Kenneth K. Liao, MD, Xiaohuan Li, MD, Ranjit John, MD, Devesh M

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Presentation transcript:

Mechanical Stress: An Independent Determinant of Early Bioprosthetic Calcification in Humans Kenneth K. Liao, MD, Xiaohuan Li, MD, Ranjit John, MD, Devesh M. Amatya, PhD, Lyle D. Joyce, MD, PhD, Soon J. Park, MD, Richard Bianco, MS, R. Morton Bolman, MD The Annals of Thoracic Surgery Volume 86, Issue 2, Pages 491-495 (August 2008) DOI: 10.1016/j.athoracsur.2008.03.061 Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Gross calcification is noted across the base and commissure of the inflow valve (arrows). The Annals of Thoracic Surgery 2008 86, 491-495DOI: (10.1016/j.athoracsur.2008.03.061) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 The black arrow points to gross calcification at the inflow valve commissure. The white arrow points to graft displacement of the valve housing unit. The Annals of Thoracic Surgery 2008 86, 491-495DOI: (10.1016/j.athoracsur.2008.03.061) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 The incidence of calcification (black bars) and absence of calcification (white bars) in the inflow and outflow valves was significantly different, with a calcification rate of 70% for the inflow values and 58% for the outflow valves. The Annals of Thoracic Surgery 2008 86, 491-495DOI: (10.1016/j.athoracsur.2008.03.061) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 An analysis of the distribution of calcification in inflow (white bars) and outflow valves (black bars) showed that commissure and the base of valve leaflet were the most common sites of calcium deposit. The Annals of Thoracic Surgery 2008 86, 491-495DOI: (10.1016/j.athoracsur.2008.03.061) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Degree of calcification area of the inflow valves (black bar) is significantly larger than that of the outflow valves (white bar). Inflow valve calcification: 21.6 ± 30.7 mm2 vs outflow valve calcification: 15.1 ± 26.2 mm2 (p < 0.05, paired t test). The Annals of Thoracic Surgery 2008 86, 491-495DOI: (10.1016/j.athoracsur.2008.03.061) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 X-ray photograph of the inflow (A) and outflow (B) valves from the same left ventricular assist device shows significant calcification in the inflow valve (black arrow) vs no calcification in the outflow valve. The Annals of Thoracic Surgery 2008 86, 491-495DOI: (10.1016/j.athoracsur.2008.03.061) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 7 (A) Relationship of inflow valve calcification area to the duration of left ventricular assist device implantation. Inflow valve calcification (Y) = 4.96 ± 0.063 days (X); R2 = 0.096, p < 0.05, linear regression. (B) Relationship of outflow calcification area to the duration of left ventricular assist device implantation. Outflow valve calcification (Y) = 2.39 ± 0.047 days (X); R2 = 0.077, p < 0.05, linear regression. The Annals of Thoracic Surgery 2008 86, 491-495DOI: (10.1016/j.athoracsur.2008.03.061) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 8 X-ray photograph shows calcification area (arrows) in the (A) inflow and (B) outflow valves 66 days after implantation. The calcification area is significantly larger in the inflow valve than in the outflow valve. The Annals of Thoracic Surgery 2008 86, 491-495DOI: (10.1016/j.athoracsur.2008.03.061) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions