title: Evaluation of a novel bioprosthetic heart valve incorporating anticalcification and antimicrobial technology in a sheep model.
abstract: OBJECTIVE
  The St. Jude Medical (SJM) Epic valve has been designed to diminish the risk of prosthetic valve endocarditis by the use of silver-coated polyester fabric, and to inhibit dystrophic calcification by the use of ethanol pretreatment.
  
  
  METHODS
  A 20-week juvenile sheep mitral valve implant model was used to determine safety and efficacy of the device, as well as the rate of silver release and degree of dystrophic calcification. The SJM Epic valves were compared with SJM Biocor porcine valves (not ethanol-pretreated, not silver-modified polyester fabric) and Baxter Carpentier-EdwardsR standard valves.
  
  
  RESULTS
  Blood concentrations of silver reached a maximum of 40 p.p.b. within 10 days of SJM Epic valve implantation, and were well below toxic levels (300 p.p.b.). Blood silver concentrations returned to baseline within 30 days after surgery. Maximal silver accumulation occurred in the liver (16.75 mg/g dry weight); concentrations in the brain, spleen, kidney and lung were similar to those reported for other silver-modified prosthetic valves. No statistically significant difference was found in calcium content between SJM Epic and Biocor valves. The fibrous response to the sewing cuff was similar among the three valve types.
  
  
  CONCLUSIONS
  At all times tested, silver release from the SJM Epic valve led to blood concentrations well below toxic levels. Although calcification in the two SJM valve groups was extremely low, the 20-week sheep model may be insufficiently sensitive to detect differences in calcium accumulation in modern bioprosthetic valves.
authors.affiliation: St. Jude Medical, Inc., St. Paul, Minnesota 55117, USA. DLanganki@sjm.com
authors.forename: D
authors.initials: D
authors.lastname: Langanki
authors.forename: M F
authors.initials: MF
authors.lastname: Ogle
authors.forename: J D
authors.initials: JD
authors.lastname: Cameron
authors.forename: R A
authors.initials: RA
authors.lastname: Lirtzman
authors.forename: R F
authors.initials: RF
authors.lastname: Schroeder
authors.forename: M W
authors.initials: MW
authors.lastname: Mirsch
mesh_terms: D000818:Animals; D001705:Bioprosthesis; D002114:Calcinosis / Q000517:prevention & control; D005069:Evaluation Studies as Topic; D006350:Heart Valve Prosthesis; D008943:Mitral Valve; D011091:Polyesters; D011183:Postoperative Complications / Q000517:prevention & control; D011897:Random Allocation; D012756:Sheep
chemical_list: D011091:Polyesters