The role of mechanical valves in the aortic position in the era of bioprostheses and TAVR: Evidence-based appraisal and focus on the On-X valve

Gerdisch, Marc W.; Sathyamoorthy, Mohanakrishnan; Michelena, Héctor I.

doi:10.1016/j.pcad.2022.06.001

Cited by 5 publications

(3 citation statements)

References 78 publications

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“… 28 Data from observational and propensity-matched studies, randomized controlled trials, and meta-analyses have provided evidence of survival advantage of mechanical aortic valves over bioprosthetic valves, especially in patients younger than 65 years of age as bioprosthetic valves lack durability. 29 …”

Section: Introductionmentioning

confidence: 99%

Bicuspid Aortic Valve Disease: Classifications, Treatments, and Emerging Transcatheter Paradigms

Kalra,

Das,

Alkhalil

et al. 2024

Structural Heart

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Section: Introductionmentioning

confidence: 99%

Bicuspid Aortic Valve Disease: Classifications, Treatments, and Emerging Transcatheter Paradigms

Kalra,

Das,

Alkhalil

et al. 2024

Structural Heart

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“…Mechanical valve replacements require patients to take anticoagulants indefinitely, and bioprosthetic valves have relatively poor durability. Neither valve replacement can provide a permanent solution to VHDs for patients because these valves cannot grow or remodel after implantation . Thus, heart valve tissue engineering aims to overcome the limitations of current valve replacements using biodegradable polymer substrates to develop tissue-engineered valves capable of growth and remodeling.…”

Section: Introductionmentioning

confidence: 99%

Elastomeric Trilayer Substrates with Native-like Mechanical Properties for Heart Valve Leaflet Tissue Engineering

Snyder

Jana

2023

ACS Biomater. Sci. Eng.

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Heart valve leaflets have a complex trilayered structure with layer-specific orientations, anisotropic tensile properties, and elastomeric characteristics that are difficult to mimic collectively. Previously, trilayer leaflet substrates intended for heart valve tissue engineering were developed with nonelastomeric biomaterials that cannot deliver native-like mechanical properties. In this study, by electrospinning polycaprolactone (PCL) polymer and poly(l-lactide-co-ε-caprolactone) (PLCL) copolymer, we created elastomeric trilayer PCL/PLCL leaflet substrates with native-like tensile, flexural, and anisotropic properties and compared them with trilayer PCL leaflet substrates (as control) to find their effectiveness in heart valve leaflet tissue engineering. These substrates were seeded with porcine valvular interstitial cells (PVICs) and cultured for 1 month in static conditions to produce cell-cultured constructs. The PCL/PLCL substrates had lower crystallinity and hydrophobicity but higher anisotropy and flexibility than PCL leaflet substrates. These attributes contributed to more significant cell proliferation, infiltration, extracellular matrix production, and superior gene expression in the PCL/PLCL cell-cultured constructs than in the PCL cell-cultured constructs. Further, the PCL/PLCL constructs showed better resistance to calcification than PCL constructs. Trilayer PCL/PLCL leaflet substrates with native-like mechanical and flexural properties could significantly improve heart valve tissue engineering.

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“…Mechanical prosthetic valves (MPVs), for which oral direct Factor Xa inhibitors failed to be a valid option ( 2 , 3 ), are not generally considered in patients above 65 years-old, even if a long-standing anticoagulant therapy is required and despite the fact that acceptable outcomes with a MPV may be achieved in selected elderly patients ( 4 ). To avoid imposing to a young patient a life-long anticoagulant therapy whenever a Ross procedure or an aortic valvular repair is out of reach, a BPV in aortic position is often perceived to be the best second choice.…”

Section: Introductionmentioning

confidence: 99%

Trends in SAVR with biological vs. mechanical valves in middle-aged patients: results from a French large multi-centric survey

Caus,

Chabry,

Nader

et al. 2023

Front. Cardiovasc. Med.

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Background/introductionCurrently, despite continued issues with durability ( 1), biological prosthetic valves are increasingly chosen over mechanical valves for surgical aortic valve replacement (SAVR) in adult patients of all ages, at least in Western countries. For younger patients, this choice means assuming the risks associated with a redo SAVR or valve-in-valve procedure.PurposeTo assess the use of mechanical vs. biological valve prostheses for SAVR relative to patient's age and implant time in a large population extracted from the French National Database EPICARD.MethodsPatients in EPICARD undergoing SAVR from 2007 to 2022 were included from 22 participating public or private centers chosen to represent a balanced representation of centre sizes and geographical discrepancies. Patients with associated pathology of the aorta (aneurysm or dissection) and requiring a vascular aortic prosthesis were excluded. Comparisons were made amongst centers, valve choice, implant date range, and patient age.ResultsWe considered 101,070 valvular heart disease patients and included 72,375 SAVR (mean age 71.4 ± 12.2 years). We observed a mechanical vs. biological prosthesis ratio (MBPR) of 0.14 for the overall population. Before 50 years old (y-o), MBPR was >1.3 (p < 0.001) while patients above 60 years-old received principally biological SAVR (p < 0.0001). Concerning patients between 50 and 60 years-old patients, MPVR was 1.04 (p = 0.03). Patients 50–60 years-old from the first and second study duration quartile (before August 2015) received preferentially mechanical SAVR (p < 0.001). We observed a shift towards more biological SAVR (p < 0.001) for patients from the third and fourth quartile to reach a MBPR at 0.43 during the last years of the series. Incidentally, simultaneous mitral valve replacement were more common in case of mechanical SAVR (p < 0.0001), while associated CABGs were more frequent in case of biological SAVR (p < 0.0001).ConclusionIn a large contemporary French patient population, real world practice showed a recent shift towards a lower age-threshold for biological SAVR as compared to what would suggest contemporary guidelines.

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The role of mechanical valves in the aortic position in the era of bioprostheses and TAVR: Evidence-based appraisal and focus on the On-X valve

Cited by 5 publications

References 78 publications

Bicuspid Aortic Valve Disease: Classifications, Treatments, and Emerging Transcatheter Paradigms

Bicuspid Aortic Valve Disease: Classifications, Treatments, and Emerging Transcatheter Paradigms

Elastomeric Trilayer Substrates with Native-like Mechanical Properties for Heart Valve Leaflet Tissue Engineering

Trends in SAVR with biological vs. mechanical valves in middle-aged patients: results from a French large multi-centric survey

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