Effect of alternative crosslinking methods on the low strain rate viscoelastic properties of bovine pericardial bioprosthetic material

Donkey pericardium compares favorably with commercial xenopericardia used in the manufacture of transcatheter heart valves

Transcatheter aortic valve implantation (TAVI) has gained considerable acceptance in the past decade due to its lower risks than conventional open-heart surgery. However, the deformation and delamination of the leaflets during the crimping procedure have raised questions about the durability and long-term serviceability of the pericardium tissue from which the leaflets are made. The collagen architecture, wall thickness and mechanical properties of donkey pericardium were investigated to assess its suitability as an alternative material for the manufacture of heart valves. Coupons sampled from different locations of donkey pericardium were investigated. Bovine, equine, and porcine pericardium specimens served as controls. The donkey pericardium had a similar surface morphology to that of the control pericardia except for the wavy topology on both the fibrous and serous sides. The average thickness of donkey pericardium (ca. 120 µm) was significantly lower than that from bovine (375 µm) and equine (410 µm), but slightly higher than that from porcine (99 µm) specimens. The interlaced wavy collagen bundles in the pericardium were composed of collagen fibers about 100 nm in diameter. This unique structure ensures that the donkey pericardium has a comparable ultimate tensile strength (UTS) and a much higher failure strain than the commercial pericardia used for the manufacture of heart valves. The donkey pericardium has an organized wavy collagen bundle architecture similar to that of bovine pericardium and has a satisfactory UTS and high failure strain. The thin and strong donkey pericardium might be a good candidate valve leaflet material for TAVI.

The mechanical properties of fresh versus fresh/frozen and preserved (Thiel and Formalin) long head of biceps tendons: A cadaveric investigation

Human cadaveric specimens commonly serve as mechanical models and as biological tissue donors in basic biomechanical research. Although these models are used to explain both in vitro and in vivo behavior, the question still remains whether the specimens employed reflect the normal in vivo situation. The mechanical properties of fresh-frozen or preserved cadavers may differ, and whether they can be used to reliably investigate pathology could be debated. The purpose of this study was to therefore examine the mechanical properties of cadaveric long biceps tendons, comparing fresh (n=7) with fresh-frozen (n=8), formalin embalmed (n=15), and Thiel-preserved (n=6) specimens using a Universal Testing Machine. The modulus of elasticity and the ultimate tensile strength to failure was recorded. Tensile failure occurred at an average of 12N/mm² in the fresh group, increasing to 40.1N/mm² in the fresh-frozen group, 50.3N/mm² in the formalin group, and 52N/mm² in the Thiel group. The modulus of elasticity/stiffness of the tendon increased from fresh (25.6MPa), to fresh-frozen (55.3MPa), to Thiel (82.5MPa), with the stiffest being formalin (510.6MPa). Thiel-preserved and formalin-embalmed long head of biceps tendons and fresh-frozen tendons have a similar load to failure. Either the Thiel or formalin preserved tendon could therefore be considered as alternatives for load to failure studies. However, the Young's modulus of embalmed tendons were significantly stiffer than fresh or fresh frozen specimens, and these methods might be less suitable alternatives when viscoelastic properties are being investigated.

Biomechanical Behavior of Bioprosthetic Heart Valve Heterograft Tissues: Characterization, Simulation, and Performance

The use of replacement heart valves continues to grow due to the increased prevalence of valvular heart disease resulting from an ageing population. Since bioprosthetic heart valves (BHVs) continue to be the preferred replacement valve, there continues to be a strong need to develop better and more reliable BHVs through and improved the general understanding of BHV failure mechanisms. The major technological hurdle for the lifespan of the BHV implant continues to be the durability of the constituent leaflet biomaterials, which if improved can lead to substantial clinical impact. In order to develop improved solutions for BHV biomaterials, it is critical to have a better understanding of the inherent biomechanical behaviors of the leaflet biomaterials, including chemical treatment technologies, the impact of repetitive mechanical loading, and the inherent failure modes. This review seeks to provide a comprehensive overview of these issues, with a focus on developing insight on the mechanisms of BHV function and failure. Additionally, this review provides a detailed summary of the computational biomechanical simulations that have been used to inform and develop a higher level of understanding of BHV tissues and their failure modes. Collectively, this information should serve as a tool not only to infer reliable and dependable prosthesis function, but also to instigate and facilitate the design of future bioprosthetic valves and clinically impact cardiology.

A comparative study of bovine and porcine pericardium to highlight their potential advantages to manufacture percutaneous cardiovascular implants

Rationale:

Prosthetic heart valves designed to be implanted percutaneously must be loaded within delivery catheters whose diameter can be as low as 18 F (6 mm). This mandatory crimping of the devices may result in deleterious damages to the tissues used for valve manufacturing. As bovine and porcine pericardial tissue are currently given preference because of their excellent availability and traceability, a preliminary comparative study was undertaken to highlight their potential advantages.

Materials and methods:

Bovine and pericardium patches were compared morphologically (light microscopy, scanning electron microscopy and transmission electron microscopy). The acute thrombogenicity of both materials was measured in term of platelet uptake and observed by scanning electron microscopy, porcine intact and injured arteries being used as controls. The pericardium specimens were also subjected to uniaxial tensile tests to compare their respective mechanical characteristics.

Results:

Both pericardiums showed a layered architecture of collagen bundles presenting some interstitial cells. They displayed wavy crimps typical of an unloaded collagenous tissue. The collagen bundles were not bound together and the fibrils were parallel with characteristic periodicity patterns of cross striations. The mesothelial cells found in vivo on the serous surface were no longer present due to tissue processing, but the adjacent structure was far more compacted when compared to the fibrous side. The fibrinocollagenous surfaces were found to be more thrombogenic for both bovine and porcine tissues and the serous side of the porcine pericardium retained more platelets when compared to the bovine samples, making the acute thrombogenicity more important in the porcine pericardium.

Conclusion:

Both bovine and porcine pericardium used in cardiovascular implantology can be selected to manufacture percutaneous heart valves. The selection of one pericardium preferably to the other should deserve additional testing regarding the innocuousness of crimping when loaded in delivery catheters and the long-term durability after percutaneous deployment.

Detoxification of Glutaraldehyde Treated Porcine Pericardium Using L-arginine & NABH(4)

Background

Calcification is the most frequent cause of clinical failure of bioprosthetic tissues fabricated from GA-fixed porcine valves or bovine pericardium. A multi-factorial approach using different mechanisms was recently developed to reduce the calcification of bioprosthetic tissues. The purpose of the present study was to evaluate the synchronized synergism of using L-arginine and NaBH₄, compared with ethanol and L-lysine, in glutaraldehyde treated porcine pericardium from the standpoint of calcification and tissue elasticity.

