To investigate the role of extracellular matrix (ECM) injury in bioprosthetic valve calcification, we constructed an ECM damage model by applying a 15 N stress to the bovine pericardium sample in both transverse and longitudinal directions after tissue cross-linking, whereas no stress was applied in the control group. Then we implanted two pieces of bovine pericardium on both sides of the dorsal midline in Wistar rats from both groups and measured the calcium content of the implanted bovine pericardium. The results showed that the calcium content of experimental group was significantly higher than that of control group ( p < 0.05). Second, we implanted prosthetic valves made from bovine pericardium in the experimental and control groups into small-tailed Han sheep ( Ovis aries ). After 180 days, the prosthetic valve was removed for gross and histopathological observation as well as quantitative analysis of calcium. We found a higher average calcium content in bovine pericardium from the experimental group than that from controls. Furthermore, calcium salt deposition was detected on the ventricular surface of valves along with roughened valve leaflets in the experimental group. Our data support the hypothesis that the bovine pericardium with ECM injury is more prone to calcification.
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