Novel Approaches to Cardiac Valve Repair

Yacoub, Magdi H.; Cohn, Lawrence H.

doi:10.1161/01.cir.0000115634.66549.4d

Cited by 97 publications

(8 citation statements)

References 75 publications

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“…AV pathology can be caused by inflammation or degenerative valve disease, both of which can be caused by increasing longevity coupled with rheumatic and infective endocarditis (295). Although a significant amount of progress has been made in the development of heart valves, there is yet to be an “ideal” heart valve replacement available (225).…”

Section: A Multiscale Approach To Understanding Heart Valve Biomechanmentioning

confidence: 99%

Heart Valve Biomechanics and Underlying Mechanobiology

Ayoub

Ferrari

Gorman

et al. 2016

Comprehensive Physiology

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Heart valves control unidirectional blood flow within the heart during the cardiac cycle. They have a remarkable ability to withstand the demanding mechanical environment of the heart, achieving lifetime durability by processes involving the ongoing remodeling of the extracellular matrix. The focus of this review is on heart valve functional physiology, with insights into the link between disease-induced alterations in valve geometry, tissue stress, and the subsequent cell mechanobiological responses and tissue remodeling. We begin with an overview of the fundamentals of heart valve physiology and the characteristics and functions of valve interstitial cells (VICs). We then provide an overview of current experimental and computational approaches that connect VIC mechanobiological response to organ- and tissue-level deformations and improve our understanding of the underlying functional physiology of heart valves. We conclude with a summary of future trends and offer an outlook for the future of heart valve mechanobiology, specifically, multiscale modeling approaches, and the potential directions and possible challenges of research development.

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Section: A Multiscale Approach To Understanding Heart Valve Biomechanmentioning

confidence: 99%

Heart Valve Biomechanics and Underlying Mechanobiology

Ayoub

Ferrari

Gorman

et al. 2016

Comprehensive Physiology

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“…Collectively, these developments have facilitated a growing understanding of how shortand long-term biomechanical valve function at the organ level relates to tissue and cell structure and normal valve function, elucidated the pathological anatomy and mechanisms of valvular dysfunction, fostered improvements in tissue heart valve substitutes and surgical repairs, and informed innovative approaches to heart valve tissue engineering and regeneration. [1][2][3][4] In this communication, we highlight key recent insights into heart valve function and dysfunction and their implications for the prevention, diagnosis, and treatment of clinical heart valve disease, currently and in the future. The heart valves are tissue structures whose motions are driven by mechanical forces exerted by the surrounding blood and heart.…”

mentioning

confidence: 99%

Evolving Concepts of Cardiac Valve Dynamics

2008

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Abstract-Considerable progress has been made in recent years toward elucidating a conceptual framework that integrates the dynamic functional structure, mechanical properties, and pathobiological behavior of the cardiac valves. This communication reviews the evolving paradigm of a continuum of heart valve structure, function, and pathobiology and explores its implications. Specifically, we discuss (1) the interactions of valve biology and biomechanics (eg, correlations of function with structure at the cell, tissue, and organ levels and mechanical considerations, development, endothelial cell and interstitial cell biology, extracellular matrix biology, homeostasis, and adaptation to environmental change); (2) Key Words: aortic valve Ⅲ mitral valve Ⅲ pathology Ⅲ prosthesis Ⅲ tissue engineering I mportant conceptual advances, new data, and evolution in our understanding and application of the principles underlying the dynamic functional, biological, and mechanical behavior of the cardiac valves have occurred in recent years. Research in heart valve biology and disease has been enabled by the availability of cultures of heart valve cells, computational methodology, the design and use of in vitro and in vivo experimental systems that model elements of valve biological and pathobiological activity, and targeted study of normally functioning and pathological native and substitute human valves. Collectively, these developments have facilitated a growing understanding of how shortand long-term biomechanical valve function at the organ level relates to tissue and cell structure and normal valve function, elucidated the pathological anatomy and mechanisms of valvular dysfunction, fostered improvements in tissue heart valve substitutes and surgical repairs, and informed innovative approaches to heart valve tissue engineering and regeneration. [1][2][3][4] In this communication, we highlight key recent insights into heart valve function and dysfunction and their implications for the prevention, diagnosis, and treatment of clinical heart valve disease, currently and in the future. The heart valves are tissue structures whose motions are driven by mechanical forces exerted by the surrounding blood and heart. The ability of the valves to permit unobstructed forward flow depends on the mobility, pliability, and structural integrity of their leaflets (in the TV and MV) and cusps (in the PV and AV).The individual AV cusps attach to the aortic wall in a crescentic (or semilunar) fashion, ascending to the commissures (where adjacent cusps come together at the aorta) and descending to the basal attachment of each cusp to the aortic wall. Behind the cusps are dilated pockets in the aortic root, called sinuses of Valsalva, which bulge with each ejection of blood. The AV cusps and their respective sinuses are named for their relationship to the coronary artery ostia that arise from them, normally a left, a right, and a noncoronary (cusp and associated sinus). In the middle of the free edge of each cusp on the ventricular surface is a ...

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“…Most of the techniques are well described in the surgical literature [8, 15, 16], yet achieving consistent, durable repair in more than 90% of cases requires direct and adequate “hands-on” training. Such an experience can only be achieved through training programs, master classes and workshops dedicated to mitral valve repair.…”

Section: Indications Of Surgery For Mitral Regurgitationmentioning

confidence: 99%

Management-Oriented Classification of Mitral Valve Regurgitation

Oakley

Shah

2011

ISRN Cardiology

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Mitral regurgitation (MR) has previously been classified into rheumatic, primary, and secondary MR according to the underlying disease process. Carpentier's/Duran functional classifications are apt in describing the mechanism(s) of MR. Modern management of MR, however, depends primarily on the severity of MR, status of the left ventricular function, and the presence or absence of symptoms, hence the need for a management-oriented classification of MR. In this paper we describe a classification of MR into 4 phases according to LV function: phase I = MR with normal left ventricle, phase II = MR with normal ejection fraction (EF) and indirect signs of LV dysfunction such as pulmonary hypertension and/or recent onset atrial fibrillation, phase III = EF ≥ 30%–< 50% and/or mild to moderate LV dilatation (ESID 40–54 mm), and phase IV = EF < 30% and/or severe LV dilatation (ESDID ≥ 55 mm). Each phase is further subdivided into three stages: stage “A” with an effective regurgitant orifice (ERO) < 20 mm, stage “B” with an ERO = 20–39 mm, and stage “C” with an ERO ≥ 40 mm. Evidence-based indications and outcome of intervention for MR will also be discussed.

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Novel Approaches to Cardiac Valve Repair

Cited by 97 publications

References 75 publications

Heart Valve Biomechanics and Underlying Mechanobiology

Heart Valve Biomechanics and Underlying Mechanobiology

Evolving Concepts of Cardiac Valve Dynamics

Management-Oriented Classification of Mitral Valve Regurgitation

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