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Goode D, Scotten L, Siegel R, Mohammadi H. Can mechanical heart valves perform similarly to tissue valves? An in vitro study. J Biomech 2024; 174:112270. [PMID: 39141959 DOI: 10.1016/j.jbiomech.2024.112270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 08/06/2024] [Accepted: 08/08/2024] [Indexed: 08/16/2024]
Abstract
Current surgical aortic valve (AV) replacement options include bioprosthetic and mechanical heart valves (MHVs), each with inherent limitations. Bioprosthetic valves offer superior hemodynamics but suffer from durability issues, typically initiating deterioration within 7-8 years. MHVs, while durable, necessitate lifelong anticoagulation therapy, presenting risks such as severe bleeding and thromboembolic events. The need for anticoagulants is caused by non-physiological flow through the hinge area during the closed phase and large spikes of regional backflow velocity (RBV) during the closing phase that produces high shear events. This study introduces the iValve, a novel MHV designed to combine the hemodynamic benefits of bioprosthetic valves with the durability of MHVs without requiring anticoagulation. The iValve features eye-like leaflets, a saddle-shaped housing, and an optimized hinge design to enhance blood flow and minimize thrombotic risk. Fabricated using 6061-T6 aluminum and polyether ether ketone (PEEK), twelve iValve iterations were evaluated for their opening and closing dynamics. The reported top-performing prototypes demonstrated competitive performance against industry standards. The proposed iValve prototype exhibited a mean RBV of -4.34 m/s with no spikes in RBV, performing similarly to bioprosthetic valves and significantly outperforming existing MHVs. The iValve's optimized design showed a 7-10% reduction in closing time and a substantial decrease in RBV spikes, potentially reducing the need for anticoagulation therapy. This study highlights the iValve's potential to revolutionize prosthetic heart valve technology by offering a durable, hemodynamically superior solution that mitigates the drawbacks of current MHVs.
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Affiliation(s)
- Dylan Goode
- The Heart Valve Performance Laboratory, School of Engineering, Faculty of Applied Science, University of British Columbia, Kelowna, BC, Canada
| | | | | | - Hadi Mohammadi
- The Heart Valve Performance Laboratory, School of Engineering, Faculty of Applied Science, University of British Columbia, Kelowna, BC, Canada.
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Butany J, Schoen FJ. Cardiac valve replacement and related interventions. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00010-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Taghizadeh B, Ghavami L, Derakhshankhah H, Zangene E, Razmi M, Jaymand M, Zarrintaj P, Zarghami N, Jaafari MR, Moallem Shahri M, Moghaddasian A, Tayebi L, Izadi Z. Biomaterials in Valvular Heart Diseases. Front Bioeng Biotechnol 2020; 8:529244. [PMID: 33425862 PMCID: PMC7793990 DOI: 10.3389/fbioe.2020.529244] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 11/16/2020] [Indexed: 01/07/2023] Open
Abstract
Valvular heart disease (VHD) occurs as the result of valvular malfunction, which can greatly reduce patient's quality of life and if left untreated may lead to death. Different treatment regiments are available for management of this defect, which can be helpful in reducing the symptoms. The global commitment to reduce VHD-related mortality rates has enhanced the need for new therapeutic approaches. During the past decade, development of innovative pharmacological and surgical approaches have dramatically improved the quality of life for VHD patients, yet the search for low cost, more effective, and less invasive approaches is ongoing. The gold standard approach for VHD management is to replace or repair the injured valvular tissue with natural or synthetic biomaterials. Application of these biomaterials for cardiac valve regeneration and repair holds a great promise for treatment of this type of heart disease. The focus of the present review is the current use of different types of biomaterials in treatment of valvular heart diseases.
