A geometrically adaptable heart valve replacement

Abstract

Congenital heart valve disease has life-threatening consequences that warrant early valve replacement; however, the development of a growth-accommodating prosthetic valve has remained elusive. Thousands of children continue to face multiple high-risk open-heart operations to replace valves that they have outgrown. Here, we demonstrate a biomimetic prosthetic valve that is geometrically adaptable to accommodate somatic growth and structural asymmetries within the heart. Inspired by the human venous valve, whose geometry is optimized to preserve functionality across a wide range of constantly varying volume loads and diameters, our balloon-expandable synthetic bileaflet valve analog exhibits similar adaptability to dimensional and shape changes. Benchtop and acute in vivo experiments validated design functionality, and in vivo survival studies in growing sheep demonstrated that mechanical valve expansion accommodated growth. As illustrated in this work, dynamic size adaptability with preservation of unidirectional flow in prosthetic valves thus offers a paradigm shift in the treatment of heart valve disease.

Biomaterials in Valvular Heart Diseases

“…The adjustable dimensions of this valve allows it to be implanted at any age. Although, they used ePTFE for fabricating valve leaflets, the authors conclude that more research is needed to confirm that ePTFE is the ideal biomaterial for this purpose (Hofferberth et al, 2020).…”

“…(G-I) Valve expansion geometry for the primary valve geometry and functional prototype, in vitro flow loop testing of functional prototype at two polar expansion states, and representative right ventricular and pulmonary artery pressures recorded at two states of valve expansion. Reprinted with permission fromHofferberth et al (2020). Copyright (2020), American Association for the advancement of Science.…”

Porcine Model of the Arterial Switch Operation: Implications for Unique Strategies in the Management of Hypoplastic Left Ventricles

“…This directs pulmonary venous blood to the right atrium and systemic venous blood to the left atrium, thus enhancing atrial mixing. Although we initially chose the pig model system for this project due to its close molecular homology to humans, similarity to the human heart in anatomy and conserved changes in RV systolic pressure following birth in piglets compared to human infants [12][13][14] we are also considering an ovine model given its more favorable cardiac anatomy and hemostasis noted in our prior experience with fetal and neonatal surgery in lambs [15][16][17][18][19].…”

Feasibility Study of Catheter-Based Interventions for Anisotropic Expanded Polytetrafluoroethylene Cardiovascular Conduits in a Growing Lamb Model

“…Surgery for congenital heart disease often requires implantation of conduits for repair, conduits which do not have growth potential and will require multiple repeat interventions or operations [1][2][3][4]. There is an ongoing search for bioactive conduits that grow with a patient, potentially eliminating the need for repeated surgical procedures to replace faulty valves and outgrown conduits [5][6][7][8][9][10][11][12][13][14][15].…”