Reducing calcification

[Peter Easton]

As I get used to the "other side" and move along with convalescene, I have a question for people, particuarly those with -- or contemplating -- bioprotheses: porcine, bovine and human valves (other than one's own, as in RP pulmonary-to-aortic transplant).

Rejection of the implant, which is identical (I guess) to long-term immune reaction by our organism, takes the form, as I understand it, of progressive calcification of the implanted valve. This leads in turn to reduced valve opening and lower flexibility, and that begins once again to cause the symptoms of reduced flow: breathlessness, dizziness etc that require eventual reoperation of the replacement.

My question: what, if anything, do we know about REDUCING the rate of calcification? I gather that it is naturally somewhat lower among older patients, and for that reason the life of an implanted bioprosthetic valve tends to be significantly longer in someone over, say, 65 than it is in someone 20-40. But what other factors influence it and what else can be done to enhance the life of the valve or (inversely) slow down calcification and immune response? Someone mentioned not taking calcium somewhere on a thread, but I have forgotten where. Any other insight or empirical findings that folks have? Or is this just an area for the fates?

Peter

 

[srwieland]

I asked a similar question on another thread about alternative supplements, etc., for reducing calcification, and there were some good suggestions and information provided, but I don't remember where it is. Perhaps a search done for 'calcification' will turn it up.

 

[srwieland]

Just found it in a thread called "homograft longevity" that both you and I contributed to. Check it out and maybe some of those who commented there could continue the discussion here.

 

[Peter Easton]

Found it, Steve, over on the Heart Talk forum. Here are what seemed to be the two most relevant entries. Anyone have anything else to add?

Peter

Well- my "original" aortic valve was calcified when they yanked it. I think some calcification is inevitable...my bro the doctor told me that. The surgeon told me the hope with the CryoValve SG --I got one for my pulmonic and Steve, didn't you get that for your AVR? is that it will not calcify as quickly.

If you've been lurking you know that I have been seeing an integrated medicine MD. He told me to take some of those supplements that the muscle guys take.... Cytovol and Betagen, to help with cellular regeneration and buildup...suppose to help the heart muscle grow new cells and bulk up the ones there that might have taken a beating during surgery.

Also, that old favorite Co-Q10. Plus do that heart helathy diet thing. Plus those groovy anti-oxidants...E, B, and the biggie Lipoic Acid. I do feel as though my pre-op regimine of vitamins and supplements helped me bounce back more quickly. I was out of the hospital in 3.5 days and off the vent 3 hours post op, etc. Apart from some soft tissue pain around the incision, I feel great.

That is all I know about. I am hoping to get a long while out of this Ross Procedure...

Mara

Calcium
Here is another angle I have not heard discussed. My dad's surgeon - Dr. Lytle (the Cleveland Clinic) discussed with him his previous intake of calcium.... My dad takes lots of vitamins/supplements. Dr. Lytle suspects that years ago when he took pretty high doses of calcium (1 gm/day) over a period of years - *may* have contributed to his calcification of his aortic artery and valve. He stated he even sees more of this in older people who are raised on dairy farms and probably ate more dairy products than the average person..... Interesting.... He cautioned my mom not to take calcium - even though her mom had a broken hip from osteoperosis.... Cindy

 

[ken]

Calcification

Calcification

http://www.lerner.ccf.org/bme/valve/tutorial/

"Many consider calcification to be the prime factor responsible for the degeneration and ultimate failure of bioprosthetic valves. Indeed, calcification is very severe in patients younger than twenty, probably because of their increased calcium metabolism. The severity of calcification can be correlated with both the concentration of fixative used to process the valve, and with the degree of mechanical disruption of the collagen fibers. The location of calcific deposits has also been shown to correlate well with sites that are likely to experience high tensile and flexural stresses. The resultant stiffening of the leaflets from calcification likely increases stressing of the material and accelerates the mechanical damage further. Leaflet calcification and mechanical disruption therefore appear to be interrelated,although in some cases, both calcification and tearing can occur without the presence of the other. The development and implementation of anti calcific strategies such as diphosphonate loading of cuspal material, and others will surely increase. Since subdermal implants of cuspal tissue calcify faster than whole valves in situ, results from animal modeling cannot be easily extrapolated to the clinical scenario. The effectiveness of such anticalcification schemes can, unfortunately, only be shown over the course of time."