Materials and Methods

Porcine pericardium was fixed at 0.625% GA (7 days at room temperature after 2 days at 4℃). An interim step of ethanol (80%; 1 day at room temperature) or L-lysine (0.1 M; 2 days at 37℃) or L-arginine (0.1 M; 2 days at 37℃) was followed by completion of the GA fixation. A final step of NaBH₄ (0.1 M; 2 days at room temperature) was followed. Their tensile strength, thickness, and thermal stability were measured. Treated pericardia were implanted subcutaneously into three-week-old Sprague-Dawley rats for 8 weeks. Calcium content was assessed by atomic absorption spectroscopy and histology.

Results

L-arginine and NaBH₄ pretreatment (1.81±0.39 kgf/5 mm p=0.001, 0.30±0.08 mm p<0.001) significantly increased tensile strength and thickness compared with the control (0.53±0.34 kgf/5 mm, 0.10±0.02 mm). In a thermal stability test, L-arginine and NaBH₄ pretreatment (84.25±1.12℃, p=0.023) caused a significant difference from the control (86.25±0.00℃). L-lysine and NaBH₄ pretreatment (183.8±42.6 ug/mg, p=0.804), and L-arginine and NaBH₄ pretreatment (163.3±27.5 ug/mg, p=0.621) did not significantly inhibit calcification compared to the control (175.5±45.3 ug/mg), but ethanol and NaBH₄ pretreatment did (38.5±37.3 ug/mg, p=0.003).

Conclusion

The combined pretreatment using L-arginine and NaBH₄ after GA fixation seemed to increase the tensile strength and thickness of porcine pericardium, fixed with GA. Additionally, it seemed to keep thermal stability. However it could not decrease the calcification of porcine pericardium fixed with GA. NaBH₄ pretreatment seemed to decrease the calcification of porcine pericardium fixed with GA, but only with ethanol.

Differences in collagen cross-linking between the four valves of the bovine heart: a possible role in adaptation to mechanical fatigue

Hydrothermal isometric tension (HIT) testing and high-performance liquid chromatography were used to assess the molecular stability and cross-link population of collagen in the four valves of the adult bovine heart. Untreated and NaBH4-treated tissues under isometric tension were heated in a water bath to a 90°C isotherm that was sustained for 5 h. The denaturation temperature (Td), associated with hydrogen bond rupture and molecular stability, and the half-time of load decay ( t1/2), associated with peptide bond hydrolysis and intermolecular cross-linking, were calculated from acquired load/temperature/time data. An unpaired group of samples of the same population was biochemically assayed for the types and quantities of enzymatic cross-links present. Tissues known to endure higher in vivo transvalvular pressures had lower Td values, suggesting that molecular stability is inversely related to in vivo loading. The treated inflow valves (mitral and tricuspid) had significantly lower t1/2 values than did treated outflow valves (aortic and pulmonary), suggesting lower overall cross-linking in the inflow valves. Inflow valves were also found to fail during HIT testing significantly more often than outflow valves, also suggestive of a decreased cross-link population. Inflow valves may be remodeling at a faster rate and may be at an earlier state of molecular “maturity” than outflow valves. At the molecular level, the thermal stability of collagen is associated with in vivo loading and may be influenced by the mature, aldimine-derived cross-link, histidinohydroxylysinonorleucine. We conclude that the valves of the heart utilize differing, location-specific strategies to resist biomechanical fatigue loading.

Glutaraldehyde cross-linking of tendon--mechanical effects at the level of the tendon fascicle and fibril

Conclusive insight into the microscopic principles that govern the strength of tendon and related connective tissues is lacking and the importance of collagen cross-linking has not been firmly established. The combined application of whole-tissue mechanical testing and atomic force spectroscopy allowed for a detailed characterization of the effect of cross-linking in rat-tail tendon. The cross-link inducing agent glutaraldehyde augmented the tensile strength of tendon fascicles. Stress at failure increased from approximately 8 MPa to approximately 39 MPa. The mechanical effects of glutaraldehyde at the tendon fibril level were examined by atomic force microscopy. Peak forces increased from approximately 1379 to approximately 2622 pN while an extended Hertz fit of force-indentation data showed a approximately 24 fold increase in Young's modulus on indentation. The effect of glutaraldehyde cross-linking on the tensile properties of a single collagen fibril was investigated by a novel methodology based on atomic force spectroscopy. The Young's modulus of a secluded fibril increased from approximately 407 MPa to approximately 1.1 GPa with glutaraldehyde treatment. Collectively, the findings indicate that cross-linking at the level of the collagen fibril is of key importance for the mechanical strength of tendon tissue. However, when comparing the effects at the level of the tendon fascicle and fibril, respectively, further questions are prompted regarding the pathways of force through the tendon microstructure as fibril strength seems to surpass that of the tendon fascicle.

Bioprosthetic heart valve heterograft biomaterials: structure, mechanical behavior and computational simulation

The present review surveys significant developments in the biomechanical characterization and computational simulation of biologically derived chemically cross-linked soft tissues, or 'heterograft' biomaterials, used in replacement bioprosthetic heart valve (BHV). A survey of mechanical characterization techniques, relevant mechanical properties and computational simulation approaches is presented for both the source tissues and cross-linked biomaterials. Since durability remains the critical problem with current bioprostheses, changes with the mechanical behavior with fatigue are also presented. Moreover, given the complex nature of the mechanical properties of heterograft biomaterials it is not surprising that most constitutive (stress-strain) models, historically used to characterize their behavior, were oversimplified. Simulations of BHV function utilizing these models have inevitably been inaccurate. Thus, more recent finite element simulations utilizing nonlinear constitutive models, which achieve greater model fidelity, are reviewed. An important conclusion of this review is the need for accurate constitutive models, rigorously validated with appropriate experimental data, in order that the design benefits of computational models can be realized. Finally, for at least the coming 20 years, BHVs fabricated from heterograft biomaterials will continue to be extensively used, and will probably remain as the dominant valve design. We should thus recognize that rational, scientifically based approaches to BHV biomaterial development and design can lead to significantly improved BHV, over the coming decades, which can potentially impact millions of patients worldwide with heart valve disease.

Dynamic simulation pericardial bioprosthetic heart valve function

While providing nearly trouble-free function for 10-12 years, current bioprosthetic heart valves (BHV) continue to suffer from limited long-term durability. This is usually a result of leaflet calcification and/or structural degeneration, which may be related to regions of stress concentration associated with complex leaflet deformations. In the current work, a dynamic three-dimensional finite element analysis of a pericardial BHV was performed with a recently developed FE implementation of the generalized nonlinear anisotropic Fung-type elastic constitutive model for pericardial BHV tissues (W. Sun and M.S. Sacks, 2005, [Biomech. Model. Mechanobiol., 4(2-3), pp. 190-199]). The pericardial BHV was subjected to time-varying physiological pressure loading to compute the deformation and stress distribution during the opening phase of the valve function. A dynamic sequence of the displacements revealed that the free edge of the leaflet reached the fully open position earlier and the belly region followed. Asymmetry was observed in the resulting displacement and stress distribution due to the fiber direction and the anisotropic characteristics of the Fung-type elastic constitutive material model. The computed stress distribution indicated relatively high magnitudes near the free edge of the leaflet with local bending deformation and subsequently at the leaflet attachment boundary. The maximum computed von Mises stress during the opening phase was 33.8 kPa. The dynamic analysis indicated that the free edge regions of the leaflets were subjected to significant flexural deformation that may potentially lead to structural degeneration after millions of cycles of valve function. The regions subjected to time varying flexural deformation and high stresses of the present study also correspond to regions of tissue valve calcification and structural failure reported from explanted valves. In addition, the present simulation also demonstrated the importance of including the bending component together with the in-plane material behavior of the leaflets towards physiologically realistic deformation of the leaflets. Dynamic simulations with experimentally determined leaflet material specification can be potentially used to modify the valve towards an optimal design to minimize regions of stress concentration and structural failure.

