NON-DESTRUCTIVE METHOD FOR ASSESSING THE DEGREE OF CALCIFICATION IN BIOPROSTHETIC HEART VALVES

Highlights

• Micro-computed tomography allows specialists to qualitatively and quantitatively assess the structure of calcified areas of explanted bioprosthetic heart valves.
• This method enables the evaluation of changes in the structure of the bioprosthesis that have occurred during its prolonged operation.

Aim of the study. To evaluate the potential of high-resolution tomography for the study of mitral valve bioprostheses of different designs explanted due to dysfunction and various calcification patterns (microcalcification and macrocalcification).

Methods. Single samples of the «UniLine» and «PeriCor» bioprostheses were the objects of study, they were explanted due to dysfunction developed after 76 and 87 months of operation in recipients. The peculiarities of calcification localization in the structure of bioprostheses were studied using high-resolution tomography followed by reconstruction of volumetric images and quantitative analysis of radiodense areas. Moreover, we used light microscopy with Alizarin Red S staining to detect calcifications.

Results. The study results showed that the nature of the distribution and volume of calcinates significantly differ between the studied samples: for the «UniLine» bioprosthesis, the affected areas were located in the leaflet material and constituted 21.1% of the total biological tissue volume; for the «PeriCor» bioprosthesis, calcifications were diffusely distributed in small structural formations, accounting for a total of 5.1% of the biological material, primary localized on the «auxiliary» structures of the prosthesis – the covering made of porcine or calf xenopericardium. In addition, high-resolution tomography allowed us to determine the degree of deformation of the «UniLine» bioprosthesis frame, with the posts deviating inward by 1.1–1.4 mm.

Conclusion. The possibility of using computed microtomography for qualitative and quantitative assessment of calcified xeno-pericardial and xeno-aortal bioprostheses has been demonstrated. However, this method is limited in its ability to detect macrocalcification within the leaflet thickness.

1. Bokeriya L.A., Milievskaya E.B., Kudzoeva Z.F., Pryanishnikov V.V., Scopin A.I., Yurlov I.A. Serdechnososudistaya khirurgiya – 2018. Bolezni i vrozhdennye anomalii sistemy krovoobrashcheniya. Moscow: NMITsSSKh im. A.N. Bakuleva MZ RF; 2018. 270p. (In Russian)

2. Li K.Y.C. Bioprosthetic Heart Valves: Upgrading a 50-Year Old Technology. Frontiers in Cardiovascular Medicine. 2019; 6. doi:10.3389/fcvm.2019.00047

3. Foroutan F., Guyatt G.H., O’Brien K., Bain E., Stein M., Bhagra S., Sit D., Kamran R., Chang Y., Devji T., Mir H., Manja V., Schofield T., Siemieniuk R.A., Agoritsas T., Bagur R., Otto C.M., Vandvik P.O. Prognosis after surgical replacement with a bioprosthetic aortic valve in patients with severe symptomatic aortic stenosis: systematic review of observational studies. BMJ (Clinical research ed.). 2016; 354: i5065. doi:10.1136/bmj.i5065

4. Odarenko Yu.N., Rutkovskaya N.V., Rogulina N.V., Stasev A.N., Kokorin S.G., Kagan E.S., Barbarash L.S. Analysis of 23-year experience epoxy treated xenoaortic bioprosthesis in surgery mitral heart disease. Research factors of recipients by positions of influence on the development of calcium degeneration. Complex Issues of Cardiovascular Diseases. 2015; (4): 17–25. doi:10.17802/2306-1278-2015-4-17-25. (In Russian)

5. Rogulina N.V., Odarenko Yu.N., Zhuravleva I.Yu., Barbarash L.S. Remote results of application of mechanical and biological prostheses at patients of various age. Medicine and education in Siberia. 2014; (3): 47. (In Russian)

6. Fedorov S.A., Chiginev V.A., Zhurko S.A., Gamzaev A.B., Medvedev A.P. Clinical and hemodynamic results of applying different biological prosthesis models for correction of calcific aortic valve disease. Sovremennye tehnologii v medicine 2016; 8(4): 292-296. (In Russian)

7. Dangas G.D., Weitz J.I., Giustino G., Makkar R., Mehran R. Prosthetic Heart Valve Thrombosis. Journal of the American College of Cardiology. United States; 2016; 68(24): 2670–2689. doi:10.1016/j.jacc.2016.09.958

8. Kostyunin A.E., Ovcharenko E.A., Klyshnikov K.Y. Modern understanding of mechanisms of bioprosthetic valve structural degeneration: a literature review. Russian Journal of Cardiology. 2018; (11): 145–152. doi:10.15829/1560-4071-2018-11-145-152 (In Russian)

