The return of elastomer valves

Mechanical considerations for polymeric heart valve development: Biomechanics, materials, design and manufacturing

The native human heart valve leaflet contains a layered microstructure comprising a hierarchical arrangement of collagen, elastin, proteoglycans and various cell types. Here, we review the various experimental methods that have been employed to probe this intricate microstructure and which attempt to elucidate the mechanisms that govern the leaflet's mechanical properties. These methods include uniaxial, biaxial, and flexural tests, coupled with microstructural characterization techniques such as small angle X-ray scattering (SAXS), small angle light scattering (SALS), and polarized light microscopy. These experiments have revealed complex elastic and viscoelastic mechanisms that are highly directional and dependent upon loading conditions and biochemistry. Of all engineering materials, polymers and polymer-based composites are best able to mimic the tissue-level mechanical behavior of the native leaflet. This similarity to native tissue permits the fabrication of polymeric valves with physiological flow patterns, reducing the risk of thrombosis compared to mechanical valves and in some cases surpassing the in vivo durability of bioprosthetic valves. Earlier work on polymeric valves simply assumed the mechanical properties of the polymer material to be linear elastic, while more recent studies have considered the full hyperelastic stress-strain response. These material models have been incorporated into computational models for the optimization of valve geometry, with the goal of minimizing internal stresses and improving durability. The latter portion of this review recounts these developments in polymeric heart valves, with a focus on mechanical testing of polymers, valve geometry, and manufacturing methods.

Hydrodynamic Function of a Biostable Polyurethane Flexible Heart Valve after Six Months in Sheep

Survival to six months for sheep with a non-biostable polyurethane mitral heart valve prosthesis has been reported previously, however, with surface degradation and accumulation of calcified fibrin/thrombus that impaired leaflet motion and compromised hydrodynamic function. Newly available biostable polyurethanes may overcome this problem.

Six adult sheep with biostable polyurethane trileaflet heart valve prostheses of documented hydrodynamic performance, implanted in the mitral position, were allowed to survive for 6 months. Explanted valves were photographed, resubmitted to hydrodynamic function testing, and studied by light and electron microscopy.

Explanted valves were structurally intact and differed little in appearance from their preimplant state. Hydrodynamic testing showed no deterioration in pressure gradient or energy losses compared with pre-implant values.

Biostable polyurethanes demonstrated improved blood compatibility leaving leaflets flexible and valve function unimpaired. Biostable polyurethanes may thus improve prospects for prolonged function of synthetic heart valve prostheses.

Calcification Modelling in Artificial Heart Valves

This study has examined a range of methods of studying the calcification process in bovine pericardial and polyurethane biomaterials. The calcification methods include static and dynamic, in vitro and in vivo tests. The analytical methods include measurement of depletion rates of calcium and phosphate from in vitro calcifying solutions, analysis of tissue contents of calcium, histological staining of tissue sections for calcium, X-ray elemental analysis, by scanning electron microscopy, of calcium and phosphorus distributions over valve leaflets calcified in vitro under dynamic conditions. Bovine pericardium, in all test settings, calcified to a much greater degree than polyurethane biomaterials. Polyurethane extracts calcified to a greater degree than bulk polyurethanes. The test protocol used allows progress through increasily demanding calcification tests, with the possibility of eliminating unsuitable materials with tests of limited complexity and expense.

Hydrolytic Stability of Some Thermoplastic Poly(Ether-Urethane-Urea)s

Two thermoplastic poly(ether-urethane-urea)s were synthesized from isophorone diisocyanate, hexamethylene diamine, and polyethylene glycol as macrodiol. The molecular weight of the macrodiol was 2000 g mol−1. The polymers have been characterized by means of transmission electron microscopy, 1H-NMR, infrared spectroscopy, and other techniques. The hydrolytic stability of these materials was investigated under in vitro condition using Ringer's solution and phosphate-buffered saline. The stability of these series was compared with a poly(ether-urethane) prepared from isophorone diisocyanate, polyethylene glycol and 1,4-butanediol. The in vitro study revealed possible use of poly(ether-urethane-urea)s for long-term biomedical applications.

