Bioprosthetic Heart Valves: Upgrading a 50-Year Old Technology

Li, Kan Yan Chloe

doi:10.3389/fcvm.2019.00047

Cited by 47 publications

(36 citation statements)

References 75 publications

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“…Several noncalcific mechanisms have been proposed to contribute to SVD, including inflammatory oxidation, tissue thickening, and collagen network degeneration 4,8 . however, technologies to address known mechanisms thus far have not significantly improved valve durability, suggesting that additional key mechanisms remain unidentified 9,10 .…”

Section: Introductionmentioning

confidence: 99%

Glycation and Serum Albumin Infiltration Contribute to the Structural Degeneration of Bioprosthetic Heart Valves

Frasca

Xue

Kossar

et al. 2020

Preprint

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Background: Bioprosthetic heart valves (BHV) are widely used to treat heart valve disease but are fundamentally limited by structural valve degeneration (SVD). Non-calcific mechanisms of SVD entirely account for approximately 30% of SVD cases and contribute to calcific SVD but remain understudied. Glycation mechanisms have not been previously associated with SVD, despite being established as degenerative in collagenous native tissues. Objectives:To determine whether blood component infiltration-based glycation and concomitant human serum albumin (HSA) deposition contribute mechanistically to SVD.Methods: Immunohistochemistry (IHC) was used to identify advanced glycation end-products (AGEs) and serum albumin accumulation in 45 aortic valve BHV explanted due to SVD, glutaraldehyde-treated bovine pericardium (BP) incubated in vitro in glyoxal and HSA, and rat subcutaneous BP implants. Structural impacts of glycation-related mechanisms were evaluated by second harmonic generation (SHG) collagen imaging. Hydrodynamic effects of valve glycation and concomitant HSA exposure were studied with an ISO-5840-compliant pulse duplicator system using surgical grade BHV.Results: All 45 clinical explants and in vitro-incubated BP demonstrated accumulated AGE and HSA compared to un-implanted, un-exposed BHV. SHG revealed instigation of collagen malalignment similar to that in SVD explants by glycation and HSA infiltration. Rat subdermal explants also showed AGE and serum albumin accumulation. Pulse duplication demonstrated significantly reduced orifice area and increased pressure gradient and peak fluid velocity following glyoxal and HSA incubations. Conclusions:Glycation and concomitant HSA infiltration occur in clinical BHV and contribute to structural and functional degeneration of leaflet tissue, thus representing novel, interacting mechanisms of BHV SVD.

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Section: Introductionmentioning

confidence: 99%

Glycation and Serum Albumin Infiltration Contribute to the Structural Degeneration of Bioprosthetic Heart Valves

Frasca

Xue

Kossar

et al. 2020

Preprint

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“…The semilunar valves are uniquely structured to open and close without the aid of the chords and papillary muscles. The tricuspid semilunar valve with properly sized and shaped sinuses of Valsalva appears to be the ideal configuration for optimal hemodynamics, compared to mono or bicuspid variants [4,[8][9][10]. Any alteration in the number of valve leaflets, the size of the valve annulus and the size and shape of the sinuses may result in inadequate flow or turbulence across the valvular orifice and damage to the valve leaflets.…”

Section: Discussionmentioning

confidence: 99%

Simulation of semilunar valve function: computer-aided design, 3D printing and flow assessment with MR

et al. 2020

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Background: The structure of the valve leaflets and sinuses are crucial in supporting the proper function of the semilunar valve and ensuring leaflet durability. Therefore, an enhanced understanding of the structural characteristics of the semilunar valves is fundamental to the evaluation and staging of semilunar valve pathology, as well as the development of prosthetic or bioprosthetic valves. This paper illustrates the process of combining computer-aided design (CAD), 3D printing and flow assessment with 4-dimensional flow magnetic resonance imaging (MRI) to provide detailed assessment of the structural and hemodynamic characteristics of the normal semilunar valve. Methods: Previously published geometric data on the aortic valve was used to model the 'normal' tricuspid aortic valve with a CAD software package and 3D printed. An MRI compatible flow pump with the capacity to mimic physiological flows was connected to the phantom. A peak flow rate of 100 mL/s and heart rate of 60 beats per minute were used. MRI measurements included cine imaging, 2D and 4D phase-contrast imaging to assess valve motion, flow velocity and complex flow patterns. Results: Cine MRI data showed normal valve function and competency throughout the cardiac cycle in the 3Dprinted phantom. Quantitative analysis of 4D Flow data showed net flow through 2D planes proximal and distal to the valve were very consistent (26.03 mL/s and 26.09 mL/s, respectively). Measurements of net flow value agreed closely with the flow waveform provided to the pump (27.74 mL/s), confirming 4D flow acquisition in relation to the pump output. Peak flow values proximal and distal to the valve were 78.4 mL/s and 63.3 mL/s, respectively. Particle traces of flow from 4D-phase contrast MRI data demonstrated flow through the valve into the ascending aorta and vortices within the aortic sinuses, which are expected during ventricular diastole. Conclusion: In this proof of concept study, we have demonstrated the ability to generate physiological 3D-printed aortic valve phantoms and evaluate their function with cine-and 4D Flow MRI. This technology can work synergistically with promising tissue engineering research to develop optimal aortic valve replacements, which closely reproduces the complex function of the normal aortic valve.

