Aldehyde tanning: the villain in bioprosthetic calcification

Abstract

Preservation of bioprosthetic valves may play a role in valvular calcification. Subcutaneous implants in rats were used to test the effect of different preservation solutions. Fifty male Sprague-Dawley rats were divided into five groups. Fresh bovine pericardium was treated in one of five ways: group A: 99.5% glycerol for 1 week; group B: as group A, then normal saline wash and 0.25% formaldehyde storage for 24 h; group C: as group A, then normal saline wash and 4% formaldehyde storage for 24 h; group D: as group A, then normal saline wash and 0.625% glutaraldehyde storage for 24 h; group E: 0.625% glutaraldehyde and 4% buffered formaldehyde storage. Treated bovine pericardium was cut into 1-cm2 pieces and washed for 30 min with normal saline before implantation. In each animal, three pieces were implanted in the subcutaneous tissue of the back. After 70 days, retrieved specimens were examined grossly, and X-ray densitometry, calcium analysis, and histological examinations were carried out. The results showed that glycerol-treated tissue (group A) had less calcification (calcium 6.92 +/- 4.46 micrograms/mg dry weight) than other groups: group B (calcium 323.12 + 63.56 micrograms/mg dry weight); group C (calcium 240.65 + 13.47 micrograms/mg dry weight); group D (calcium 232.29 + 13.01 micrograms/mg dry weight). These differences were markedly significant (p less than 0.0001). It appears that aldehydes play an important role in the calcification of bioprosthetic valves. Experience with glutaraldehyde- and glycerol-treated pericardium in valvular applications in sheep support these observations.