Design of a novel polymeric heart valve

Polymeric heart valves could offer an optimum alternative to current prostheses, by joining the advantages of mechanical and bioprosthetic valves. Though a number of materials suitable for this application have recently become available, significant improvements in the valve design are still needed. In this paper, a novel polymeric heart valve design is proposed and its optimization procedure, based on the use of finite elements, is described. The design strategy was aimed at reducing the energy absorbed during the operating cycle, resulting in high hydrodynamic performances and reduced stress levels. The efficacy of the design strategy was assessed by comparing the valve dynamics and stress levels predicted numerically during the cycle with those of an existing and well qualified polymeric valve design. The improved hydrodynamic performance of the proposed design was confirmed experimentally, by in vitro testing in a pulse duplicator.

Polymeric heart valves: new materials, emerging hopes

Heart valve (HV) replacements are among the most widely used cardiovascular devices and are in rising demand. Currently, clinically available devices are restricted to slightly modified mechanical and bioprosthetic valves. Polymeric HVs could represent an attractive alternative to the existing prostheses, merging the superior durability of mechanical valves and the enhanced haemodynamic function of bioprosthetic valves. After early unsatisfactory clinical results, polymeric HVs did not reach commercialization, mainly owing to their limited durability. Recent advances in polymers, nanomaterials and surface modification techniques together with the emergence of novel biomaterials have resulted in improved biocompatibility and biostability. Advances in HV design and fabrication methods could also lead to polymeric HVs that are suitable for long-lasting implantation. Considering all these progresses, it is likely that the new generation of polymeric HVs will find successful long-term clinical applications in future.

Biomechanical studies on aliphatic physically crosslinked poly(urethane urea) for blood contact applications

Hydrophobic and physically crosslinked (virtually crosslinked through hydrogen bonding) aliphatic poly(urethane urea)s were developed and characterized for its biomechanical properties. The aging under induced-stress (bend samples) condition reveals resistance of poly(urethane urea) to environmental stress corrosion cracking (ESC) in hydrolytic media, Ringer's solution and phosphate buffered saline at 50 degrees C. The strain-induced (20% tensile strain) and aged polymer in hydrolytic enzyme medium, papain and in buffer reveals increase of elastic modulus in papain enzyme and papain buffer. The increase of elastic modulus is attributed to unidirectional reorganisation of chains under continually strained conditions. The polymer exposed in boiling alcoholic potassium hydroxide solution (accelerated hydrolytic chemical degradation) reveals no degradation. A comparative evaluation of poly(ether urethane urea)s reveals inferior properties. Poly(ether urethane urea)s polymer undergo hydrolytic degradation in boiling alcoholic potassium hydroxide solution. The candidate poly(urethane urea) HFL 18-PUU is more promising elastomer for long-term biomechanically sensitive blood contact applications such as heart valve and blood pump diaphragm of left ventricular assist device.

Experimental and Computer-Based Performance Analysis of Two Elastomer VAD Valve Designs

The development of a new generation pneumatic Ventricular Assist Device (VAD) required the design of valves for the optimization of its performance. Experiments and computer-based simulations under hydrostatic conditions were analyzed in order to test and compare two low-cost elastomer valve designs. The trileaflet valve design showed a superior hydrostatic performance, having almost a ratio of 1:2 hydraulic resistance than the bileaflet valve design in agreement with both, the experimental and the simulation evidences. This study will address the use of a trileaflet valve designs in the future VAD redesign.

Hydrodynamic effects of the partial opening of a trileaflet valve

Manufacturing process of medical grade silicon rubber trileaflet valves for VADs could propitiate important leaflet thickness variations which could result in partial opening of the valve and affect its hydrodynamic performance. The leaflets of a total of 10 valves were measured to assess its thickness variability. Two experiments were performed to asses the impact of the leaflets thickness variation under hypothetical situations. The first experiment was divided into three hypothetical cases. In each case either none, one or two leaflets of different valves were mechanically blocked, resembling possible critical working circumstances. The second experiment was intended to know how the variation on the leaflets thickness affects the hydrodynamic performance of the valves. The results demonstrated a significant variation on the leaflets thickness was found. As for the first experiment, a small variation on the hydrodynamic performance was found above 4 L/min flow rates and a slightly higher energy loss was found in one of the cases. As for the second experiment, the results showed that the variation of the leaflet thickness does not affect the general hydrodynamic performance of the valves. No relationship between the thickness variability and the hydrostatic performance of the valves was found.