9. Zhuravleva I.Y., Karpova E. V., Oparina L.A., Poveschenko O. V., Surovtseva M.A., Titov A.T., Ksenofontov A.L., Vasilieva M.B., Kuznetsova E. V., Bogachev-Prokophiev A. V., Trofimov B.A. Cross-linking method using pentaepoxide for improving bovine and porcine bioprosthetic pericardia: A multiparametric assessment study. Materials Science and Engineering: C. 2021; 118: 111473. doi:10.1016/j.msec.2020.111473

10. Danilov V. V., Klyshnikov K.Y., Gerget O.M., Skirnevsky I.P., Kutikhin A.G., Shilov A.A., Ganyukov V.I., Ovcharenko E.A. Aortography Keypoint Tracking for Transcatheter Aortic Valve Implantation Based on Multi-Task Learning. Frontiers in Cardiovascular Medicine. 2021; 8: 699. doi:10.3389/fcvm.2021.697737

11. VeDepo M.C., Detamore M.S., Hopkins R.A., Converse G.L. Recellularization of decellularized heart valves: Progress toward the tissue-engineered heart valve. Journal of Tissue Engineering. 2017; 8: 204173141772632. doi:10.1177/2041731417726327

12. Miclăuş T., Valla V., Koukoura A., Nielsen A.A., Dahlerup B., Tsianos G.-I., Vassiliadis E. Impact of Design on Medical Device Safety. Therapeutic Innovation & Regulatory Science. 2020; 54(4): 839–849. doi:10.1007/s43441-019-00022-4

13. Joung Y.-H. Development of Implantable Medical Devices: From an Engineering Perspective. International Neurourology Journal. 2013; 17(3): 98. doi:10.5213/inj.2013.17.3.98

14. Gellis L., Baird C.W., Emani S., Borisuk M., Gauvreau K., Padera R.F., Sanders S.P. Morphologic and histologic findings in bioprosthetic valves explanted from the mitral position in children younger than 5 years of age. The Journal of Thoracic and Cardiovascular Surgery. 2018; 155(2): 746–752. doi:10.1016/j.jtcvs.2017.09.091

15. Lepidi H., Casalta J.-P., Fournier P.-E., Habib G., Collart F., Raoult D. Quantitative Histological Examination of Bioprosthetic Heart Valves. Clinical Infectious Diseases. 2006; 42(5): 590–596. doi:10.1086/500135

16. Uchasova E., Barbarash O., Rutkovskaya N., Hryachkova O., Gruzdeva O., Ponasenko A., Kondyukova N., Odarenko Y., Barbarash L. Impact of recipient-related factors on structural dysfunction of xenoaortic bioprosthetic heart valves. Patient Preference and Adherence. 2015; 9: 389. doi:10.2147/PPA.S76001

17. Hamdi S.E., Delisée C., Malvestio J., Da Silva N., Le Duc A., Beaugrand J. X-ray computed microtomography and 2D image analysis for morphological characterization of short lignocellulosic fibers raw materials: A benchmark survey. Composites Part A: Applied Science and Manufacturing. 2015; 76: 1–9. doi:10.1016/j.compositesa.2015.04.019

18. Markl D., Zeitler J.A., Rasch C., Michaelsen M.H., Müllertz A., Rantanen J., Rades T., Bøtker J. Analysis of 3D Prints by X-ray Computed Microtomography and Terahertz Pulsed Imaging. Pharmaceutical Research. 2017; 34(5): 1037–1052. doi:10.1007/s11095-016-2083-1

19. Orlovsky P.I., Gritsenko V.V., Yukhnev A.D., Evdokimov S.V., Gavrilenko V.I. Artificial heart valves. Saint Petersburg: JSC ‘Olma-media group’; 2007. 448p. (In Russian)

20. Gondim Teixeira P.A., Villani N., Ait Idir M., Germain E., Lombard C., Gillet R., Blum A. Ultra-high resolution computed tomography of joints: practical recommendations for acquisition protocol optimization. Quantitative Imaging in Medicine and Surgery. 2021; 11(10): 4287–4298. doi:10.21037/qims-21-217

21. Lin E., Alessio A. What are the basic concepts of temporal, contrast, and spatial resolution in cardiac CT? Journal of Cardiovascular Computed Tomography. 2009; 3(6): 403–408. doi:10.1016/j.jcct.2009.07.003

22. Barbarash L.S., Rogulina N.V., Rutkovskaya N.V., Ovcharenko E.A. Mechanisms underlying bioprosthetic heart valve dysfunctions. Complex Issues of Cardiovascular Diseases. 2018;7(2):10-24. doi:10.17802/2306-1278-2018-7-2-10-24. (In Russian)

23. Barbarash L.S., Borisov V.V., Rutkovskaya N.V., Burago A.Yu., Odarenko Yu.N., Stasev A.N., Kokorin S.G., Zhuravleva I.Yu. Clinical and morphological study of epoxy-treated xenoaortic bioprostheses dysfunctions in mitral position. Cardiology and cardiovascular surgery. 2014; 7(4): 84–86. (In Russian)