Functional evaluation of collagen fiber scaffolds for ACL reconstruction: Cyclic loading in proteolytic enzyme solutions

The mechanical properties of anterior cruciate ligament (ACL) reconstruction scaffolds were evaluated after exposure to functional challenges in vitro: cyclic loading combined with various proteolytic enzymes. Scaffolds were prepared from collagen fibers that were uncrosslinked (UNXL), crosslinked with ultraviolet irradiation (UV), or 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC; 10 or 25 mM). Structural properties of scaffolds were determined following 1-h exposure to saline, trypsin, or bacterial collagenase, with and without simultaneous cyclic tensile loading (0 to 50 g; 0.5 Hz) in vitro. The breaking load and stiffness of UNXL and UV crosslinked scaffolds were significantly reduced by exposure to either trypsin or collagenase. Cyclic loads interacted synergistically with enzymes, rendering UNXL scaffolds untestable and further decreasing the breaking load of UV crosslinked scaffolds by approximately 35%. In contrast, the breaking load and stiffness of EDC crosslinked scaffolds, which were greater than those of UNXL or UV crosslinked scaffolds, were virtually unaffected by the same load and enzyme treatments. These results suggest that EDC is more effective than UV for crosslinking and stabilizing load-bearing collagen fiber ACL reconstruction scaffolds. Application of cyclic loads and enzymes may lead to development of physiologically relevant in vitro test methods for load-bearing scaffolds.

A novel chemical modification of bioprosthetic tissues using L-arginine

A novel chemical modification of biological tissues was developed by the direct coupling of bioactive molecule, L-arginine to bovine pericardium (BP). The modification involves pretreatment of BP using GA and followed by grafting arginine to BP by the reaction of residual aldehyde and amine group of L-arginine. BP was modified by direct coupling of bioactive molecules and the effect of L-arginine coupling on calcification and biocompatibility was evaluated in vitro and in vivo. Modified BPs were characterized by measuring shrinkage temperature, mechanical properties, digestion resistance to collagenase enzyme, in vitro plasma protein adsorption and platelet adhesion, and in vivo calcification. Thermal and mechanical properties showed that the durability of arginine treated tissue increased as compared with fresh tissue and GA treated tissue. Resistance to collagenase digestion revealed that modified tissues have greater resistance to enzyme digestion than did fresh tissue and GA treated tissue. Lower protein adsorption and platelet adhesion were observed on modified tissue than non-modified tissue. In vivo calcification study demonstrated much less calcium deposition on arginine treated BP than GA treated one. Obtained results attest to the usefulness of L-arginine treated BP for cardiovascular bioprostheses.

Biaxial mechanical response of bioprosthetic heart valve biomaterials to high in-plane shear

Utilization of novel biologically-derived biomaterials in bioprosthetic heart valves (BHV) requires robust constitutive models to predict the mechanical behavior under generalized loading states. Thus, it is necessary to perform rigorous experimentation involving all functional deformations to obtain both the form and material constants of a strain-energy density function. In this study, we generated a comprehensive experimental biaxial mechanical dataset that included high in-plane shear stresses using glutaraldehyde treated bovine pericardium (GLBP) as the representative BHV biomaterial. Compared to our previous study (Sacks, JBME, v.121, pp. 551-555, 1999), GLBP demonstrated a substantially different response under high shear strains. This finding was underscored by the inability of the standard Fung model, applied successfully in our previous GLBP study, to fit the high-shear data. To develop an appropriate constitutive model, we utilized an interpolation technique for the pseudo-elastic response to guide modification of the final model form. An eight parameter modified Fung model utilizing additional quartic terms was developed, which fitted the complete dataset well. Model parameters were also constrained to satisfy physical plausibility of the strain energy function. The results of this study underscore the limited predictive ability of current soft tissue models, and the need to collect experimental data for soft tissue simulations over the complete functional range.

Tissue engineering therapy for cardiovascular disease

The present treatments for the loss or failure of cardiovascular function include organ transplantation, surgical reconstruction, mechanical or synthetic devices, or the administration of metabolic products. Although routinely used, these treatments are not without constraints and complications. The emerging and interdisciplinary field of tissue engineering has evolved to provide solutions to tissue creation and repair. Tissue engineering applies the principles of engineering, material science, and biology toward the development of biological substitutes that restore, maintain, or improve tissue function. Progress has been made in engineering the various components of the cardiovascular system, including blood vessels, heart valves, and cardiac muscle. Many pivotal studies have been performed in recent years that may support the move toward the widespread application of tissue-engineered therapy for cardiovascular diseases. The studies discussed include endothelial cell seeding of vascular grafts, tissue-engineered vascular conduits, generation of heart valve leaflets, cardiomyoplasty, genetic manipulation, and in vitro conditions for optimizing tissue-engineered cardiovascular constructs.

22 week assessment of bladder acellular matrix as a bladder augmentation material in a porcine model

Previous studies on the reconstruction of porcine bladder using bladder acellular matrix allograft (BAMA) have indicated positive preliminary results with respect to graft shrinkage and cellular repopulation. The current study was conducted to investigate the feasibility of using BAMA in a similar model of bladder reconstruction out to longer time frames (22 weeks). At predetermined time points, the macroscopic, histological and mechanical properties of explanted native and BAMA tissues were evaluated and compared. Macroscopically, contracture of the BAMA was observed. The peripheral regions of the grafts experienced extensive cellular repopulation. Towards the centre however, all grafts were consistently devoid of organized smooth muscle bundles and a well-developed urothelium. An alteration in both the amount and organization of collagen was also observed within this region. Significant differences (p < 0.05) in the rupture strain and the elastic modulus of the BAMA compared to native bladder tissue appear to correlate with macroscopic graft contracture as well as the fibroproliferative tissue response of the matrix.