In vitro studies on the effect of physical cross-linking on the biological performance of aliphatic poly(urethane urea) for blood contact applications

The effect of physical cross-linking in candidate cycloaliphatic and hydrophobic poly(urethane urea) (4,4'-methylenebis(cyclohexylisocyanate), H(12)MDI/hydroxy-terminated polybutadiene, HTPBD/hexamethylenediamine, HDA) and poly(ether urethane urea)s (H(12)MDI/HTPBD-PTMG/HDA) on the in vitro calcification and blood-material interaction was studied. All the candidate poly(urethane urea)s and poly(ether urethane urea)s elicit acceptable hemolytic activity, cytocompatibility, calcification, and blood compatibility in vitro. The studies on blood-material interaction reveal that the present poly(urethane urea)s are superior to polystyrene microtiter plates which were used for the studies on blood-material interaction. The present investigation reveals the influence of physical cross-link density on biological interaction differently with poly(urethane urea) and poly(ether urethane urea)s. The higher the physical cross-link density in the poly(urethane urea)s, the higher the calcification and consumption of WBC in whole blood. On the other hand, the higher the physical cross-link density in the poly(ether urethane urea)s, the lesser the calcification and consumption of WBC in whole blood. However a reverse of the above trend has been observed with the platelet consumption in the poly(urethane urea)s and poly(ether urethane urea)s.

Mechanical and morphological study of biostable polyurethane heart valve leaflets explanted from sheep

Two novel biostable polyurethanes, designated EV3.34 and EV3.35, were used to manufacture a flexible trileaflet heart valve. The valves were implanted in the mitral position in young adult (18 month) sheep. Six valves were electively explanted at 6 months and the remaining six valves at 9 months follow-up. The leaflet material was examined by surface Fourier transform infrared spectrometry (ATR/FTIR) and scanning electron microscopy (SEM). The leaflet material was also subjected to cyclic mechanical testing and, compared with unimplanted control material, to demonstrate any change in mechanical properties during implantation. There was no degradation of functional groups detected by ATR/FTIR, although there was a slight surface enrichment of siloxane soft segment. Surface morphology of the explanted leaflet material was similar to unimplanted control material. EV3.34 demonstrated similar inelastic energy loss behavior, with no significant change in residual strain in explanted compared with control material. EV3.35 demonstrated a reduction in inelastic energy and residual strain in explanted compared with control material. There is no evidence of biodegradation of these siloxane-based polyurethanes, in functional valves up to 9 months implantation in sheep. The FTIR and SEM findings are supported by the retention of mechanical properties of the materials.

Hydrodynamic function of polyurethane prosthetic heart valves: influences of Young's modulus and leaflet thickness

The development of flexible polyurethane heart valves has been hindered by material degradation in vivo. Low modulus polyurethane leaflets are regarded as desirable to achieve good hydrodynamic function. However, low modulus materials may suffer high strain accumulation, hence poor durability. Higher modulus materials may improve durability, but may have poor hydrodynamic function. This study examines the hydrodynamic behaviour of biostable polyurethane valves, varying Young's modulus from 5 to 63.6 MPa and mean leaflet thickness from 48-238 microm. Parameters studied included mean pressure gradient, energy losses and regurgitation over 5 equivalent cardiac outputs (3.6, 4.9, 6.4, 8.0 and 9.61 min(-1)) At low cardiac output, modulus was not significantly correlated with any parameter of valve opening. At 9.61 min(-1), modulus significantly influenced mean pressure gradient (p = 0.033). Mean leaflet thickness significantly correlated with mean pressure gradient and energy losses during forward flow at all cardiac outputs (p<0.001). This study demonstrates that, over a wide range of moduli, valve hydrodynamic function is not affected significantly by the material modulus. Leaflet thickness is a highly significant factor. Higher modulus elastomers in a range up to 32.5 MPa may be useful in prosthetic heart valve leaflet manufacture, retaining good hydrodynamic function while potentially extending the lifetime of the valve.

The effect of virtual cross linking on the oxidative stability and lipid uptake of aliphatic poly(urethane urea)

