In-vitro calcification study of polyurethane heart valves.

Tri-leaflet polyurethane heart valves have been considered as a potential candidate in heart valve replacement surgeries. In this study, polyurethane (Angioflex(®)) heart valve prostheses were fabricated using a solvent-casting method to evaluate their calcification resistance. These valves were subjected to accelerated life testing (continuous opening and closing of the leaflets) in a synthetic calcification solution. Results showed that Angioflex(®) could be considered as a potential material for fabricating prosthetic heart valves with possibly a higher calcification resistance compared to tissue valves. In addition, calcification resistance of bisphosphonate-modified Angioflex(®) valves was also evaluated. Bisphosphonates are considered to enhance the calcification resistance of polymers once covalently bonded to the bulk of the material. However, our in-vitro results showed that bisphosphonate-modified Angioflex(®) valves did not improve the calcification resistance of Angioflex(®) compared to its untreated counterparts. The results also showed that cyclic loading of the valves' leaflets resulted in formation of numerous cracks on the calcified surface, which were not present when calcification study did not involve mechanical loading. Further study of these cracks did not result in enough evidence to conclude whether these cracks have penetrated to the polymeric surface.

[1]  D J Wheatley,et al.  New polyurethane heart valve prosthesis: design, manufacture and evaluation. , 1996, Biomaterials.

[2]  K. Furie,et al.  Heart disease and stroke statistics--2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. , 2008, Circulation.

[3]  N. Lamba Polyurethanes in Biomedical Applications , 1997 .

[4]  R. Stoelting,et al.  Stoelting's Anesthesia and Co-Existing Disease , 2012 .

[5]  W G Henderson,et al.  A comparison of outcomes in men 11 years after heart-valve replacement with a mechanical valve or bioprosthesis. Veterans Affairs Cooperative Study on Valvular Heart Disease. , 1993, The New England journal of medicine.

[6]  C. Schmidt,et al.  Acellular vascular tissues: natural biomaterials for tissue repair and tissue engineering. , 2000, Biomaterials.

[7]  R. Levy,et al.  Effects of metallic ions and diphosphonates on inhibition of pericardial bioprosthetic tissue calcification and associated alkaline phosphatase activity. , 1993, Biomaterials.

[8]  I. Alferiev,et al.  Bisphosphonate derivatized polyurethanes resist calcification. , 2001, Biomaterials.

[9]  Hamid Nayeb-Hashemi,et al.  Effects of fluid flow shear rate and surface roughness on the calcification of polymeric heart valve leaflet. , 2013, Materials science & engineering. C, Materials for biological applications.

[10]  G. G. Stokes "J." , 1890, The New Yale Book of Quotations.

[11]  R. Levy,et al.  Covalent binding of aminopropanehydroxydiphosphonate to glutaraldehyde residues in pericardial bioprosthetic tissue: stability and calcification inhibition studies. , 1989, Experimental and molecular pathology.

[12]  A. Azakie,et al.  Performance of bovine pericardial valves in the pulmonary position. , 2010, The Annals of thoracic surgery.

[13]  J. Cremer,et al.  Durability of bioprosthetic cardiac valves. , 2008, Deutsches Arzteblatt international.

[14]  H. Harasaki,et al.  Calcification in blood pumps. , 1979, Transactions - American Society for Artificial Internal Organs.

[15]  Ivan Vesely,et al.  Heart Valve Tissue Engineering , 2005 .

[16]  N. Vyavahare Synergism of calcium-ethanehydroxybisphosphonate (CaEHBP) and FeC13: controlled release polymers for preventing calcification of bioprosthetic aortic wall , 1995 .

[17]  Gaetano Burriesci,et al.  Polymeric heart valves: new materials, emerging hopes. , 2009, Trends in biotechnology.

[18]  G. Grunkemeier,et al.  Forty-year survival with the Starr-Edwards heart valve prosthesis. , 2004, The Journal of heart valve disease.

[19]  Scott J Hollister,et al.  Tissue-engineered heart valve prostheses: 'state of the heart'. , 2008, Regenerative medicine.

[20]  R. Levy,et al.  Calcification of polyurethanes implanted subdermally in rats is enhanced by calciphylaxis. , 1996, Journal of biomedical materials research.

[21]  D. Urry,et al.  Elastin coacervate as a matrix for calcification. , 1973, Biochemical and biophysical research communications.

[22]  Z. Zafirova,et al.  Stoeltingʼs Anesthesia and Co-Existing Disease , 2010 .

[23]  M. Schaldach,et al.  Alloplastic materials for heart-valve prostheses , 1980, Medical and Biological Engineering and Computing.

[24]  G. Grunkemeier,et al.  Twenty years' experience with the Medtronic Hall valve. , 2001, The Journal of thoracic and cardiovascular surgery.

[25]  Margaret Nichols Trans , 2015, De-centering queer theory.

[26]  Frederick J Schoen,et al.  Calcification of tissue heart valve substitutes: progress toward understanding and prevention. , 2005, The Annals of thoracic surgery.

[27]  Sandip Sarkar,et al.  Current developments and future prospects for heart valve replacement therapy. , 2009, Journal of biomedical materials research. Part B, Applied biomaterials.

[28]  I. Alferiev,et al.  Prevention of polyurethane valve cusp calcification with covalently attached bisphosphonate diethylamino moieties. , 2003, Journal of biomedical materials research. Part A.

[29]  M Jones,et al.  Evaluation of explanted polyurethane trileaflet cardiac valve prostheses. , 1987, The Journal of thoracic and cardiovascular surgery.

[30]  F J Schoen,et al.  Mechanisms of bioprosthetic heart valve failure: fatigue causes collagen denaturation and glycosaminoglycan loss. , 1999, Journal of biomedical materials research.

[31]  Ericka Stricklin-Parker,et al.  Ann , 2005 .

[32]  C. Pieper,et al.  Comparison of survival after mitral valve replacement with biologic and mechanical valves in 1139 patients. , 2001, The Journal of thoracic and cardiovascular surgery.

[33]  A. Matthews,et al.  The development of the Starr-Edwards heart valve. , 1998, Texas Heart Institute journal.

[34]  R. Emery,et al.  St. Jude Medical cardiac valve prosthesis: in vitro studies. , 1979, The Journal of thoracic and cardiovascular surgery.

[35]  G. Christie,et al.  Tears in bioprosthetic heart valve leaflets without calcific degeneration. , 1996, The Journal of heart valve disease.

[36]  E. Stinson,et al.  Long-term experience with porcine aortic valve xenografts. , 1977, The Journal of thoracic and cardiovascular surgery.

[37]  Richard A. Lange,et al.  Prosthetic heart valves. , 1996, The New England journal of medicine.

[39]  G. Golomb,et al.  Development of a new in vitro model for studying implantable polyurethane calcification. , 1991, Biomaterials.

[40]  F J Schoen,et al.  Effect of 2-amino oleic acid exposure conditions on the inhibition of calcification of glutaraldehyde cross-linked porcine aortic valves. , 1994, Journal of biomedical materials research.

[41]  B Glasmacher,et al.  Primary tissue failure of bioprostheses: new evidence from in vitro tests. , 2001, The Thoracic and cardiovascular surgeon.