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Ann Thorac Surg 1996;62:1724-1730
© 1996 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

No-React Detoxification Process: A Superior Anticalcification Method for Bioprostheses

Section of Cardiothoracic Surgery, UMDNJ-New Jersey Medical School, Departments of Surgery and Preventive Medicine and Community Health, Newark, New Jersey

Background. Glutaraldehyde pretreatment of bioprosthetic heart valves is the major pathogenic factor in their calcific degeneration. This comparative study investigates the merit of the No-React aldehyde detoxification process as an alternative modifier of xenograft tissues.

Methods. Glutaraldehyde- and No-React-pretreated porcine aortic valve cusps were implanted subcutaneously in 6-week-old rats (n = 20). At 3, 6, and 14 weeks, randomly selected animals were sacrificed and the explants underwent mineral and morphologic analyses. Glutaraldehyde- and No-React-treated bovine pericardium and porcine aortic valve cusp were incubated in fibroblast cell culture plates. Cell viability was observed under reversed microscope at 6, 24, 48, and 96 hours. Erythrosin B dye exclusion test was used to validate percent cell death.

Results. Pretreatment with No-React significantly inhibited calcification of aortic cusp subcutaneous implants throughout the 14-week period (mean tissue Ca²⁺ content = 1.3 ± 0.7 µg/mg at 14 weeks.) Glutaraldehyde-treated cusps underwent protracted calcification (Ca²⁺ content = 190.6 ± 89.5 µg/mg; p < 0.01). Morphologic findings correlated with mineral analyses. One-hundred percent of fibroblast cells survived in the presence of No-React-treated tissue, with a growth pattern indistinguishable from control cell culture (ie, in the presence of no tissue). The cells incubated with glutaraldehyde-treated tissue showed signs of nonviability by 6 hours, with 100% cell death by 48 hours. Dye exclusion tests validated these findings.

Conclusions. The No-React detoxification process completely abolishes the cytotoxicity of the xenograft tissue and inhibits calcific degeneration.

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Discussion
Ann. Thorac. Surg. 1996 62: 1730. [Extract] [Full Text]

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