Calcification resistance with aluminum-ethanol treated porcine aortic valve bioprostheses in juvenile sheep Matthew F Ogle, MS, Sheila J Kelly, BS, Richard.

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Calcification resistance with aluminum-ethanol treated porcine aortic valve bioprostheses in juvenile sheep Matthew F Ogle, MS, Sheila J Kelly, BS, Richard W Bianco, BS, Robert J Levy, MD The Annals of Thoracic Surgery Volume 75, Issue 4, Pages 1267-1273 (April 2003) DOI: 10.1016/S0003-4975(02)04489-2

Fig 1 Elemental analysis of cusp tissue after incubation with aluminum chloride solution. Note the high aluminum incorporation levels at acidic pH compared with those at physiologic pH that were barely detectable. Untreated control cusp and aortic wall were below the limits of detection (0.12 ppm). The Annals of Thoracic Surgery 2003 75, 1267-1273DOI: (10.1016/S0003-4975(02)04489-2)

Fig 2 Representative histomicrographs of cusp tissue (stained with aluminum stain ×100) incubated in either 0.1 mol/L aluminum chloride at pH 3 (A) or at pH 7.4 (B). The Annals of Thoracic Surgery 2003 75, 1267-1273DOI: (10.1016/S0003-4975(02)04489-2)

Fig 3 Ninety-day sheep study calcium histopathologic grading. See “Methods” for conditions used for group I (control), group II (sequential AlCl3 and ethanol), and group III (differential AlCl3 and ethanol). Note grading for groups I and III were zero for cusp tissue, and thus no bar graphs are shown. The Annals of Thoracic Surgery 2003 75, 1267-1273DOI: (10.1016/S0003-4975(02)04489-2)

Fig 4 Ninety-day sheep study calcium content (mg/g of dry tissue). See “Methods” for description of group I (control), group II (sequential AlCl3 and ethanol), and group III (differential AlCl3 and ethanol). Note preimplant levels and all cusp values except Group II were barely detectable. The Annals of Thoracic Surgery 2003 75, 1267-1273DOI: (10.1016/S0003-4975(02)04489-2)

Fig 5 Ninety-day sheep study percent survival. See “Methods” for pretreatments used in group I (control), group II (sequential AlCl3 and ethanol), and group III (differential AlCl3 and ethanol). Note group I and group III lines are coincident. The Annals of Thoracic Surgery 2003 75, 1267-1273DOI: (10.1016/S0003-4975(02)04489-2)

Fig 6 Roentgenogram analysis and histomicrographs showing calcium distribution in bioprosthetic sheep explants. (A) Group I (control) radiograph. (B) Group I aortic wall (Von Kossa stain, original magnification ×100). (C) Group I aortic cusp (Von Kossa stain, original magnification ×200). (D) Group II (sequential AlCl3 and ethanol) radiograph. (E) Group II aortic wall (Von Kossa stain, original magnification ×100). (F) Group II aortic cusp (Von Kossa stain, original magnification ×200). (G) Group III (differential AlCl3 and ethanol) roentgenogram. (H) Group III aortic wall (Von Kossa stain, original magnification ×100) (I) Group III aortic cusp (Von Kossa stain, original magnification ×200). The Annals of Thoracic Surgery 2003 75, 1267-1273DOI: (10.1016/S0003-4975(02)04489-2)