THE ROLE OF SUTURE MATERIAL IN THE CALCIFICATION OF CARDIOVASCULAR BIOPROSTHESIS

Purpose. Assess the impact of the sutures and unfractionated heparin on biomaterial calcification in an experiment.

Materials and methods. Porcine aortic valve cusps, preserved in glutardialdehyde and ethylene glycol diglycidyl ether, were used. The test models were sutured with polypropylene, polydioxanone and nitinol (TiNi) threads. The sutured cusps were modified with unfractionated heparin. The model of accelerated calcification was used to study the impact of suture material and heparin on biological tissue mineralization by implanting the test models into male rats for 2 months.

Results. Two months after the implantation all the test models had calcium deposits in the peri-suture region; the amount of calcium in the biomaterial with polypropylene threads was 31-fold higher (р=0,0009), with TiNi threads it was 14-fold higher (р=0,001) and with polydioxanone threads it was 9-fold higher (р=0,0049) as compared to the controls. The modification with unfractionated heparin significantly decreased the amount of calcium in the biomaterial. The maximum effect was observed in the test models containing TiNi: the amount of calcium was 14,5-fold lower (р=0,0013), which was comparable with non-implanted models.

Conclusion. Cardiovascular bioprosthetic heart valves calcification can be initiated by the suture material due to inflammation in the peri-suture region. The amount of calcium in the biomaterial depends on the quality of the latter. Polypropylene threads precipitated the calcification of epoxy-treated xenocusps in the experiment. The modification with unfractionated heparin can effectively inhibit biological tissue calcification.

1. Барбараш Л . С., Барбараш Н. А ., Журавлева И . Ю. Биопротезы клапанов сердца. Проблемы и перспективы. Кемерово, 1995. 400 с.

2. Белоярцев Д. Ф., Тимина И . Е . Ближайшие результаты реконструкций внутренней сонной артерии рассасывающимся шовным материалом// Ангиология и сосудистая хирургия. 2003. Т. 9, № 4. С. 79–88.

3. Биосовместимость / под ред. В. И. Севастьянова. М.: Медицина, 1999. 368 с.

4. Бокерия Л . А ., Гудкова Р. Г . Сердечно-сосудистая хирургия-2011. Болезни и врожденные аномалии системы кровообращения. М., 2012. 196 с.

5. 12-летний опыт использования биопротезов для замещения инфраингвинальных артерий / Л. С. Барбараш [и др.] // Ангиология и сосудистая хирургия. 2006. № 3. С. 91–97.

6. Клинико-морфологическое изучение сосудистых анастомозов после реконструктивных операций / В. А. Лазаренко [др.] // Ангиология и сосудистая хирургия. 2003. № 3 (прил.). С. 185–186.

7. Латыпов А . К . Клинико-функциональная оценка биологических клапаносодержащих кондуитов в послеоперационном периоде у детей: автореф. дис. … канд. мед. наук. Новосибирск, 2005. 23 с.

8. Отдаленные результаты применения эпоксиобработанных ксенопротезов в хирургии атриовентрикулярных пороков у лиц молодого возраста / Л. С. Барбараш [и др.] // Кардиология и сердечно-сосудистая хирургия. 2012. № 2, т. 5. С. 77–81.

9. Покровский А . В ., Гонтаренко В . Н. Состояние сосудистой хирургии в России в 2012 г. М., 2013. С. 95.

10. Струков А . И ., Серов В . В . Патологическая анатомия: учебник по медицине. Раздел «Нарушения обмена кальция». URL: http://www.medichelp.ru/posts/view/3057.

11. Chanda J., Kuribayashi R., Abe T. Heparin in calcification prevention of porcine pericardial bioprostheses // Biomaterials. 1997. Vol. 18, № 16. P. 1109–1113.

12. Golomb G., Schoen F. J., Smith M. S. The role of glutaraldehydeinduced cross-links in calcification of bovine pericardium used in cardiac valve bioprostesis // Am. J. Pathol. 1987. Vol. 127. P. 122–130.

13. Improved calcification resistance and biocompatibility of tissue patch grafted with sulfonated PEO or heparin after glutaraldehyde fixation / W. K. Lee [et al.] // J. Biomed. Mater. Res. 2001. Vol. 58, № 1. Р. 27–35.

14. Low-molecular weight and unfractionated heparins induce a downregulation of inflammation: decreased levels of proinflammatory cytokines and nuclear factor-kappaB in LPSstimulated human monocytes / H. Hochart [et al.] // Br. J. Haematol. 2006. Vol. 133, № 1. Р. 62–67.

15. Sacks M. S., Schoen F. J. Collagen fiber disruption occurs independent of calcification in clinically explanted bioprosthetic heart valve // J. Biomed. Mater. Res. 2002. Vol. 62, № 3. Р. 359–371.

16. Schoen F. J., Levy R. J. Calcification of tissue heart valve substitutes: progress toward understanding and prevention // Ann. Thorac. Surg. 2005. Vol. 79, № 3. Р. 1072–1080.