Antimineralization treatment and patient-prosthesis mismatch are major determinants of the onset and incidence of structural valve degeneration in bioprosthetic heart valves

Abstract

Antimineralization treatment of bioprosthetic heart valves is effective and reduces the incidence of SVD significantly. Because valve type and size are determined at the moment of implantation, the surgeon carries an important responsibility in protecting the patient from valve degeneration.

Accelerated Degeneration of a Bovine Pericardial Bioprosthetic Aortic Valve in Children and Young Adults

“…Of note, the absence of antimineralization treatment in some bioprosthetic valves, including the Mitroflow LXA, has been shown to be an independent predictor of structural valve deterioration in a prior report. 21 The relationship between the use of this process and the observed lower incidence of early leaflet calcification and immobility in patients receiving the Magna and Magna Ease valve is speculative but supported by these data. Patient characteristics, including known risk factors for early valve failure, differed between the valve groups.…”

“…7,9,[21][22][23][24][25] Few data are available, however, to describe the rate of progression of stenosis in the individual patient. In a longitudinal analysis of serial echocardiographic measurements after AVR in children, Karamlou et al 26 reported an initial rapid rise in prosthetic aortic valve gradient, followed by a more gradual rise.…”

Bioprosthetic Aortic Valve Replacement in the Young

“…A recent retrospective study conducted in elderly patients (mean age, 74 years) showed lack of antimineralization to be in important risk factor for early bioprosthetic valve deterioration. 20 In conclusion, the present report is a cautionary tale for those who care for young adults with aortic valve disease. The version of the Mitroflow valve available in the United States should not be implanted in young adults in the future.…”

Emerging Trends in Heart Valve Engineering: Part II. Novel and Standard Technologies for Aortic Valve Replacement

“…74 Despite advances, structural deterioration continues to be the major cause of valve failure, and the principal underlying pathologic process is cuspal calcification. 33,74 Many strategies have been used to counteract this process which includes systemic and localized drug delivery along with substrate modification. 74 While drug administration has fallen by the wayside, substrate modification through the use of inhibitors for calcium phosphate formation, removal of calcifiable material, improvement of glutaraldehyde fixation and the use of fixatives other than glutaraldehyde.…”