Residual Bioprosthetic Valve Immunogenicity: Forgotten, Not Lost

Frontiers in Cardiovascular Medicine

Paul Human¹  Deon Bezuidenhout¹  Elena Aikawa³  Peter Zilla⁴ 

[1] Cardiovascular Research Unit, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa;Chris Barnard Division of Cardiothoracic Surgery, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa;Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States;Faculty of Health Sciences, Cape Heart Institute, University of Cape Town, Cape Town, South Africa;

关键词: bioprosthetic;    valve;    extracellular matrix;    decellularization;    immunogenicity;    pathology;   

DOI  :  10.3389/fcvm.2021.760635

来源: DOAJ

【 摘 要 】

Despite early realization of the need to control inherent immunogenicity of bioprosthetic replacement heart valves and thereby mitigate the ensuing host response and its associated pathology, including dystrophic calcification, the problem remains unresolved to this day. Concerns over mechanical stiffness associated with prerequisite high cross-link density to effect abrogation of this response, together with the insinuated role of leaching glutaraldehyde monomer in subsequent dystrophic mineralization, have understandably introduced compromises. These have become so entrenched as a benchmark standard that residual immunogenicity of the extracellular matrix has seemingly been relegated to a very subordinate role. Instead, focus has shifted toward the removal of cellular compartment antigens renowned for their implication in the failure of vascularized organ xenotransplants. While decellularization certainly offers advantages, this review aims to refocus attention on the unresolved matter of the host response to the extracellular matrix. Furthermore, by implicating remnant immune and inflammatory processes to bioprosthetic valve pathology, including pannus overgrowth and mineralization, the validity of a preeminent focus on decellularization, in the context of inefficient antigen and possible residual microbial remnant removal, is questioned.

【 授权许可】

Unknown