Optimization of diamine bridges in glutaraldehyde treated bioprosthetic aortic wall tissue

Objective: Bioprosthetic calcification can be significantly mitigated by both increased concentrations of glutaraldehyde (GA) and the introduction of diamine (DA) bridges. The purpose of the present study was to evaluate whether an optimal effect of DA-enhanced fixation can be achieved by titration of dialdehyde and diamine concentrations. Methods: Porcine aortic roots were fixed at 0.05% GA (under-fixation) or 0.2% GA and 0.7% GA (commercial fixation). An interim step of DA treatment ( -Lysine; 0, 25, 50 or 100 m ; 37°C; 2 days) was followed by completion of the GA fixation (37°C; 5 days). Aortic wall coupons (12 mm) were punched out and implanted subcutaneously into seven-week old Long-Evans rats for 60 days. Calcium content was assessed by atomic absorption spectroscopy and histology. Results: Increasing the -Lysine concentrations beyond 25 m was essential to achieve the anti-calcific effect of DA-enhanced fixation. This effect was proportional to the GA concentrations applied. Compared to non-enhanced GA fixation (0 m DA), calcification increased by 17.4% (p=0.2114) in 0.05% fixed tissue but decreased by 32.0% (p<0.0001) and 45.1% (p<0.0002) in 0.2% and 0.7% GA, respectively, when the DA concentration was 100 m . Histologically the extent, but not the pattern of calcification, was affected. Conclusion: The calcium mitigating effect of diamine-treatment as an interim step of glutaraldehyde fixation is proportional to the GA concentration applied. Within commercial 0.7% GA fixation 100 m DA has the potential to practically halve aortic wall calcification.