Calcification resistance, biostability, and low immunogenic potential of porcine heart valves modified by dye-mediated photooxidation

The calcification potential, biostability, and immunogenic response of materials intended for long-term in vivo use, such as in heart-valve bioprostheses, are essential components of device performance. Here we explore these properties in photooxidized porcine heart valves. To study immunological sensitization, we injected tissue extracts intradermally into guinea pigs. Test and control animals received a challenge patch of the appropriate extract and were scored for dermal reactions. Neither cottonseed oil nor sodium chloride extracts of photooxidized heart-valve tissues caused any dermal inflammatory response. After implantation in the rat subcutaneous model for 90 days, the calcium content of 48-h-treated photooxidized cusp tissue [0.04 +/- 0.00 mg/g wet weight (gww)] was comparable to that of unimplanted control tissues (usually <1 mg/gww) and much lower than that of glutaraldehyde-treated controls (71 +/- 15 mg/gww). The porcine aortic wall calcium content (49 +/- 31 mg/gww) was comparable to that of glutaraldehyde-treated controls (59 +/- 8 mg/gww). Histologically, a time-dependent decrease in inflammation and vascularization with increasing photooxidation time was noted in the rat model along with an increase in the stability and organization of collagen bundles. In summary, porcine valve tissues treated by dye-mediated photooxidation were resistant to calcification, were biostable, and demonstrated a low immunogenic response, indicating potential for use in heart-valve bioprostheses.

The role of crosslinking in modification of the immune response elicited against xenogenic vascular acellular matrices

We have used detergent and enzymatic extraction of natural arteries to produce an acellular matrix vascular prosthesis (AMVP). Implanted as an allograft in a canine model, this AMVP shows excellent handling characteristics, low thromboreactivity, no evidence of aneurysm, and exceptional graft patency in the peripheral vasculature. As a first step in the development of xenograft AMVPs, we processed caprine carotid arteries to AMVP and implanted them as femoral interposition grafts in dogs. Explanted xenografts at 4 weeks showed multifocal mixed inflammatory infiltrates and focal destruction of the medial elastin in the inflammatory foci. To further study the immune response to xenogenic AMVP, we implanted canine-derived AMVPs and fresh canine arteries for 4 weeks in a Lewis rat model. Extraction to AMVP markedly reduced the circulating antibody response to the xenogenic implants; however, histological analysis revealed that both xenograft arteries and AMVPs produced a marked immune response with penetration of mononuclear cells into the media and adventitia. To modify the immune response, we applied three crosslinking techniques to the canine AMVPs: glutaraldehyde, polyglycidyl ether, and carbodiimide. All crosslinkers significantly reduced degradation and cellular infiltration of the prostheses. However, crosslinking neither eliminated the chronic inflammatory response surrounding the implants nor reduced the humoral response to the xenogenic materials.

Heparinized bovine pericardium as a novel cardiovascular bioprosthesis

A novel chemical modification of biological tissues was developed by the direct coupling heparin to bovine pericardium (BP). The heparinization involves pretreatment of BP using GA and followed by grafting heparin to BP by the reaction of residual aldehyde and amine group of heparin. BP was modified by direct coupling of heparin and the effect of heparin coupling on calcification was evaluated in vitro and in vivo. Heparinized BP was characterized by measuring shrinkage temperature, mechanical properties, digestion resistance to collagenase enzyme, in vitro cytotoxicity, and in vivo calcification. Thermal and mechanical properties showed that the durability of heparin-treated tissue increased as compared with fresh tissue and GA-treated tissue. Resistance to collagenase digestion revealed that heparin-treated tissue has greater resistance to enzyme digestion than did fresh tissue and GA-treated tissue. Heparinized tissue had shown to be non-cytotoxic, however, relatively high cytotoxicity was observed in the GA-treated tissues due to the release of GA. In vivo calcification study demonstrated much less calcium deposition on heparin-treated BP than GA-treated one. Obtained results attest to the usefulness of heparinized BP for cardiovascular bioprostheses.

Acellular vascular tissues: natural biomaterials for tissue repair and tissue engineering

Various research groups around the world are actively investigating cardiovascular prostheses of biological origin. This review article discusses the need for such bioprosthetics and the potential role for natural tissues in cardiovascular applications such as cardiac valves and vascular grafts. Upon implantation, unmodified natural materials are subject to chemical and enzymatic degradation, seriously decreasing the life of the prosthesis. Therefore, methods such as glutaraldehyde and polyepoxide crosslinking treatments and dye-mediated photooxidation have been developed to stabilize the tissue while attempting to maintain its natural mechanical properties. Also, residual cellular components in a bioprosthetic material have been associated with undesired effects, such as calcification and immunological recognition, and thus have been the motivation for various decellularization processes. The effects of these stabilization and decellularization treatments on mechanical, biological and chemical properties of treated tissues have been investigated, specifically with regard to calcification, immunogenicity, and cytotoxicity concerns. Despite significant advances in the area of cardiovascular prostheses, there has yet to be developed a completely biocompatible, long-lasting implant. However, with the recent advent of tissue engineering, the possibility of applying selective cell seeding to naturally derived bioprosthetics moves us closer to a living tissue replacement.

Effects of double cross-linking technique on the enzymatic degradation and calcification of bovine pericardia

The strength, resorption rates, and biocompatibility of collagenous biomaterials are profoundly influenced by the method of cross-linking. The in vitro and in vivo calcification and enzymatic degradation of bovine pericardia (BP) after a series of surface modifications were studied as a function of exposure time. Collagenase degradations of modified BP were monitored by scanning electron microscopy and tensile strength measurements. Bovine pericardium was modified by a combination of different tissue fixatives such as glutaraldehyde (GA), carbodiimide (EDC), diisocyanate (HMDIC), and polyethylene glycol (PEG). GA-PEG-EDC-PEG and GA-PEG-HMDIC-PEG combination treated BP retained maximum stability in collagenase digestion compared to GATBP. In vitro calcification studies and in vivo rat subcutaneous implantations of modified pericardium have shown substantial reduction in the calcification of double cross-linked BP with PEG modification. Further, the biocompatibility aspects of pericardial tissues were established by platelet adhesion and octane contact angle. It seems that cross-links involving amino and carboxyl residues may provide new ways of controlling biodegradation and calcification.

The antithrombotic versus calcium antagonistic effects of polyethylene glycol grafted bovine pericardium

Cardiovascular calcification, the formation of calcium phosphate deposits in cardiovascular tissue, is a common end stage phenomenon affecting a wide variety of bioprosthesis. This study proposes a novel approach of reducing pericardial calcification and thrombosis via coupling polyethylene glycols (PEG) to glutaraldehyde treated bovine pericardium via acetal linkages. The calcification of the PEG modified tissue and the control pericardium (extracted and glutaraldehyde treated) was investigated by in vivo rat subcutaneous implantation models and by in vitro meta stable calcium phosphate solutions. Scanning electron microscopy showed that calcification primarily involved the surface of collagen fibrils and the intrafibrillar spaces. However, the grafting of pericardium with PEG-20,000 had dramatically modified the surface and subsequently inhibited the deposits of calcium. Further, the modified tissue had also reduced the platelet surface attachment. Such a reduced calcification of PEG modified tissues can be explained by decrease of free aldehyde groups, a space filling effect and therefore improved biostability and synergistic blood compatible effects of PEG after coupling to the tissues. This simple method can be a useful anticalcification treatment for implantable tissue valves.

