Key result
A near-physiological non-spontaneously precipitating fluid successfully induced heterogeneous hydroxyapatite calcification on bovine pericardium patches, enabling in vitro material differentiation.
Why the study?
Cost- and time-saving in vitro analyses of bioprosthetic heart valve calcification potentials are unreliable, mostly due to superficial or spontaneous precipitation of the applied fluids.
A novel near-physiological test fluid successfully replicates in vivo-like calcification patterns in bioprosthetic materials, enabling accelerated and reliable in vitro testing.
May advance in vitro bioprosthetic valve testing; leaves open validation against clinical outcomes.
Calcification is a major failure mode of bioprosthetic heart valves. So far, cost and time saving in vitro analyses of calcification potentials are unreliable, mostly due to superficial or spontaneous precipitation of the applied fluids. In this study, we developed a near-physiological non-spontaneously precipitating fluid for an accelerated in vitro calcification assessment, and validated it by analyzing the calcification potential of two prosthetic materials within two reference-tests. The first test focused on the comparison of four calcification fluids under dynamic contact with n=12 commercial bovine pericardium patches. The second one focused on the validation of the most appropriate fluid by analyzing the calcification potential of pericardium vs. polyurethane. The patches were mounted in separate test compartments and treated simultaneously with the respective fluids at an accelerated test frequency. Calcification propensity and progression were detected macroscopically and microscopically. Structural analyses of all deposits indicated hydroxyapatite by X-ray powder diffraction, which is also most commonly observed in vivo. Histological examination by von Kossa staining showed matrix internal and superficial calcifications, depending on the fluid composition. The present study reveals promising results towards the development of a meaningful, cost and time saving in vitro analysis of the calcification potential of bioprosthetic heart valves.
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Kiesendahl et al. (2020) studied Bioprosthetic heart valve calcification (n=18). Near-physiological non-spontaneously precipitating fluid (Fluid L) vs. Spontaneously precipitating fluids and different patch materials was evaluated on Calcification propensity and progression. A near-physiological non-spontaneously precipitating fluid successfully induced heterogeneous hydroxyapatite calcification on bovine pericardium patches, enabling in vitro material differentiation.
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