In vitro oxidative degradation and lipid sorption of aliphatic, low elastic modulus and virtually cross-linked poly(urethane urea)s based on 4,4' methylene bis(cyclohexyl isocyanate), hydroxy terminated poly butadiene and hexamethylene diamine were evaluated. The aged samples revealed no weight loss in the oxidation medium. The IR spectral analyses revealed the stability of unsaturated double bonds at 964 cm(-1) (characteristic for polybutadiene soft segment) with no change in peak intensity. The poly(tetramethylene glycol) (PTMG)-added poly(ether urethane urea) polymer also revealed no disappearance of IR peaks for ether and unsaturated double bonds in samples aged in vitro oxidation medium. All the polymers have shown increase in weight due to lipid up take in lipid-rich medium (palm oil) but it was rather low in Dulbecco's modified eagle medium (DMEM) cholesterol. The slight change in mechanical properties of the present polymers in oxidation and DMEM is due to the rearrangement of molecular structure with virtual cross links of hydrogen bonding (physical cross linking) without degradation and plasticization effect of lipid. The influence of these media on the rearrangement of virtual cross links has been observed. Higher the virtual cross-link density, lesser is the loss of tensile properties of poly(urethane urea)s in the oxidation medium and vice versa. On the other hand, higher the virtual cross-link density of poly(urethane urea), higher is the loss of ultimate tensile strength and stress at 100% strain and vice versa in DMEM medium.

Studies on the effect of virtual crosslinking on the hydrolytic stability of novel aliphatic polyurethane ureas for blood contact applications

The effect of virtual crosslinking on the hydrolytic stability of completely aliphatic novel poly(urethane ureas), HFL9-PU1 (hard-segment content 57.5%) and HFL13-PU2 (hard-segment content 67.9%) based on 4,4'-methylene bis(cyclohexyl isocyanate) (H(12)MDI)-hydroxy-terminated polybutadiene-1,6-hexamethylene diamine, was studied. Fourier transform infrared-attenuated total reflectance and wide-angle X-ray diffraction studies revealed hydrogen-bonding interaction and microphase separation and formation of crystallites by short- and long-range ordering in hard-segment domains. Three-dimensional networks from hydrogen bonding in the present polymers lead to virtually crosslinking and insolubility. These polymers were noncytotoxic to L929 fibroblast cells. The hemolytic potential is below the accepted limit. The studies on in vitro biostability in Ringer's solution, phosphate buffered saline, and papain enzyme revealed no weight loss. The infrared spectral studies revealed changes in the surface, especially on HFL9-PU1 aged in Ringer's solution and phosphate buffered saline, and no changes when aged in papain. The marginal changes noticed in tensile properties were attributed to the changes in degree of hydrogen bonding and associated rearrangement of molecular structure in the bulk. The results revealed that the lesser the crosslinking in virgin polymer, the higher the crosslinking in aged polymer and vice versa. Increased crosslinking during aging provided increased tensile properties in the aged polymer over the virgin polymer and vice versa. For comparison, an aliphatic polyetherurethane urea (HFL16-PU3) was also synthesized using poly(oxy tetra methylene glycol) in addition to the above reactants. Though both HFL9-PU1 and HFL16-PU3 contained the same hard-segment content, the aged sample of the latter showed decreased tensile properties with increased crosslinking during aging in contrast to the former. This was attributed to less microphase separation in the virgin HFL16-PU3 polymer.

Polyurethane: material for the next generation of heart valve prostheses?

OBJECTIVES

The prospects for a durable, athrombogenic, synthetic, flexible leaflet heart valve are enhanced by the recent availability of novel, biostable polyurethanes. As a forerunner to evaluation of such biostable valves, a prototype trileaflet polyurethane valve (utilising conventional material of known in vitro behaviour) was compared with mechanical and bioprosthetic valves for assessment of in vivo function, durability, thromboembolic potential and calcification.

METHODS

Polyurethane (PU), ATS bileaflet mechanical, and Carpentier-Edwards porcine (CE) valves were implanted in the mitral position of growing sheep. Counting of high-intensity transient signals (HITS) in the carotid arteries, echocardiographic assessment of valve function, and examination of blood smears for platelet aggregates were undertaken during the 6-month anticoagulant-free survival period. Valve structure and hydrodynamic performance were assessed following elective sacrifice.

RESULTS

Twenty-eight animals survived surgery (ten ATS; ten CE; eight PU). At 6 months the mechanical valve group (n=9) showed highest numbers of HITS (mean 40/h, P=0.01 cf. porcine valves), and platelet aggregates (mean 62.22/standard field), but no thromboembolism, and no structural or functional change. The bioprosthetic group (n=6) showed low HITS (1/h) and fewer aggregates (41.67, P=1.00, not significant), calcification and severe pannus overgrowth with progressive stenosis. The PU valves (n=8) showed a small degree of fibrin attachment to leaflet surfaces, no pannus overgrowth, little change in haemodynamic performance, low levels of HITS (5/h) and platelet aggregates (17.50, P<0.01 cf. mechanical valves, P=0.23 cf. porcine valves), and no evidence of thromboembolism.