The role of collagen in the declining mechanical properties of aging human cortical bone

The importance of the mechanical role of collagen in bone is becoming increasingly more clear as evidence mounts on the detrimental effects of altered collagen on the mechanical properties of bone. We previously examined a set of mechanical properties (material stiffness, strength, and toughness) of human femoral bone (ages 35-92) and found that a gradual deterioration in these properties occurs with age. The present study examines the collagen of the same specimens and relates the collagen properties to the mechanical ones. In the collagen we measured the concentration of stable mature crosslinks, the shrinkage temperature, and the rate of contraction during isometric heating. The changes in the concentration of mature (pyridinium and deoxypyridinium) crosslinks showed no clear relationship to age nor did they correlate with the mechanical properties. The shrinkage temperature declined with age and correlated with a bone's toughness. The maximum rate of contraction was strongly correlated with three different measures of tissue toughness, but much less to stiffness and strength. Our results reinforce speculation regarding the toughening role of collagen in bone mechanics and suggest that the fragility of aging bone may be related to collagen changes.

Reduction of calcification by various treatments in cardiac valves

The importance of glutaraldehyde pretreated bioprosthetic heart valves fabricated from bovine pericardium or porcine aortic valves is well realized in the management of valvular heart diseases. But, calcification limits the durability and is the most frequent cause of failure of these bioprosthetic heart valves. Various research groups in the world are actively involved in describing, understanding, and preventing calcification of bioprosthetic heart valves. Since there is no satisfactory clinical means for preventing or treating this disorder, attempts are made to improve the anticalcification properties of the replacement valves in the preparation stage itself. Research in this area is very active, and many newer approaches are made to mitigate the problem. An attempt has been made in the present article to review various theories put forward to explain the causative factors involved and mechanistic aspects of biocalcification and to present various strategies attempted for the prevention of calcification with the special feature on the work done in the area in our laboratory.

Evaluation of porcine valves prepared by dye-mediated photooxidation

BACKGROUND

Previous studies demonstrated that dye-mediated photooxidation can stabilize bovine pericardium. Here, photooxidized porcine valve cusp and root tissue were assessed in comparison to fresh and glutaraldehyde-treated samples.

METHODS AND RESULTS

In an in vitro tissue solubility test, both photooxidized and glutaraldehyde-treated tissues were resistant to protein extraction compared to fresh tissue. A rat subcutaneous model was used to test in vivo stability and calcification potential. In this study, four of the six fresh leaflets were not visible because of resorption while both photooxidized and glutaraldehyde-treated tissues were biostable. Mineral contents of the rat explants were much lower for both fresh and photooxidized leaflets when compared with glutaraldehyde-treated leaflets. Also, the aortic root calcified whether treated or not with the most mineral being associated with glutaraldehyde-treated root. Analysis of photooxidized porcine valves explanted from the mitral position in sheep indicated a material that was biostable and contained only minor calcification, perhaps due to deformed stents.

CONCLUSIONS

Porcine valve tissue treated by dye-mediated photooxidation is biostable and resistant to calcification, and has potential for use in heart valve bioprostheses.

Effect of alternative crosslinking techniques on the enzymatic degradation of bovine pericardia and their calcification

The in vitro calcification and enzymatic degradation of bovine pericardia (BP) after a series of surface treatments were studied as a function of exposure time. The degradation of these treated surfaces was monitored by scanning electron micrography and tensile strength measurements. Polyethylene glycol-(PEG) grafted BP and glutaraldehyde-(GA) treated BPs retained maximum stability in collagenase digestion compared with SDS-treated BP. The ability of alpha chymotrypsin, bromelain, esterase, trypsin, and collagenase to modulate the degradation of SDS-, GA-, PEG-, Carbodiimide-, and glycidylether-treated BPs also was investigated. Incubation of various enzymes to these crosslinked pericardia variably reduced the tensile strength of these tissues. It is conceivable that chemical treatments of pericardial tissues might have altered their physical and chemical configuration and the subsequent degradation properties. In vitro calcification studies showed a substantial reduction in the calcification profile of PEG-grafted bovine pericardia compared to other treated tissues. Furthermore, the biocompatibility aspects of pericardial tissues were established by platelet adhesion and octane contact angle. In conclusion, it seems that the surface modification of bovine pericardia via GA-PEG grafting may provide new ways of controlling biodegradation and calcification.

Shelf-life of bioprosthetic heart valves: a structural and mechanical study

This study was undertaken to evaluate the influence of storage conditions on the shelf-life of porcine bioprosthetic valves. Fifty-five unimplanted porcine bioprostheses have been evaluated. The valves were stored in 0.5% buffered glutaraldehyde solution for different periods of time (7, 23 and 32 months). Twenty-eight valves were refrigerated while the remaining valves were stored at room temperature. The pH of the glutaraldehyde solution at room temperature decreased with time of storage, while that kept in the refrigerator remained stable over the course of the study. Macroscopic observations showed that the valve tissues kept at room temperature, especially for the periods of 23 and 32 months, became darker and more yellow in colour, whereas the refrigerated specimens exhibited no such changes in appearance. Scanning electron microscopy analysis revealed no noticeable differences on the surfaces of the leaflets stored under different conditions. Mechanical tests, including stress-strain response, stress relaxation and fracture behaviour, were carried out. Analysis of variance showed that the storage temperature, but not the length of storage, had a significant effect on some mechanical properties. The stress relaxation at 1000 s (P = 0.05), the ultimate tensile strength (P = 0.01) and the strain at fracture (P = 0.04) were all higher after storage at room temperature compared to the results after refrigeration. No statistically significant changes in the denaturation temperature of the collagen were observed between the different storage conditions. In conclusion, the storage temperature appears to have some influence on the bioprosthetic tissue. The bioprostheses stored under ambient conditions experience changes which may influence their longterm in vivo performance.

Methods for the treatment of collagenous tissues for bioprostheses

Collagenous tissue as a biomaterial possesses many favourable characteristics and advantages over synthetic materials. The resemblance to human tissue suggests that it has a performance advantage over alternative materials. This advantage has been exploited to produce clinical devices that have been implanted in patients for more than a quarter of a century. The method of treating collagenous tissue for bioprostheses has developed from crude exposure of tissue to chemicals to a sophisticated level of considering the biochemical, chemical, engineering and clinical aspects of the process. This review focuses on the various chemical and physical treatments that have made the bioprostheses possible, highlighting the chemical agents and the cross-linking mechanism involved.

