叶的钙含量明显低于对照瓣叶（AOA II为5.5±mg/g；对照为91.2±19.5mg/g；p = 0.0004）。主动脉壁的钙化水平相似（AOA II为156±73mg/g；对照为159±10mg/g；p = 无显著差异）。