Alpha-Amino Oleic Acid as Anticalcification Agent for Porcine Bioprosthetic Heart Valves: A Narrative Review

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ID: 329077
2026
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Abstract
Abstract Objective Calcification remains the principal mechanism limiting the durability of bioprosthetic heart valves. Alpha-amino oleic acid (AOA) was developed as an anticalcification treatment to preserve tissue integrity. This review synthesizes preclinical and clinical evidence on the efficacy of AOA–treated bioprosthetic valves. Methods A narrative review was conducted using major biomedical databases to assess experimental and clinical studies evaluating AOA–treated tissues and valve platforms. Evidence from in vitro experiments, small/large animal models, and long-term clinical cohorts was qualitatively synthesized, with emphasis on calcification, structural valve degeneration, and durability outcomes. Results Preclinical studies consistently demonstrated significant reductions in leaflet calcification in AOA–treated tissues compared with glutaraldehyde-fixed controls, across multiple models. These effects were most pronounced in leaflet tissue, whereas protection of the aortic wall or conduit tissue was less consistent. Large-animal models confirmed delayed mineralization and preservation of leaflet flexibility, but revealed susceptibility of non-leaflet components to calcific degeneration. Clinically, long-term follow-up of several surgical valve platforms incorporating AOA showed acceptable freedom from structural valve degeneration extending beyond ten years in selected patient populations. Durability remains strongly age-dependent, and late valve failures can still be associated with progressive calcification. Evidence from newer valve platforms is becoming available through various long-term follow-up studies. Conclusion AOA provides effective anticalcification protection of bioprosthetic valve leaflets, supporting durable clinical performance in surgical platforms.
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Authors Lennart Vanglabeke, Marie Bosch, Kenny Anseele, Tom Verbelen, Bart Meuris
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Journal Interdisciplinary CardioVascular and Thoracic Surgery
Year 2026
DOI
10.1093/icvts/ivag246
URL
https://doi.org/10.1093/icvts/ivag246
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