Tissue Valve Is the Preferred Option for Patients Aged 60 and Older

Kaneko, Tsuyoshi; Cohn, Lawrence H.; Aranki, Sary F.

doi:10.1161/circulationaha.113.002584

Cited by 47 publications

(47 citation statements)

References 54 publications

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“…Even though current guidelines advocate bioprosthetic implantation in patients older than 70 years, continuous improvements in valve durability technology suggest possible safe and effective implantation at a younger age. 31 …”

Section: Current Prosthesis Types and Selectionmentioning

confidence: 99%

Mitral Valve Replacement—Current and Future Perspectives

Merwe

Casselman

2017

Open�J Cardiovasc Surg

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The favorable outcomes achieved with modern mitral valve repair techniques redefined the role of mitral valve replacement. Various international databases report a significant decrease in replacement procedures performed compared with repairs, and contemporary guidelines limit the application of surgical mitral valve replacement to pathology in which durable repair is unlikely to be achieved. The progressive paradigm shift toward endoscopic and robotic mitral valve surgery is also paralleled by rapid developments in transcatheter devices, which is progressively expanding from experimental approaches to becoming clinical reality. This article outlines the current role and future perspectives of contemporary surgical mitral valve replacement within the context of mitral valve repair and the dynamic evolution of exciting transcatheter alternatives.

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Section: Current Prosthesis Types and Selectionmentioning

confidence: 99%

Mitral Valve Replacement—Current and Future Perspectives

Merwe

Casselman

2017

Open�J Cardiovasc Surg

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“…[18][19][20] It is also true, however, that a certain number of patients who need reoperation for SVD are not considered to be good surgical candidates because of their higher risk. Recently, transcatheter aortic valve replacement (TAVR) has become available for patients not only with severe native valve aortic stenosis 21 but also with failed bioprosthetic valves.…”

Section: Study Limitationsmentioning

confidence: 99%

Comparison of the Long-Term Outcomes of Mechanical and Bioprosthetic Aortic Valves　― A Propensity Score Analysis ―

Minakata

Tanaka

Tamura

et al. 2017

Circ J

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of age, either type of valve prosthesis can be chosen. The aim of this study was to assess the mortality and valverelated complications and compare the long-term outcomes of mechanical vs. bioprosthetic valves in Japanese patients undergoing aortic valve replacement (AVR) stratified into 3 age groups (<60 years; 60-69 years, and ≥70 years). Methods PatientsThis study was a pooled analysis of 2 large retrospective T he American College of Cardiology/American Heart Association (ACC/AHA) recently published their revised guidelines on the selection of prosthetic valves. 1 According to their class I recommendation, patient values and preferences must be taken into account, based on full disclosure and understanding of the indications for anticoagulant therapy and the potential need for and risk of reoperation. Besides patient preference, age has been one of the most important factors influencing prosthetic valve choice: mechanical valves are recommended for patients <60 years of age, and bioprosthetic valves for those >70 years of age. For those between 60 and 70 years Background: The aim of this study was to assess the long-term outcomes of aortic valve replacement (AVR) with either mechanical or bioprosthetic valves according to age at operation.

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“…Consequently, many of the patients implanted with these inert heart valves are exposed to a lifelong risk for valve prosthesis-related morbidity and mortality. As a particularly vulnerable patient population, children with congenital heart malformation often require multiple reoperations due to the lack of growth inherent to current prosthetic materials, which is associated with an exponentially increased risk for surgical complications (6,7).…”

Section: Introductionmentioning

confidence: 99%

Computational modeling guides tissue-engineered heart valve design for long-term in vivo performance in a translational sheep model

et al. 2018

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Valvular heart disease is a major cause of morbidity and mortality worldwide. Current heart valve prostheses have considerable clinical limitations due to their artificial, nonliving nature without regenerative capacity. To overcome these limitations, heart valve tissue engineering (TE) aiming to develop living, native-like heart valves with self-repair, remodeling, and regeneration capacity has been suggested as next-generation technology. A major roadblock to clinically relevant, safe, and robust TE solutions has been the high complexity and variability inherent to bioengineering approaches that rely on cell-driven tissue remodeling. For heart valve TE, this has limited long-term performance in vivo because of uncontrolled tissue remodeling phenomena, such as valve leaflet shortening, which often translates into valve failure regardless of the bioengineering methodology used to develop the implant. We tested the hypothesis that integration of a computationally inspired heart valve design into our TE methodologies could guide tissue remodeling toward long-term functionality in tissue-engineered heart valves (TEHVs). In a clinically and regulatory relevant sheep model, TEHVs implanted as pulmonary valve replacements using minimally invasive techniques were monitored for 1 year via multimodal in vivo imaging and comprehensive tissue remodeling assessments. TEHVs exhibited good preserved long-term in vivo performance and remodeling comparable to native heart valves, as predicted by and consistent with computational modeling. TEHV failure could be predicted for nonphysiological pressure loading. Beyond previous studies, this work suggests the relevance of an integrated in silico, in vitro, and in vivo bioengineering approach as a basis for the safe and efficient clinical translation of TEHVs.

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Tissue Valve Is the Preferred Option for Patients Aged 60 and Older

Cited by 47 publications

References 54 publications

Mitral Valve Replacement—Current and Future Perspectives

Mitral Valve Replacement—Current and Future Perspectives

Comparison of the Long-Term Outcomes of Mechanical and Bioprosthetic Aortic Valves　― A Propensity Score Analysis ―

Computational modeling guides tissue-engineered heart valve design for long-term in vivo performance in a translational sheep model

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Tissue Valve Is the Preferred Option for Patients Aged 60 and Older

Cited by 47 publications

References 54 publications

Mitral Valve Replacement—Current and Future Perspectives

Mitral Valve Replacement—Current and Future Perspectives

Comparison of the Long-Term Outcomes of Mechanical and Bioprosthetic Aortic Valves ― A Propensity Score Analysis ―

Computational modeling guides tissue-engineered heart valve design for long-term in vivo performance in a translational sheep model

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Comparison of the Long-Term Outcomes of Mechanical and Bioprosthetic Aortic Valves　― A Propensity Score Analysis ―