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“…They have high durability profile and usually outlive their patients but very thrombogenic and as such require long-term anticoagulation therapy [6,7]. They are less preferred among young individuals, pregnant or women in reproductive age, in developing world where anti-coagulation monitoring might be a challenge [8] and moreover the side effects of embryopathy or teratogenicity associated with the long-term anticoagulation that these patients had to be on, especially the oral anticoagulant, warfarin.…”

Section: Artificial Bioprosthetic (Tissue) Heart Valvesmentioning

confidence: 99%

“…As such, it is deemed a less safe option for implantation in younger patients who are less than 50 years as compared to mechanical valves since the patient may outlive the valve. And this more common in areas of the world with high life expectancy as in high income countries due to the risk of structural valve deterioration [8,9]. Therefore, the search of a longer lasting bioprosthetic (tissue) heart valve has continued.…”

Section: Artificial Bioprosthetic (Tissue) Heart Valvesmentioning

confidence: 99%

The First Implantation of the Novel Biological Heart Valve, the Inspiris Resilia Aortic Tissue Valve in Africa

Okyere¹,

Singh²,

Okyere³

et al. 2020

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The durability of artificial bioprosthestic or tissue heart valves is limited by structural valve deterioration (SVD) due to long-term calcification especially in young patients and in Africa. A novel bioprosthestic valve, the Resilia Inspiris Aortic Tissue Valve has been developed which, in preclinical studies, has shown reduced calcification thus improving durability. The Inspiris Resilia Aortic Valve is a stented tri-leaflet valve made from bovine pericardial tissue. The tissue is created by treating bovine pericardial tissue with Edwards Integrity Preservation. It incorporates a stable capping anticalcification process, which blocks residual aldehyde groups known to bind with calcium. Tissue preservation with glycerol allows the valve to be stored without a traditional liquid-based solution, such as glutaraldehyde. Therefore, the valve is stored under dry packaging conditions and consequently does not require rinsing prior to implantation. The novel tissue preservation technology significantly improves hemodynamic and anticalcification properties compared with the standard artificial bioprosthestic aortic valve, the Perimount tissue valve. The experience of the implantation of this valve in Africa is limited for there seems to be no published experience of the behaviour of the implantation of this special long lasting bioprosthestic valve in Africa and therefore the purpose of this paper is to share our initial experience of the first successful implantation of this Inspiris Resilia Aortic Valve™ in Ghana, Africa. The implantation was done in a 57-year-old patient who presented with symptomatic moderate to severe aortic valve regurgitation with adequate left ventricular systolic function. He has been followed-up for a year now with well-healed wounds and a transthoracic echocardiography revealing a well-seated valve with no regurgitant flow or paravalvular leak. This is the first report describing the use of the new Inspiris Resilia Aortic valve which has increased durability and does not require anticoagulation in Africa as far as we know.

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Bioprosthetic Heart Valves: Upgrading a 50-Year Old Technology

Cited by 47 publications

References 75 publications

Glycation and Serum Albumin Infiltration Contribute to the Structural Degeneration of Bioprosthetic Heart Valves

Glycation and Serum Albumin Infiltration Contribute to the Structural Degeneration of Bioprosthetic Heart Valves

Simulation of semilunar valve function: computer-aided design, 3D printing and flow assessment with MR

The First Implantation of the Novel Biological Heart Valve, the Inspiris Resilia Aortic Tissue Valve in Africa

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