Novel anti-calcification treatment of biological tissues by grafting of sulphonated poly(ethylene oxide)

Biological porcine tissue was modified by the direct coupling of sulphonated poly(ethylene oxide) (PEO-SO3) containing amino acid end groups after glutaraldehyde fixation. The calcification of the modified tissue [bioprosthetic tissue (BT)-PEO-SO3] and control (BT control) was investigated by in vivo rate subdermal, canine aorta-illiac shunt and right ventricle-pulmonary artery shunt implantation models. Less calcium deposition of BT-PEO-SP3 than of BT control was observed in in vivo tests. Such a reduced calcification of BT-PEO-SO3 can be explained by decreases of residual glutaraldehyde groups, a space filling effect and, therefore, improved biostability and synergistic blood-compatible effects of PEO and SO3 groups after the covalent binding of PEO-SO3 to tissue. This simple method can be a useful anti-calcification treatment for implantable tissue valves.

Effect of applied uniaxial stress on rate and mechanical effects of cross-linking in tissue-derived biomaterials

Conformational changes in collagen fibrils, and indeed the triple helix, can be produced by application of mechanical stress or strain. We have demonstrated that the rate of cross-linking in glutaraldehyde and epoxide homobifunctional reagents can be modulated by uniaxial stress (strain). Two poly(glycidyl ether) epoxides were used: Denacol EX-810 (a small bifunctional reagent), and Denacol EX-512 (a large polyfunctional reagent). To prevent any possible effect from being masked by saturation of cross-linking sites, bovine pericardium was cross-linked to such an extent that the increase in collagen denaturation temperature, Td, was one-half of the maximal rise achievable with each reagent. Uniaxial tensile stress of 0, 15, 124 or 233 kPa was applied during cross-linking. Cross-linking rate (as observed by increase in Td) increased with increasing stress to a maximum at 124 kPa in glutaraldehyde at pH 7 but decreased in EX-810 at pH 7. In each case, the effect was small but statistically significant. No effect was observed with the larger EX-512. Cross-linking under increasing stress also showed systematic effects on mechanical properties: decreasing extensibility and plastic strain while increasing tensile strength. In each case, the effects of the epoxides were slightly different from those of glutaraldehyde. In preparation for the above experiments, studies of the effect of pH, temperature, and exposure time were carried out for each epoxide and (to a lesser extent) for glutaraldehyde. Again, systematic changes in mechanical properties were observed with increasing Td. Conformational changes in collagen produced by mechanical stress (strain) modulate the rate of cross-linking and the resulting mechanical properties; however, the effects are sensitive to the reagent employed.

Shrinkage temperature versus protein extraction as a measure of stabilization of photooxidized tissue

A rise in thermal denaturation temperature has been utilized as an indication of stabilization of collagen-containing materials such as pericardial tissue and porcine heart-valve leaflets following treatment with glutaraldehyde, Denacol, or other chemical agents. In contrast, stabilization of bovine pericardial tissue by dye-mediated photooxidation does not result in a significant rise in shrinkage temperature comparable with these treated materials. It was therefore hypothesized that a rise in shrinkage temperature is not a necessary indication for tissue stabilization. A sensitive protein extraction assay has been developed which can be used to monitor the stabilization of pericardial tissue by a variety of treatment methods, including photooxidation. A reduction in extractable protein, as analyzed by polyacrylamide gel electrophoresis, is noted for pericardial tissue treated with photooxidation, glutaraldehyde, or Denacol. Loss of extractable protein, as a function of treatment time, correlates well with a significant rise in shrinkage temperature for pericardium treated with glutaraldehyde or Denacol but not with photooxidation. This difference is attributed to the stabilization processes of glutaraldehyde and Denacol, which involve extensive crosslinking and polymer formation within and in addition to the native pericardial matrix, leading to a rise in matrix complexity and thermal stability. In contrast, photooxidation is a catalytic process involving modification and crosslink formation within existing matrix components, resulting in a material with little added matrix complexity.

Solvent environment modulates effects of glutaraldehyde crosslinking on tissue-derived biomaterials

Bioprosthetic materials utilized in the construction of heart valves and vascular grafts possess limited performance and viability in vivo. This is due (in part) to the failure of these materials to mimic the mechanical properties of the host tissue they replace. If bioprosthetic materials could be engineered to meet the mechanical performance required in vivo, the functional lifetime of implants would be increased. In this study, glutaraldehyde/solvent solutions of decreasing dielectric constant (polarity) were utilized to modify the properties of crosslinked collagen in whole bovine pericardial tissue. Solvents included phosphate buffer, methanol, 95% (w/w) ethanol, n-propanol, and n-butanol. Exogenous crosslinking was verified in collagen by thermal denaturation tests and amino acid analyses. Tensile mechanical behavior of collagenous pericardial samples was found to depend upon the dielectric constant (polarity) of the glutaraldehyde/solvent solutions employed; however, treatment in the solvents alone had little, if any, effect. As the dielectric constant of the solvents decreased, three mechanical properties were systematically altered: plastic strain fell from a mean of 8.9 +/- 1.5% (buffer) to 1.6 +/- 0.4% (n-butanol); strain at fracture increased from 32.2 +/- 2.6% (buffer) to 55.6 +/- 4.6% (n-butanol); and percent stress remaining after 1000-s stress relaxation from an 80-g initial load fell from 86.3 +/- 1.1% (buffer) to 76.9 +/- 1.0% (n-butanol). Crosslinking using a glutaraldehyde/n-butanol solution produced materials with tensile mechanical behavior that was very close to that of fresh tissue; however, the flexural properties of the treated tissue were different from those of fresh tissue. This decoupling of the flexural and tensile mechanical behaviors of crosslinked bioprosthetic materials is unique to this form of treatment. The observed phenomena may be the results of conformational changes in collagen facilitated by polar/nonpolar interactions with the solvent that are "locked in" by the action of glutaraldehyde. This technique may aid in the "customized" design of mechanical properties in tissue-derived biomaterials.

Glutaraldehyde as a fixative in bioprostheses and drug delivery matrices

The use of glutaraldehyde as a fixative in bioprostheses and drug delivery matrices is reviewed. The chemistry of glutaraldehyde cross-linking and its effect on the biological performance of a number of bioprostheses such as tissue heart valves, vascular grafts, pericardial patches, tendon grafts and drug delivery matrices are examined.

Properties of collagen and hyaluronic acid composite materials and their modification by chemical crosslinking

This article describes properties of composites of collagen-hyaluronic acid shaped to layered materials. According to the results, interactions of these two polymers are very strong. The properties can be influenced by chemical crosslinking using glyoxal and starch dialdehyde. The different behavior during enzymatic degradation by collagenase and in swelling experiments is discussed in relation to material composition. The valuable properties of the composites observed in this study show the possibility of their use as biomaterials.

New concepts in the design and use of biological prosthetic valves

The natural aortic valve is a structure that has thus far eluded all attempts at duplication with synthetic materials. Real success in the replacement of the aortic valve has come about primarily through the use of biological devices, such as the porcine aortic valve xenograft. In the future, bioprostheses based more closely on the natural aortic valve may ultimately succeed where synthetic approaches have failed. Some recent advances in the design and development of bioprosthetic heart valves, such as the absence of a stent and the better preservation of the valve's natural biomechanical properties, show considerable promise in improving the long term durability of these devices. With a greater understanding of the structure/function relationship of the aortic valve at the micromechanical level, the future of bioprostheses may be even more biologically oriented than it is today.

