Bioprosthetic Heart Valves: Impact of Implantation on Biomaterials

Singhal, Pooja; Luk, Adriana; Butany, Jagdish

doi:10.5402/2013/728791

Cited by 70 publications

(78 citation statements)

References 54 publications

(69 reference statements)

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“…Valve replacements generally exist in two forms: mechanical heart valves (MHVs) or bioprosthetic (biological) heart valves (BHVs) [9]. There are five categories of biological heart valves: autograft, autologous, homografts, pericardial valves, and porcine xenografts [7].…”

Section: Heart Valvesmentioning

confidence: 99%

“…Mechanical valves are typically created from non-biological materials like polymers, metal, carbon, and various alternatives [9]. Of the two valve replacement types, roughly half of U.S. patients receive bioprosthetic valves.…”

Section: Heart Valvesmentioning

confidence: 99%

“…BHVs are fixed in glutaraldehyde to reduce immunogenicity and ameliorate the mechanical strength of the heart valve; however, this fixation reduces antigen presentation and chemical stabilization by concealing antigens and eventually leading to an influx in calcium [9]. Consequently, glycoproteins and other substances are lost during glutaraldehyde fixation which allows for the formation of a calcium phosphate precipitate that would not occur under normal cardiac conditions [17].…”

Section: Stentedmentioning

confidence: 99%

“…Post-implantation failure is another factor, largely due to age of the patient given that children and young adults have a more competent immune system and experience a higher rate of BHV failure. In some countries lacking adequate ways of monitoring patients, mortality is an increased risk [9]. Calcification is also a major cause of deterioration in BHV replacements.…”

Section: Future Workmentioning

confidence: 99%

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Calcification of Biomaterials and Diseased States

Mosier¹,

Nguyen²,

Parker³

et al. 2018

Biomaterials - Physics and Chemistry - New Edition

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Calcification is one of the most common issues that arise concerning biocompatibility, known to affect many systems in the body. It is often associated with an increase in free phosphate and calcium particles in the serum that leads to mineral deposition. Calcification is problematic both in the naturally occurring state of the body, as well as when it exists as result of biomaterial implants. While calcification is prominent in many different forms, not all mechanisms and processes associated with the phenomenon are completely understood. In this chapter, materials affected by calcification, potential mechanisms of action, and potential treatments will be discussed. Both bioprosthetic and polymer heart valves and urinary implants will be evaluated for material composition, application, and failure. Current research on the assessment of these materials will be reported, with the associated chemical and biological mechanisms explained. The chapter will also detail diseased states of the arteries that induce calcification and what treatments can be used for both arterial and bioprosthetic calcification. Finally, the chapter will conclude by detailing future designs for biomaterials to prevent and treat calcification in both natural and synthetic applications.

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Section: Heart Valvesmentioning

confidence: 99%

Section: Heart Valvesmentioning

confidence: 99%

Section: Stentedmentioning

confidence: 99%

Section: Future Workmentioning

confidence: 99%

See 2 more Smart Citations

Calcification of Biomaterials and Diseased States

Mosier¹,

Nguyen²,

Parker³

et al. 2018

Biomaterials - Physics and Chemistry - New Edition

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“…These favorable hemodynamic features observed in the MVRm may translate into better functional capacity. Furthermore, the durability of mitral bioprostheses is limited because of the high mechanical stress during systole 33 and this may compromise their outcome. However, further studies are needed to determine the underlying fac- …”

Section: Clinical Outcomesmentioning

confidence: 99%

Exercise Hemodynamic and Functional Capacity After Mitral Valve Replacement in Patients With Ischemic Mitral Regurgitation

Fino¹,

Iacovoni²,

Pepper³

et al. 2018

Circ: Heart Failure

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BACKGROUND:In patients with ischemic mitral regurgitation requiring mitral valve replacement (MVR), the choice of the prosthesis type is crucial. The exercise hemodynamic and functional capacity performance in patients with contemporary prostheses have never been investigated. To compare exercise hemodynamic and functional capacity between biological (MVRb) and mechanical (MVRm) prostheses. METHODS AND RESULTS:We analyzed 86 consecutive patients with ischemic mitral regurgitation who underwent MVRb (n=41) or MVRm (n=45) and coronary artery bypass grafting. All patients underwent preoperative resting echocardiography and 6-minute walking test. At follow-up, exercise stress echocardiography was performed, and the 6-minute walking test was repeated. Resting and exercise indexed effective orifice areas of MVRm were larger when compared with MVRb The MVRm had lower exercise systolic pulmonary arterial pressure at follow-up compared with MVRb (41±5 versus 59±7 mm Hg; P=0.0001). Six-minute walking test distance was improved in the MVRm (pre-operative: 242±43, post-operative: 290±50 m; P=0.001), whereas it remained similar in the MVRb (pre-operative: 250±40, post-operative: 220±44 m; P=0.13). In multivariable analysis, type of prosthesis, exercise indexed effective orifice area, and systolic pulmonary arterial pressure were joint predictors of change in 6-minute walking test (ie, difference between baseline and follow-up). CONCLUSIONS:In patients with ischemic mitral regurgitation, bioprostheses are associated with worse hemodynamic performance and reduced functional capacity, when compared with MVRm. Randomized studies with longer follow-up including quality of life and survival data are required to confirm these results.

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Management of Prosthetic Valve Complications

Kazzi

Burke

2021

Emergency Management of the Hi‐Tech Patient in Acute and Critical Care

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Bioprosthetic Heart Valves: Impact of Implantation on Biomaterials

Cited by 70 publications

References 54 publications

Calcification of Biomaterials and Diseased States

Calcification of Biomaterials and Diseased States

Exercise Hemodynamic and Functional Capacity After Mitral Valve Replacement in Patients With Ischemic Mitral Regurgitation

Management of Prosthetic Valve Complications

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