Effect of 2‐amino oleic acid exposure conditions on the inhibition of calcification of glutaraldehyde cross‐linked porcine aortic valves

Abstract

Postimplant calcific degeneration is a frequent cause of clinical failures of glutaraldehyde cross-linked porcine bioprosthetic heart valves (BPHV). It was demonstrated previously that 2-amino oleic acid (AOA) used as a bioprosthesis treatment was highly effective in mitigating aortic valve cusp but not aortic wall calcification. Our main objective was to study the efficacy of various AOA exposure conditions for inhibiting calcification of both cusps and aortic wall tissues using rat subdermal implants. BPHV tissues were treated with a saturated AOA solution for different time intervals before experimentation. Aortic wall AOA levels were consistently lower than that of the cusps after the same exposure times. The diffusion of calcium ion across both cusp and aortic wall tissues was evaluated, and the results demonstrated that there was an AOA exposure time-dependent retardation of calcium ion penetration for cusp but not aortic wall. An 8-month extraction study was performed to determine the stability of AOA binding. When Tween 80 was used as an extraction medium, cusp and aortic wall retained 12.9 and 48.7%, respectively, of their initial AOA levels. AOA inhibition of calcification in rat subdermal implants (60 days) was found to be exposure time-dependent with maximum treatment time (120 h), resulting in the lowest calcium levels (20.1 ± 10.3 and 71.4 ± 5.4 μg/mg of cusp and aortic wall, respectively) as compared with control (219.1 ± 6.8 and 104.9 ± 8.5 μg/mg of cusp and aortic wall respectively). The significance of AOA binding on BPHV tissue was determined by either blocking or reducing BPHV's (cusp and aortic wall) free aldehyde residues with lysine or NaBH₄, respectively, before AOA treatment. For aortic cusps, the AOA contents after 72 h were 98.3 ± 2.7, 34.2 ± 3.6, and 54.1 ± 3.0 nM/mg of tissue for AOA (control), lysine-pretreated (plus AOA) and NaBH₄-pretreated (plus AOA) tissues, respectively. However, their calcium levels after 60 days of rat subdermal implant were all comparable (i. e., 48.1 ± 6.2, 38.2 ± 9.1, and 47.0 ± 15.0 μg calcium per mg of tissue). Similar results were observed on BPHV aortic wall. It can thus be concluded that AOA inhibition of BPHV calcification is exposure time-dependent, but the efficacy of AOA for aortic wall is less than that noted for aortic cusps, perhaps because of lower AOA bindings and differences in calcium diffusion kinetics. © 1994 John Wiley & Sons, Inc.