Calcification – A Persisting Problem of (Bio-)Materials for CHD-Patients

Background: Calcification is a major degeneration cause of (bio-)materials used for reconstructive surgery in patients with congenital heart disease (CHD). In this study, we investigate the influence of age at primary and re-operation and duration of implantation on calcification in explants from CHD-patients.

Methods: Explanted (bio-) materials gathered from re-operations of CHD-patients from 03/2015 – 07/2023 were processed histologically and stained with alizarin red S to visualize calcification. After standardized microscopy, we identified samples with clear calcification. We divided samples into 4 calcification degrees (0: no calcification – 3: extreme calcification). The patient cohort was partitioned according to duration of implantation (short: 0–3 years, medium: 3–10 years and long: > 10 years). First, we analyzed in how far duration of implantation, age at primary surgery and age at re-operation can predict clear calcification in logistic regression analysis. Then X2 test was performed to assess the relationship between calcification degree and partitioned duration of implantation.

Results: 108 patients were included in the analysis (male n = 62 (57.4%), age at reoperation 14.9 (29.2 – 9) years). 16 (14.8%) explants showed short, 41 (38%) medium and 51 (47.2%) long implantation times. 87 (80.5%) explants were gathered from RVOT and 21 (19.4%) were LVOT samples. (Bio-) materials had a median duration of implantation of 9.4 (22.4 – 4.5) years. 66 explants (61.1%) showed clear calcification. Although significant, the prediction coefficients of duration of implantation and age at re-operation on clear calcification were low (duration of implantation: 0.05, p = 0.005, age at re-operation: 0.03, p = 0.017). Age at primary operation did not predict clear calcification (0.004, p = 0.857). There was no significant relationship between calcification degree and partitioned duration of implantation groups in X2 test (p = 0.28).

Conclusion: Duration of implantation and age at re-operation showed only a low predictive ability on clear calcification. Age at primary operation did not influence clear calcification. The degree of calcification was independent of partitioned duration of implantation in our cohort. Calcification remains a major problem of material degeneration in CHD-patients in all implantation times. Research should focus on underlying mechanisms to prevent calcification as early as possible.

Publication History

Article published online:
14 June 2024