CONCLUSIONS

In the absence of valve-related death and morbidity, and retention of good haemodynamic function, the PU valve was superior to the bioprosthesis; lower HITS and aggregate counts in the PU valve imply lower thrombogenicity compared with the mechanical valve. A biostable polyurethane valve could offer clinical advantage with the promise of improved durability (cf. bioprostheses) and low thrombogenicity (cf. mechanical valves).

Experimental right ventricle to pulmonary artery discontinuity: outcome of polyurethane valved conduits

OBJECTIVE

The ideal substitute for the treatment of ventricle-pulmonary artery discontinuity remains a topic of controversy, because of calcifications and degeneration of biologic substitutes leading to subsequent reoperations. Because polyurethane valves used in ventricular assist devices show a satisfactory biocompatibility, the aim of this study was to evaluate a valved conduit composed of a Dacron graft incorporating a trileaflet 25 mm polyurethane valve.

METHODS

The conduit was implanted between the right ventricle and the main pulmonary artery in adult sheep, with ligation of the proximal pulmonary artery. The animals received no medications. Serial hemodynamic data were collected at the time of implantation and at postoperative intervals of 6 and 12 months.

RESULTS

The peak pressure gradient across the valve increased significantly between implantation (0.17 +/- 5.6 mm Hg) and 6 months after operation (7.3 +/- 3 mm Hg, p = 0.0007) and remained stable thereafter (6.7 +/- 3 mm Hg at 12 months), whereas the cardiac output remained unchanged (4.6 +/- 0.6 L/min at implantation, 4 +/- 0.6 L/min at 6 months, and 3.9 +/- 1.1 L/min at 12 months). At the completion of the study, valve samples were processed and vapor coated with carbon for microscopic examination. There was one instance of nonadherent thrombus formation inside a cusp but no structural failures. The other valves were free of calcium deposits and no significant amounts of phosphorus could be detected by scanning electron microscopy and energy dispersive spectrometry.

CONCLUSIONS

These data demonstrate the good hemodynamic performance, low thrombogenicity, and acceptable durability of the polyurethane valves implanted in the right side of the heart in a chronic sheep model.

Finite element stress analysis of a new design of synthetic leaflet heart valve

This paper presents a parametric finite element analysis of the stresses in the leaflets of a new design of polyurethane heart valve in the closed position. The alpharabola geometry of the valve has previously been reported by Leat and Fisher (1) and has been shown to demonstrate good opening characteristics. The effects of variations in leaflet offset parameter, g, length, h, and local thickening have been determined for a valve where the frame is assumed rigid. A spherical leaflet geometry has also been analysed for comparative purposes. Results have shown that the alpharabola leaflet geometry can reduce the maximum principal tensile stress to 60 per cent of that for a spherical valve of the same mesh density.

In vitro determination of the curvatures and bending strains acting on the leaflets of polyurethane trileaflet heart valves during leaflet motion

Leaflet tears originating from the free leaflet edge and calcification around the commissural region are common modes of failure exhibited by explanted bioprosthetic trileaflet heart valves. These may be a result of the cyclic bending and high levels of curvature that affect the leaflets within these areas during normal valve operation. These high levels of curvature occur in a short time period (approximately 20 ms) during rapid leaflet opening and to a lesser degree during leaflet closure. The curvatures that occur at the free leaflet edge of two designs of polyurethane trileaflet heart valve were determined in vitro at various stages during a cardiac cycle using a high-speed video camera (1000 frames/s). Significant deformations at the free leaflet edge were observed and bending radii as low as 0.55 +/- 0.125 mm (mean +/- standard deviation) were present during leaflet opening, 0.76 +/- 0.24 mm during leaflet closure and 1.01 +/- 0.27 mm while the valve was fully open during peak systole. The values of curvature were used to determine the values of bending strain and bending stress acting at the free leaflet edge using thin shell bending theory. The calculated values of bending strain were a maximum during the leaflet flexure associated with valve opening. These high levels of bending strain, which occur for short periods of time, are likely to be an important determinant of the valve's durability. It has been shown that the method of manufacture significantly influenced the level of bending strain in the valve leaflets. Valves manufactured using a dip-casting technique resulted in open leaflet bending strains up to 31 per cent lower than valves manufactured from solvent-cast sheets of polyurethane.