Cytocompatibility of calf pericardium treated by glutaraldehyde and by the acyl azide methods in an organotypic culture model

Glutaraldehyde (GTA) is used to cross-link collagen-based biomaterials, but these materials are often cytotoxic. In order to overcome this problem, we have proposed the use of the acyl azide methods with either hydrazine or diphenylphosphoryl azide (DPPA) as reagents. In this paper we determine the cytocompatibility of acyl azide- and GTA-treated pericardium in vitro, by an organotypic chick aorta culture technique developed for the evaluation of the propensity of vascular cells (both endothelial and smooth muscle cells) to migrate and grow on the surface of biomaterials. We first examined pericardium stabilization as a function of GTA concentration and time, so that we could minimize residual GTA molecules in the material. Treatment for 72 h with 0.05% GTA was optimal for thermal stabilization of the pericardium with a denaturation temperature (Td) of 86.8 degrees C, providing similar results to treatment with 0.6% GTA for 4 h (Td = 85.1 degrees C). Pericardium treated in this way was, however, poorly cytocompatible with little vascular cell migration and growth when compared with tissues treated by the acyl azide methods. The best results were obtained with 0.5% DPPA; treated tissues showed a high level of cross-linking (Td = 82.4 degrees C) and three-fold increases in cell growth and migration over those in a non-toxic control.

A multi-sample denaturation temperature tester for collagenous biomaterials

The temperature at which collagen denatures from a triple helix to a random coil structure is a useful measure of the degree of crosslinking. A new multi-sample denaturation temperature tester (DTT) has been constructed for rapid determination of the collagen denaturation temperature of natural tissues and collagenous biomaterials. To validate the system, the denaturation temperatures measured for the DTT are compared with results from differential scanning calorimetry (DSC). Data are presented for bovine pericardium in three states with denaturation temperatures ranging from 68 to 85 degrees C: fresh, or crosslinked with glutaraldehyde or the epoxide reagent Denacol EX-512 poly (glycidyl ether). Denaturation temperatures measured by DTT were not significantly different from those measured by differential scanning calorimetry (DSC); however, DSC onset systematically occurred at a slightly lower temperature than that measured by DTT. This result, seen only for fresh tissue is in agreement with earlier experiments using hydrothermal isometric tension (HIT) testing. By contrast, DTT and DSC onset were identical for the exogenously crosslinked materials. Since the measured transition temperature was independent of initial load, this variable may be chosen to yield sharper force-temperature transitions with a given sample geometry. This instrument allows accurate assessment of collagen denaturation temperatures for multiple samples in a fraction of the time required by other methods.

Effect of molecular structure of poly(glycidyl ether) reagents on crosslinking and mechanical properties of bovine pericardial xenograft materials

With the identification of the exacerbating effect of glutaraldehyde on calcification of heart valve materials, there exists a renewed interest in both alternative reagents and the effects of crosslinking on connective tissues. One potentially useful class of reagents are poly(glycidyl ether) compounds. We have examined 5 of these reagents with different molecular sizes and functionalities for their effects on mechanical properties and collagen denaturation (shrinkage) temperature. Samples of bovine pericardium were tested fresh or after 48 h fixation in one of the five compounds for denaturation temperature, stress-strain response, stress relaxation, plastic deformation, and fracture properties. Of the compounds tested, those with intermediate length backbones and 4 or 5 epoxide groups were most effective in producing intrahelical crosslinking and increased denaturation temperature over 48 h. However, in samples examined after 17 months of fixation, all reagents had equivalently increased the denaturation temperature. Examination of mechanical results revealed two distinct mechanisms for mechanical change. Observed shifting of the stress-strain curve to the right (due to shrinkage), increased plastic deformation, and some reduction of stress relaxation are all unrelated to denaturation temperature (and hence to changes in intrahelical crosslinking). An alternate mechanism, perhaps formation of intermolecular crosslinks may be responsible. Intrahelical crosslinking produces only lesser reductions in stress relaxation. Cross-comparison of reagents of differing molecular structure provides a useful tool toward increased understanding of the mechanical consequences of tissue crosslinking.

Development of a pericardial acellular matrix biomaterial: biochemical and mechanical effects of cell extraction

There is evidence to suggest that the cellular components of homografts and bioprosthetic xenografts may contribute to calcification or immunogenic reactions. A four-step detergent and enzymatic extraction process has been developed to remove cellular components from bovine pericardial tissue. The process results in an acellular matrix material consisting primarily of elastin, insoluble collagen, and tightly bound glycosaminoglycans. Light and electron microscopy confirmed that nearly all cellular constituents are removed without ultrastructural evidence of damage to fibrous components. Collagen denaturation temperatures remained unaltered. Biochemical analysis confirmed the retention of collagen and elastin and some differential extraction of glycosaminoglycans. Low strain rate fracture testing and high strain rate viscoelastic characterization showed that, with the exception of slightly increased stress relaxation, the mechanical properties of the fresh tissue were preserved in the pericardial acellular matrix. Crosslinking of the material in glutaraldehyde or poly(glycidyl ether) produced mechanical changes consistent with the same treatments of fresh tissue. The pericardial acellular matrix is a promising approach to the production of biomaterials for heart valve or cardiovascular patching applications.

Stabilization of pericardial tissue by dye-mediated photooxidation

Bovine pericardial tissue was stabilized through a dye-mediated photooxidation reaction. Shrink temperature analysis of the stabilized tissue indicated a material with similar properties to untreated pericardial tissue and unlike identical tissue treated with glutaraldehyde. Photooxidized tissue was resistant to extraction when compared with untreated tissue or control tissues treated in the absence of light or dye. Photooxidized tissue was also resistant to enzymatic digestion by pepsin and to chemical digestion by cyanogen bromide (CNBr). In contrast, untreated or control treated tissues were readily digested by these reagents. Reduction of photooxidized tissue with beta-mercaptoethanol prior to CNBr digestion partially restored susceptibility of the tissue to CNBr digestion, indicating the photooxidation of methionine residues. Soluble collagen derived from bovine pericardium was used as a model compound for the photooxidation reaction. Polyacrylamide gel electrophoresis analysis indicated the photooxidative conversion of collagen into higher molecular weight aggregates consistent with intermolecular crosslink formation. Photooxidized tissue was stable to in vivo degradation when compared with control tissue. Results presented here indicate a crosslinked pericardial tissue produced by dye-mediated photooxidation possessing properties of chemical stability, enzymatic stability, in vivo stability, and biomechanical integrity suitable for use as a biomaterial.

