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Journal of Long-Term Effects of Medical Implants
Inflammatory and Immune Processes: The Neglected Villain of Bioprosthetic Degeneration?
Department of Cardiothoracic Surgery, Cape Heart Centre, University of Cape Town Medical School, Cape Town, South Africa
Department of Cardiothoracic Surgery, University of Cape Town, Cape Town, 7925, South Africa
In an attempt to avoid the destructive process of bioprosthetic heart-valve calcification associated with the use of glutaraldehyde, valves are today prepared using low concentrations of the crosslinking reagent. In this review, we summarize our findings and those of others that confirm that the immunogenicity of such tissue is not sufficiently masked and that a defined humoral response is indeed mounted against a repertoire of antigens unrelated to those associated with vascularized and noncross-linked xenograft organs. We demonstrate the need for increased cross-linking of tissue to satisfactorily mitigate that response; furthermore, we examine the impact of increased cross-link density on the macrophage as antigen presenting cell with respect to its involvement in both tissue erosion and pannus overgrowth. Finally we present evidence for a role of circulating antibodies in bioprosthesis calcification.
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