Determination of the curvatures and bending strains in open trileaflet heart valves

The leaflets of trileaflet artificial heart valves manufactured from polyurethane, gluteraldehyde-treated porcine aortic valves and pericardial tissue are subject to cyclic stresses and strains which can reduce the lifetime of the implanted valves through leaflet calcification and fatigue failure. A detailed knowledge of the stress state within a valve leaflet throughout a cardiac cycle is desirable in order to improve the geometry of the valve leaflets and ultimately improve the valve performance. An experimental method to evaluate the radius of curvature at the free edge of the open valve leaflet is presented. The technique has been applied to polyurethane trileaflet heart valves manufactured within the authors' laboratory and to commercially available bioprosthetic valves in the fully open position under steady and pulsatile flow conditions. Simple bending theory has been applied to the polyurethane valves to calculate bending stresses and strains at the free leaflet edge based on the measured curvature. The results showed that in the fully open position the highest curvatures occurred at the commissural regions for all the valves analysed. Additional areas of high curvature were present along the free leaflet edge. Average curvatures as high as 0.85 mm-1 were observed at the leaflet commissures for the polyurethane valves with a resultant bending stress of 0.72 MPa. The porcine bioprosthetic valves showed average curvatures as high as 2.5 mm-1 which also occurred at the leaflet commissures. The results of the study have been compared to values of stress obtained from numerical analysis of closed polyurethane valve leaflets reported in the literature.(ABSTRACT TRUNCATED AT 250 WORDS)

The influence of manufacturing methods on the function and performance of a synthetic leaflet heart valve

There is considerable interest in polyurethane synthetic leaflet heart valves for both ventricular assist devices and direct implantation in the body. Two different manufacturing methods, thermal forming, and dip casting, of the leaflets have been investigated. There were only small differences in the hydrodynamic function of the valves made by the two methods. However, the durability of dip cast valves was far superior to the thermally formed film fabricated leaflets, with all of the dip cast valves reaching 160 million cycles without failure. This study indicates that a correctly designed and manufactured polyurethane synthetic leaflet heart valve has the potential for long-term implantation in the body.

Calcification and fatigue failure in a polyurethane heart value

The prosthetic heart valves were fabricated from a polyurethane containing a 4,4'-diphenylmethane diisocyanate hard segment, chain-extended with butanediol and with a polyether soft segment. The rate of calcification of these polyurethane heart valves was much slower in a dynamic in vitro test system than similar bioprosthetic heart valves. The calcified deposits were located exclusively at regions of material failure. Fourier transform infrared (FTIR) spectroscopy indicated the involvement of the polyether soft segments of the polymer directly in the calcification process. Calcification of polymer fractions also suggested that small molecular weight extractable components are accelerating factors in the calcification process.

A synthetic leaflet heart valve with improved opening characteristics

A new geometry for the design of polyurethane leaflet heart valves has been investigated. The geometry termed the 'alpharabola' has a radius of curvature that increases from the centre of the leaflet at the free edge towards the base of the valve and perimeter of the leaflet. The hydrodynamic function and leaflet opening characteristics of the new valve design have been compared to a valve with a spherical leaflet geometry using the same material. The pressure and flow required to open alpharabola leaflets in steady flow tests was markedly lower than for spherical leaflets. Under pulsatile flow conditions with the valve leaflets fully open, the pressure drop across the alpharabola and spherical leaflets was similar, but much lower than in a porcine bioprosthesis. High speed photography showed that the alpharabola leaflets opened in less than 30 ms with the leaflet opening initiating in the base of the leaflet where the radius of curvature was larger. The synthetic leaflet valve has demonstrated short term durability in accelerated fatigue tests to 100 million cycles.

Comparative study of the function of the Abiomed polyurethane heart valve for use in left ventricular assist devices

Hydrodynamic testing of the Abiomed polyurethane trileaflet valve has been carried out to establish performance data of valve function. A Medtronic Hall tilting disk, a Carbomedics bileaflet, a Hancock II bioprosthesis and an Abiomed polyurethane trileaflet valve, all size 27 mm, underwent both pulsatile and steady-flow hydrodynamic testing. Results of the variation of pressure difference with RMS pulsatile flow and steady flow, and effective orifice area, showed that the Abiomed valve had significantly poorer opening characteristics than the tissue valve and the two mechanical valves. The Abiomed valve's performance was seen to be related to its construction and manufacture. This study highlights some of the problems associated with the design and development of synthetic trileaflet heart valve prostheses.