Numerical simulation of leaflet flexure in bioprosthetic valves mounted on rigid and expansile stents

Recent studies suggest that flexural stresses induced during the opening phase may be responsible for much of the mechanical failures of bioprosthetic heart valves. Sharp leaflet bending is promoted by the mounting of valves on rigid stents that do not mimic the systolic expansion of the natural aortic root. We, therefore, hypothesized that flexural stresses could be significantly reduced by incorporating a flexible or expansile supporting stent into the valve design. Using our own non-linear finite element code (INDAP) and the pre- and post-processor modules of a commercial finite element package (PATRAN), we simulated the opening and closing behaviour a trileaflet bovine pericardial valve. The leaflets of this valve were assumed to be of uniform thickness, with a non-linear elastic behaviour adapted from experimentally obtained bending stiffness data. Our simulations have shown that during maximal systolic valve opening, sharp curvatures are induced in the leaflets near their commissural attachment to the supporting stent. These areas of sharp flexure experience compressive stresses of similar magnitude to the tensile stresses induced in the leaflets during valve closure. By incorporating a stent with posts that pivot about their base, such that a 10% expansion at the commissures is realized, we were able to reduce the compressive commissural stressing from 250 to 150 kPa. This was a reduction of 40%. Conversely, a simple pliable stent with stent posts that deflect inward and outward under load did not achieve a significant reduction of compressive stresses. This numerical analysis, therefore, supports the theory that (i) high flexural and compressive stresses exist at sites of sharp leaflet bending and may promote bioprosthetic valve failure, and (ii) that proper design of the supporting stent can significantly reduce such flexural stresses.

Natural preload of aortic valve leaflet components during glutaraldehyde fixation: effects on tissue mechanics

The mechanics of glutaraldehyde-fixed aortic valve leaflets depend largely on the amount of stress present during fixation. Our previous work has suggested that even when the aortic valve is flaccid, the leaflet components are preloaded. We have, therefore, hypothesized that fixing valve leaflets in this naturally preloaded state will affect the function of their components, the fibrosa and the ventricularis. We have compared the elastic response of fibrosa and ventricularis fixed under 'low' and 'zero' tensile and compressive preload by testing 120 of these layers: (i) fresh, (ii) glutaraldehyde-fixed, and (iii) isolated from whole porcine aortic valve leaflets fixed while intact. In both the radial and circumferential directions, the fibrosa from intact-fixed valves was more extensible than the fresh (39.2 vs 29.2% strain to high modulus phase at p < 0.0122, and 12.7 vs 8.1% strain, at p < 0.0003, respectively). The ventricularis from intact-fixed valves, however, was less extensible than when fresh (35.4 vs 63.7% strain, at p < 0.00001 in the radial direction). The fibrosa must have, therefore, been fixed under compression and the ventricularis under tension, when fixed together in the intact aortic valve cusp. The tensile stresses in the intact-fixed ventricularis produced a greater circumferential elastic modulus than in separately fixed tissue (9.62 vs 4.65 MPa, at p < 0.00001), likely through a fibre recruitment process. Compressive stresses in the fibrosa produced a decrease in the elastic modulus both radially and circumferentially (from 3.79 to 2.26 MPa at p < 0.0023, and from 9.55 to 4.65 MPa at p < 0.00001, respectively). Fixing porcine aortic valves at even minimal tensile and compressive preload, such as that which occurs naturally, significantly alters both the extensibility and the elastic modulus of the valve leaflet components.

Effect of pretreatment with epoxy compounds on the mechanical properties of bovine pericardial bioprosthetic materials

Early failures of bovine pericardial heart valves are due to leaflet perforation, tearing and calcification. Since glutaraldehyde fixation has been shown to produce marked changes in leaflet mechanics and has been linked to development of calcification, bovine pericardium fixed with the four hydrophilic epoxy formulations and their mechanical properties are studied in this paper. We measured the thicknesses, shrinkage temperatures, stress relaxations and stress-strain curves of bovine pericardiums after different treatments with (1) non-treatment (fresh), (2) glutaraldehyde (GA), (3) epoxy compounds followed by the posttreatment with GA (EP 1#, EP 2#), and (4) epoxy compounds (EP 3# and EP 4#). Results of this study showed that the hydrophilic epoxy compounds are good crosslinking agents. There are no significant differences of shrinkage temperature and ultimate tensile stress among all tissue samples pretreated with GA, EP 1# and EP 2#. However, the stress relaxations of tissue-samples pretreated with epoxy compounds followed by the posttreatment with GA (EP 1# and EP 2#) are significantly slower than that pretreated with GA, and the strains at fracture of EP 1# and EP 2# are also significantly larger than that of GA or epoxy compounds. These facts show that the bovine pericardium pretreated with the epoxy compound followed by the posttreatment with GA (EP 1# and EP 2#) possesses greater tenacity and potential durability in dynamic stress.

In vitro contraction rate of collagen in sponge-shape matrices

Connective tissue substitute can be made of collagen sponge-shaped matrice which is reconstituted by freeze-drying a collagen dispersion. This procedure is then followed by a crosslinking treatment to decrease the in vivo biodegradation rate. In the present study, collagen dispersions made of collagen fibrils with a D-staggered pattern were submitted to the following treatments: (1) cyanamide or glutaraldehyde was introduced during the dispersion step followed by the manufacture of sponges; (2) uncrosslinked sponges were exposed to formaldehyde vapor; or (3) uncrosslinked and crosslinked sponges were severely dehydrated. To characterize the in vitro contraction rate, the surface areas of sponges were sequentially recorded in relation to soaking time. Contraction did not significantly occur when sponges were chemically treated. However, collagen in sponges treated by either severe dehydration or by both cyanamide treatment and severe dehydration contracted. On the other hand, the different treatments of the collagen modified the distribution of the D-staggered pattern within fibrils. After glutaraldehyde treatment, the periodicity of collagen fibrils disappeared and large fibres were observed. These experiments show that the different treatments of the collagen can be useful for designing a contractile as well as a non-contractile biomaterial.

Chemical modification of bovine pericardium and its effect on calcification in the rat subdermal model

Specific modification of functional groups in collagen has been used to investigate their influence on calcification and thermal stability of bovine pericardium. Pretreatment of pericardium with iron (III) citrate reduced calcification in the rat subcutaneous implant model, as did acyl azide activation of carboxyl and amide groups. Chondroitin sulphate had no significant effect, while cyanamide treatment was mainly effective in combination with iron (III) citrate. Glutaraldehyde pretreatment restricted reaction with other modifying agents, but, as a post-fixation treatment, improved the thermal stability of other agents. Glutaraldehyde post-fixation had no significant relationship to the calcification rate.

Mechanical properties and histology of charge modified bioprosthetic tissue resistant to calcification

Modification of bioprosthetic heart valves tissue by covalently binding protamine sulphate, results in stable covalent links of protamine to the tissue, conferring resistance to calcification. We report here the morphological evaluation and mechanical properties (elastic modulus and ultimate tensile strength) of protamine-bound bioprosthetic tissue that have high anticalcification potential. Protamine-bound bioprosthetic tissue had significantly higher tissue modulus and ultimate tensile strength values than control tissue groups. However, the mechanical properties and tissue architecture were inferior to those of bioprosthetic tissue.