Refinement of the Alpha Aminooleic Acid Bioprosthetic Valve Anticalcification Technique John Parker Gott, Marie-Nadia Girardot, Jean-Marie D Girardot,

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Presentation transcript:

Refinement of the Alpha Aminooleic Acid Bioprosthetic Valve Anticalcification Technique John Parker Gott, Marie-Nadia Girardot, Jean-Marie D Girardot, James D Hall, Joseph D Whitlark, W.Stewart Horsley, Lynne M.A Dorsey, Robert J Levy, Weiliam Chen, Frederick J Schoen, Robert A Guyton The Annals of Thoracic Surgery Volume 64, Issue 1, Pages 50-58 (July 1997) DOI: 10.1016/S0003-4975(97)00118-5

Fig. 1 (A) Placement of circumferential apical mattress sutures, which anchor the valved conduit. (B) A Foley catheter introduced through a left ventricular apical stab wound serves as a guide for the rotational cutting action of the myocardial coring trocar. (C) Partial exclusion technique for placement of valved conduit onto the descending aorta. (D) The ascending aorta is occluded after completion of apical-to-descending aortic valved conduit. (Reprinted with permission from Wise DL, Trantolo DJ, Altobelli DE, Yaszemski M, Gresser JD, Schwartz ER, eds. Encyclopedic handbook of biomaterials and bioengineering. New York: Marcel Dekker, 1995, by courtesy of Marcel Dekker Inc.) The Annals of Thoracic Surgery 1997 64, 50-58DOI: (10.1016/S0003-4975(97)00118-5)

Fig. 2 Scanning electron microscopy of radial cross-sections of (A) an unimplanted untreated control cusp, (B) an unimplanted cusp treated in the original unfiltered AOA solution, and (C) an unimplanted cusp treated in the modified filtered AOA II solution. Note the nodules and the rough surface produced by the unsolubilized particles of alpha aminooleic acid during treatment in the original AOA solution (B) (arrows), and the smooth surface and absence of nodules in both the control untreated cusp (A) (arrows) and the AOA II-treated cusp (C) (arrows). (Reprinted with permission from Wise DL, Trantolo DJ, Altobelli DE, Yaszemski M, Gresser JD, Schwartz ER, eds. Encyclopedic handbook of biomaterials and bioengineering. New York: Marcel Dekker, 1995, by courtesy of Marcel Dekker Inc.) The Annals of Thoracic Surgery 1997 64, 50-58DOI: (10.1016/S0003-4975(97)00118-5)

Fig. 3 Calcium levels in control and AOA II cusps at 4, 8, 12, and 16 weeks in a rat subdermal implant model (n = 6 for each condition; values are means ± standard error of the mean). The Annals of Thoracic Surgery 1997 64, 50-58DOI: (10.1016/S0003-4975(97)00118-5)

Fig. 4 Gross photographs and radiographs of removed AOA II-treated and control nonstented porcine valves implanted as apicoaortic shunts. (A) Gross appearance and (B) radiograph of AOA II-treated valve; prominent calcification is present in aortic wall, but not in cusps. (C) Gross appearance and (D) radiograph of control valve. Radiographic calcification of aortic wall of control specimen (D) is equivalent to that of the AOA II-treated specimen shown in B, and is accompanied by cuspal calcification (white arrow). Gross calcification of aortic wall in both B and D predominates along the margins of the sinuses of Valsalva. In A and C, the open arrow delineates the proximal and the closed arrow the distal anastomosis; the noncoronary cusp is on the left and the right cusp is at the right. The Annals of Thoracic Surgery 1997 64, 50-58DOI: (10.1016/S0003-4975(97)00118-5)

Fig. 5 Microscopic histology of removed AOA II-treated and control nonstented porcine valves implanted as apicoaortic shunts. (A) Cusp and (B) aortic wall of AOA-treated valve. No calcification is present in the cusp, but calcification is diffuse in the aortic wall, involving its entire cross-section, most predominantly in the innermost and outermost 20% of the media. (C) Cusp and (D) aortic wall of control valve. In C, calcification of the cusp is designated by the arrow. Aortic wall mineralization in D is equivalent in extent and location to that of the AOA II-treated valve in B. (All stained with von Kossa’s reagent [calcium phosphates black]; A and C originally approximately ×100, B and D originally approximately ×25.) The Annals of Thoracic Surgery 1997 64, 50-58DOI: (10.1016/S0003-4975(97)00118-5)

Fig. 6 Calcium content analysis of AOA II and control valvular tissue (values are expressed as mean ± standard error of the mean). The Annals of Thoracic Surgery 1997 64, 50-58DOI: (10.1016/S0003-4975(97)00118-5)

Fig. 7 The alpha aminooleic acid molecule is an 18-carbon fatty acid derived from oleic acid by adding an amine in the alpha position for binding to glutaraldehyde. The Annals of Thoracic Surgery 1997 64, 50-58DOI: (10.1016/S0003-4975(97)00118-5)