Glycation and Serum Albumin Infiltration Contribute to the Structural Degeneration of Bioprosthetic Heart Valves
A. Frasca, Yingfei Xue, Alexander P. Kossar, Samuel Keeney, Christopher A. Rock, Andrey Zakharchenko, Matthew D. Streeter, Robert C. Gorman, Juan B. Grau, Isaac George, Joseph E. Bavaria, Abba Μ. Krieger, David A. Spiegel, Robert J. Levy, Giovanni Ferrari
Abstract
Valvular heart diseases are associated with significant cardiovascular morbidity and mortality, and often require surgical and/or percutaneous repair or replacement. Valve replacement is limited to mechanical and biological prostheses, the latter of which circumvent the need for lifelong anticoagulation but are subject to structural valve degeneration (SVD) and failure. Although calcification is heavily studied, noncalcific SVD, which represent roughly 30% of BHV failures, is relatively underinvestigated. This original work establishes 2 novel and interacting mechanisms-glycation and serum albumin incorporation-that occur in clinical valves and are sufficient to induce hallmarks of structural degeneration as well as functional deterioration.