Heart valve replacement: Which valve for which patient?

Huh, Joseph; Bakaeen, Faisal G.

doi:10.1007/s11886-006-0021-2

Cited by 2 publications

(1 citation statement)

References 61 publications

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“…The compliance monitoring (based on the measure of its diametric displacement) was a method first used by Vilendrer and Nickel [104] and Webb and colleagues [105] for the real-time assessment of the TEHV behavior. TEHVs' ability to undergo growth and remodeling would overcome the limited lifetime of currently mechanical valves and bioprostheses [106,107] providing cardiac surgeons with an alternative choice to the latest commercially available valvular substitutes.…”

Section: Development Of Customized Bioreactorsmentioning

confidence: 99%

Cells, scaffolds and bioreactors for tissue-engineered heart valves: a journey from basic concepts to contemporary developmental innovations☆

Gandaglia

Bagno

Naso

et al. 2011

European Journal of Cardio-Thoracic Surgery

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The development of viable and functional tissue-engineered heart valves (TEHVs) is a challenge that, for almost two decades, the scientific community has been committed to face to create life-lasting prosthetic devices for treating heart valve diseases. One of the main drawbacks of tissue-based commercial substitutes, xenografts and homografts, is their lack of viability, and hence failure to grow, repair, and remodel. In adults, the average bioprostheses life span is around 13 years, followed by structural valve degeneration, such as calcification; in pediatric, mechanical valves are commonly used instead of biological substitutes, as in young patients, the mobilization of calcium, due to bone remodeling, accelerates the calcification process. Moreover, neither mechanical nor bioprostheses are able to follow children's body growth. Cell seeding and repopulation of acellular heart valve scaffolds, biological and polymeric, appears as a promising way to create a living valve. Biomechanical stimuli have significant impact on cell behavior including in vitro differentiation, and physiological hemodynamic conditioning has been found to promote new tissue development. These concepts have led scientists to design bioreactors to mimic the in vivo environment of heart valves. Many different types of somatic and stem cells have been tested for colonizing both the surface and the core of the valve matrix but controversial results have been achieved so far.

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Section: Development Of Customized Bioreactorsmentioning

confidence: 99%

Cells, scaffolds and bioreactors for tissue-engineered heart valves: a journey from basic concepts to contemporary developmental innovations☆

Gandaglia

Bagno

Naso

et al. 2011

European Journal of Cardio-Thoracic Surgery

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Computational analysis of heart valve growth and remodeling after the Ross procedure

Middendorp,

Braeu,

Baaijens

et al. 2024

Biomech Model Mechanobiol

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During the Ross procedure, an aortic heart valve is replaced by a patient’s own pulmonary valve. The pulmonary autograft subsequently undergoes substantial growth and remodeling (G&R) due to its exposure to increased hemodynamic loads. In this study, we developed a homogenized constrained mixture model to understand the observed adaptation of the autograft leaflets in response to the changed hemodynamic environment. This model was based on the hypothesis that tissue G&R aims to preserve mechanical homeostasis for each tissue constituent. To model the Ross procedure, we simulated the exposure of a pulmonary valve to aortic pressure conditions and the subsequent G&R of the valve. Specifically, we investigated the effects of assuming either stress- or stretch-based mechanical homeostasis, the use of blood pressure control, and the effect of root dilation. With this model, we could explain different observations from published clinical studies, such as the increase in thickness, change in collagen organization, and change in tissue composition. In addition, we found that G&R based on stress-based homeostasis could better capture the observed changes in tissue composition than G&R based on stretch-based homeostasis, and that root dilation or blood pressure control can result in more leaflet elongation. Finally, our model demonstrated that successful adaptation can only occur when the mechanically induced tissue deposition is sufficiently larger than tissue degradation, such that leaflet thickening overrules leaflet dilation. In conclusion, our findings demonstrated that G&R based on mechanical homeostasis can capture the observed heart valve adaptation after the Ross procedure. Finally, this study presents a novel homogenized mixture model that can be used to investigate other cases of heart valve G&R as well.

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Heart valve replacement: Which valve for which patient?

Cited by 2 publications

References 61 publications

Cells, scaffolds and bioreactors for tissue-engineered heart valves: a journey from basic concepts to contemporary developmental innovations☆

Cells, scaffolds and bioreactors for tissue-engineered heart valves: a journey from basic concepts to contemporary developmental innovations☆

Computational analysis of heart valve growth and remodeling after the Ross procedure

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