Prosthetic Aortic Valves: A Surgical and Bioengineering Approach

Mavrilas, Dimosthenis; Apostolakis, Efstratios; Koutsoukos, Petros G.

doi:10.5772/20860

Cited by 2 publications

(2 citation statements)

References 90 publications

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“…The experimental setup described was an upgraded version of the respective layout used in earlier works [10], [19], [26]- [29], [33]- [35]. The setup in the present work was re-designed to improve the accuracy and reproducibility of the measurements, reduced the data processing time, enhanced the user interaction by a simpler interface design showing the process progress in real-time.…”

Section: Methodsmentioning

confidence: 99%

Calcification Assessment of Bioprosthetic Heart Valve Tissues Using an ImprovedIn VitroModel

D’Alessandro

Komninou

Badria

et al. 2020

IEEE Trans. Biomed. Eng.

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Calcification is a recurrent problem in patients suffering from heart valve disease and it is the main cause of failure in biological heart valve prostheses. The development of reliable calcification tests that consider both the material properties of the prostheses and the fluid composition is of paramount importance for the effective testing and subsequent selection of new cardiovascular implants. In this work, a fast, reliable and highly reproducible method for the assessment of the calcification potential of biomaterials was developed. The developed method simulated closely the chemical environment in vivo, where the supersaturation levels of calcium and phosphate remain constant. Seeded hydroxyapatite (HAP) crystal growth experiments were used as the reference system and compared to the mineralization kinetics and extent of frozen untreated bovine and porcine pericardium, and glutaraldehyde-fixed bovine pericardium. Untreated pericardial patches did not calcify in the supersaturated calcium phosphate solutions whereas glutaraldehyde-fixed bovine pericardial patches mineralized at the same conditions. The present work suggested that the loose collagenous serosa side of the pericardium mineralized at lower rates compared to its dense collagenous fibrous side. Concordant with these findings, the mineralization of bioprostheses may also be attributed, to the structural deterioration of collagen-rich tissues, induced by chemical treatment used to control in vivo structural stability and immunomodulation of the implants.

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Section: Methodsmentioning

confidence: 99%

Calcification Assessment of Bioprosthetic Heart Valve Tissues Using an ImprovedIn VitroModel

D’Alessandro

Komninou

Badria

et al. 2020

IEEE Trans. Biomed. Eng.

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“…Mechanical valves are mechanical devices from metals and/ or polymers working as non-return flow valves. The main disadvantage of this type of valves is the formation of thrombotic clots in the stagnation points and/or hemolysis which requires lifelong anticoagulation therapy for the patients [5]. Bioprosthetic heart valves, on the other hand, consist of homograft or heterograft tissues taken from human or animals, usually pigs or cows, previously treated with various physicochemical processes for the amelioration of their performance.…”

Section: Introductionmentioning

confidence: 99%

Decellularized tissue-engineered heart valves calcification: what do animal and clinical studies tell us?

Badria

Koutsoukos

Mavrilas

2020

J Mater Sci: Mater Med

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Cardiovascular diseases are the first cause of death worldwide. Among different heart malfunctions, heart valve failure due to calcification is still a challenging problem. While drug-dependent treatment for the early stage calcification could slow down its progression, heart valve replacement is inevitable in the late stages. Currently, heart valve replacements involve mainly two types of substitutes: mechanical and biological heart valves. Despite their significant advantages in restoring the cardiac function, both types of valves suffered from serious drawbacks in the long term. On the one hand, the mechanical one showed non-physiological hemodynamics and the need for the chronic anticoagulation therapy. On the other hand, the biological one showed stenosis and/or regurgitation due to calcification. Nowadays, new promising heart valve substitutes have emerged, known as decellularized tissue-engineered heart valves (dTEHV). Decellularized tissues of different types have been widely tested in bioprosthetic and tissue-engineered valves because of their superior biomechanics, biocompatibility, and biomimetic material composition. Such advantages allow successful cell attachment, growth and function leading finally to a living regenerative valvular tissue in vivo. Yet, there are no comprehensive studies that are covering the performance of dTEHV scaffolds in terms of their efficiency for the calcification problem. In this review article, we sought to answer the question of whether decellularized heart valves calcify or not. Also, which factors make them calcify and which ones lower and/or prevent their calcification. In addition, the review discussed the possible mechanisms for dTEHV calcification in comparison to the calcification in the native and bioprosthetic heart valves. For this purpose, we did a retrospective study for all the published work of decellularized heart valves. Only animal and clinical studies were included in this review. Those animal and clinical studies were further subcategorized into 4 categories for each depending on the effect of decellularization on calcification. Due to the complex nature of calcification in heart valves, other in vitro and in silico studies were not included. Finally, we compared the different results and summed up all the solid findings of whether decellularized heart valves calcify or not. Based on our review, the selection of the proper heart valve tissue sources (no immunological provoking residues), decellularization technique (no damaged exposed residues of the decellularized tissues, no remnants of dead cells, no remnants of decellularizing agents) and implantation techniques (avoiding suturing during the surgical implantation) could provide a perfect anticalcification potential even without in vitro cell seeding or additional scaffold treatment.

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Prosthetic Aortic Valves: A Surgical and Bioengineering Approach

Cited by 2 publications

References 90 publications

Calcification Assessment of Bioprosthetic Heart Valve Tissues Using an ImprovedIn VitroModel

Calcification Assessment of Bioprosthetic Heart Valve Tissues Using an ImprovedIn VitroModel

Decellularized tissue-engineered heart valves calcification: what do animal and clinical studies tell us?

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