Ann Thorac Surg 1991;51:30-33
© 1991 The Society of Thoracic Surgeons
Binding of preformed xenoantibodies to porcine bioprosthetic valves
Juan A. Sanchez, MD,
Charles C. Marboe, MD,
Joseph S. Auteri, MD,
Valluvan Jeevanandum, MD,
Niloo M. Edwards, MD,
Carole L. Berger, PhD,
Eric A. Rose, MD*
Departments of Surgery and Pathology, Columbia-Presbyterian Medical Center, New York, New York USA
Accepted for publication August 22, 1990.
* Address reprint requests to Dr Rose, Department of Surgery, Columbia-Presbyterian Medical Center, 622 West 168th St, New York, NY 10032.
We have investigated whether preformed antibodies against xenoantigens bind to cellular elements remaining on porcine bioprosthetic valves after various methods of preservation. Fresh porcine valves treated with either acetone, 4% formaldehyde, or 0.625% glutaraldehyde, as well as an unfixed valve, were incubated with antiserum against porcine xenoantigens. This serum was prepared using the affinity purification method with porcine lymphocytes as the target. The valves were stained with secondary fluorescein-conjugated antibody against immunoglobulin M or immunoglobulin G and examined under fluorescent microscopy. Intense binding of immunoglobulin M to the endocardium was observed in the unfixed valve as well as in valves fixed in acetone and formaldehyde. Glutaraldehyde fixation eliminated binding of antibody. Binding was not noted within the connective tissue. No binding of antiimmunoglobulin G was noted on the endocardium of any of the sections. Examination of three glutaraldehyde-treated porcine valves explanted from the aortic position after 10 years in situ showed no immunoglobulin deposition. These results demonstrate the elimination of antigenicity to preformed antibodies in the endocardium and connective tissue of glutaraldehyde-preserved porcine valves. The findings may, in part, explain the poor performance of formaldehyde-preserved bioprosthetic xenograft valves in the past and support the use of glutaraldehyde as a preferred agent for preservation of bioprosthetic endovascular materials.
Presented in part at the Twelfth Congress of the European Society of Cardiology, Stockholm, Sweden, Sep 16–20, 1990.
- Ferrans VJ, Spray TL, Billingham ME, Roberts WC. Structural changes in glutaraldehyde-treated porcine heterografts used as substitute cardiac valves Am J Cardiol 1978;41:1159-1184.[Medline]
- Ferrans VJ, Tomita Y, Hilbert SL, Jones M, Roberts WC. Pathology of bioprosthetic cardiac valves Hum Pathol 1987;18:586-595.[Medline]
- Ishihara T, Ferrans VJ, Jones M, Boyce SW, Jones M, Roberts WC. Structure and classification of cuspal tears and perforations in porcine bioprosthetic cardiac valves implanted in patients Am J Cardiol 1981;48:665-678.[Medline]
- Fishbein MC, Gissen SA, Collins Jr JJ, Barsamian EM, Cohn LH. Pathologic findings after cardiac valve replacement with glutaraldehyde-fixed porcine valves Am J Cardiol 1977;40:331-337.[Medline]
- Carpentier A, Lemaigre G, Carpentier S, Dubost C. Biological factors affecting long-term results of valvular heterografts J Thorac Cardiovasc Surg 1969;58:467-481.[Medline]
- Roccini AP, Weesner KM, Heidelberger K, Keren D, Behrendt D, Rosenthal A. Porcine xenograft valve failure in children: an immunologic response Circulation 1981;64(Suppl 2):162-171.
- Salgaller ML, Bajpai PK. The effect of glutaraldehyde-treated bovine pericardial xenografts on humoral immune response in rabbits IRCS Med Sci 1981;9:672-673.
- Spray TL, Roberts WC. Structural changes in porcine xenografts used as substitute cardiac valves. Gross and histologic observations in 51 glutaraldehyde-preserved Hancock valves in 41 patients Am J Cardiol 1977;40:319-330.[Medline]
- Tector AJ, Boyd WC, Korns ME. Aortic valve allograft rejection J Thorac Cardiovasc Surg 1971;65:592-599.
- Talbert WM, Wright P. Acute aortic stenosis of a porcine valve heterograft apparently caused by graft rejection Tex Heart J 1982;9:225-229.
- Bajpai PK, Stull PA. Glutaraldehyde-crosslinked porcine heart valve xenografts and cell mediated immune response IRCS Med Sci 1980;8:642-643.
- Edwards N, Ott G, Berger C, et al. Incidence of preformed antibodies against potential xenodonors in human sera Transplantation 1990;49:1022-1024.[Medline]
- Duran CG, Gunning AJ. Heterograft in aortic position Lancet 1962;2:488.[Medline]
- Angell WW, Angell JD, Kosek JC. Twelve year experience with glutaraldehyde-preserved porcine xenografts J Thorac Cardiovasc Surg 1982;83:493-502.[Abstract]
- Binet JP, Duran CG, Carpentier A, Langlois J. Heterologous aortic valve replacement Lancet 1965;2:1275.[Medline]
- Binet JP. Pioneering in heterografts Ann Thorac Surg 1989;48:S71-S72(Suppl).[Medline]
- Carpentier A. From valvular xenograft to valvular bioprosthesis: 1965–1970 Ann Thorac Surg 1989;48:S73-S74(Suppl).[Medline]
- Buch WS, Kosek JC, Angell WW. Deterioration of formalintreated aortic valve heterografts J Thorac Cardiovasc Surg 1970;60:673-680.[Medline]