Bioprosthetic heart valve structural degeneration associated with metabolic syndrome: Mitigation with polyoxazoline modification

Figures

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  Fig. 1.. Analysis of clinical data of patients with BHVs affected by SVD. (A) Density plot of patient age at the time of reoperation; (B) Forest plot with odds ratio for SVD according to study covariates; (C) Stratified density plot of duration of implant of patients with and without MetS; (D) Kaplan–Meier analysis of bioprosthetic valve explants from patients with and without MetS.

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  Fig. 2.. Proteomics analysis of clinical BHV explants. (A) Volcano plot represents proteins with log2FC difference in abundance between MetS and non-MetS groups on the x-axis and corresponding q-value transformed on log10 scale on the y-axis for each observation; (B) Venn diagram summarizing makers that were differentially expressed in MetS and non-MetS groups and associated with MetS; (C) Ranking of pathways that were significantly different between MetS and non-MetS groups; (D) Network map summarizing pathways that were significantly different between MetS and non-MetS groups; (E) Representative IHC images of markers identified from proteomics analysis for MetS and non-MetS groups. IHC was visualized using HRP-conjugated secondary antibodies and DAB substrate. Unimplanted BP served as control. (Scale bars, 100 µm.)

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  Fig. 3.. Ex vivo serum incubation model (A) Workflow of ex vivo serum incubation model. Serum from MetS and control patients were pooled and analyzed followed by 8-wk incubation with POZ modified or control BP; (B) Von Kossa staining (Scale bars, 500 µm) and (C) calcification quantification of serum treated BP after 8 wk; (D) Thermal denature temperature of serum treated BP after 8 wk; (E) SHG imaging of serum treated BP after 8 wk (Scale bars, 100 µm); (F) Alignment coefficient of serum treated BP after 8 weeks from SHG imaging. *** indicates P < 0.001.

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  Fig. 4.. Subcutaneous implantation model in MetS rat (A) Workflow of in vivo subcutaneous implantation model in MetS rat. POZ modified or control BP were implanted in control or MetS rats for 7 or 30 d; (B) ALP activities of control and MetS rat plasma; (C) Von Kossa staining (Scale bars, 500 µm) and (D) calcification quantification of explanted BP after 30 d; (E) Thermal denature temperature of explanted BP after 30 d; (F) SHG imaging of explanted BP after 30 d (Scale bars, 100 µm); (G) Alignment coefficient of explanted BP after 30 d from SHG imaging. * indicates P < 0.05, ** indicates P < 0.01, *** indicates P < 0.001.