Alpha-Amino Oleic Acid as Anticalcification Agent for Porcine Bioprosthetic Heart Valves: A Narrative Review

OBJECTIVE: Calcification remains the principal mechanism limiting the durability of bioprosthetic heart valves. Alpha-amino oleic acid (AOA) was developed as an anticalcification treatment to preserve tissue integrity. This review synthesizes preclinical and clinical evidence on the efficacy of AOA-treated bioprosthetic valves. METHODS: A narrative review was conducted using major biomedical databases to assess experimental and clinical studies evaluating AOA-treated tissues and valve platforms. Evidence from in vitro experiments, small/large animal models, and long-term clinical cohorts was qualitatively synthesized, with emphasis on calcification, structural valve degeneration, and durability outcomes. RESULTS: Preclinical studies consistently demonstrated significant reductions in leaflet calcification in AOA-treated tissues compared with glutaraldehyde-fixed controls, across multiple models. These effects were most pronounced in leaflet tissue, whereas protection of the aortic wall or conduit tissue was less consistent. Large-animal models confirmed delayed mineralization and preservation of leaflet flexibility, but revealed susceptibility of non-leaflet components to calcific degeneration. Clinically, long-term follow-up of several surgical valve platforms incorporating AOA showed acceptable freedom from structural valve degeneration extending beyond ten years in selected patient populations. Durability remains strongly age-dependent, and late valve failures can still be associated with progressive calcification. Evidence from newer valve platforms is becoming available through various long-term follow-up studies. CONCLUSION: AOA provides effective anticalcification protection of bioprosthetic valve leaflets, supporting durable clinical performance in surgical platforms.