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Affiliation(s)
- Bita Taghizadeh
- Department of Medical Biotechnology, School of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Laleh Ghavami
- Laboratory of Biophysics and Molecular Biology, Department of Biophysics, Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
| | - Hossein Derakhshankhah
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ehsan Zangene
- Department of Bioinformatics, Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
| | - Mahdieh Razmi
- Department of Biochemistry, Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
| | - Mehdi Jaymand
- Nano Drug Delivery Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Payam Zarrintaj
- Polymer Engineering Department, Faculty of Engineering, Urmia University, Urmia, Iran
| | - Nosratollah Zarghami
- Department of Medical Biotechnology, School of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahmoud Reza Jaafari
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Matin Moallem Shahri
- Cardiology Department, Taleghani Trauma Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Lobat Tayebi
- Marquette University School of Dentistry, Milwaukee, WI, United States
| | - Zhila Izadi
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Department of Regenerative Medicine, Cell Science Research Center, Academic Center for Education, Culture and Research (ACECR), Royan Institute for Stem Cell Biology and Technology, Tehran, Iran
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De Martino A, Milano AD, Thiene G, Bortolotti U. Diamond Anniversary of Mechanical Cardiac Valve Prostheses: A Tale of Cages, Balls, and Discs. Ann Thorac Surg 2020; 110:1427-1433. [PMID: 32599040 DOI: 10.1016/j.athoracsur.2020.04.143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/03/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
Abstract
This year marks the 60th anniversary of the first aortic and mitral valve replacements using mechanical artificial prosthesis. The first caged-ball devices represented a milestone in cardiac surgery and in the treatment of valvular disease. The following decades witnessed a great evolution in mechanical valve technology providing, through frustrating complications and stimulating successes, more reliable models to be safely used in the clinical setting. This review pays tribute to pioneers of this field who made currently available the most advanced models of mechanical prostheses with extended records of durability and performance, to be used as reliable alternatives to biological devices.
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Affiliation(s)
| | - Aldo D Milano
- Division of Cardiac Surgery, University of Bari, Bari, Italy
| | - Gaetano Thiene
- Department of Cardiovascular Pathology, University of Padua, Padua, Italy
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Li RL, Russ J, Paschalides C, Ferrari G, Waisman H, Kysar JW, Kalfa D. Mechanical considerations for polymeric heart valve development: Biomechanics, materials, design and manufacturing. Biomaterials 2019; 225:119493. [PMID: 31569017 PMCID: PMC6948849 DOI: 10.1016/j.biomaterials.2019.119493] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/21/2019] [Accepted: 09/11/2019] [Indexed: 01/12/2023]
Abstract
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.
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Affiliation(s)
- Richard L Li
- Department of Mechanical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, New York, NY, USA; Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, USA
| | - Jonathan Russ
- Department of Civil Engineering and Engineering Mechanics, Fu Foundation School of Engineering and Applied Science, Columbia University, New York, NY, USA
| | - Costas Paschalides
- Department of Mechanical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, New York, NY, USA
| | - Giovanni Ferrari
- Department of Surgery and Biomedical Engineering, Columbia University Medical Center, New York, NY, USA
| | - Haim Waisman
- Department of Civil Engineering and Engineering Mechanics, Fu Foundation School of Engineering and Applied Science, Columbia University, New York, NY, USA
| | - Jeffrey W Kysar
- Department of Mechanical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, New York, NY, USA; Department of Otolaryngology - Head and Neck Surgery, Columbia University Medical Center, New York, NY, USA.
| | - David Kalfa
- Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, USA.
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Basir A, Loncq de Jong M, Gründeman PF, van Herwaarden JA, Kluin J, Moll FL. The early days of vascular and heart valve prostheses: a historical review. THE JOURNAL OF CARDIOVASCULAR SURGERY 2019; 61:528-537. [PMID: 31486614 DOI: 10.23736/s0021-9509.19.11011-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This surgical heritage article provides a historical overview of the most important early advances of vascular- and valvular surgery, that lead to the development of currently used vascular- and valvular prostheses and materials. The first writings describing techniques in vascular surgery mainly focussed on hemorrhage control and date from around 1600 B.C. The strategy of vessel ligation was first mentioned in Western literature around 200 B.C. In the 18<sup>th</sup> century, techniques of ligation were expanded towards attempts of vessel restoration. The first artificial vascular prosthesis was made in 1894. From this time on, vascular prostheses were used in animal experiments and around 1900 for the first time in humans. More than 60 years later, in 1952, the first mechanical heart valve prosthesis was implanted. Four years later, the first successful biological heart valve implantation followed. In 2000, a transcatheter heart valve was successfully implanted in a human for the first time. Over time, procedures and techniques became more efficient and effective. This led to new developments, such as the manufacturing of a tissue engineered blood vessel in 1986. Nowadays, dozens of different valve prostheses have been devised, both mechanical and biological. Still, no ideal model of vascular and heart valve prosthesis exists.
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Affiliation(s)
- Amir Basir
- Department of Experimental Cardiology, University Medical Center, Utrecht, the Netherlands -
| | - Mylène Loncq de Jong
- Department of Experimental Cardiology, University Medical Center, Utrecht, the Netherlands
| | - Paul F Gründeman
- Department of Experimental Cardiology, University Medical Center, Utrecht, the Netherlands
| | | | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Frans L Moll
- Department of Vascular Surgery, University Medical Center, Utrecht, the Netherlands
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Polymeric heart valves for surgical implantation, catheter-based technologies and heart assist devices. Biomaterials 2015; 36:6-25. [DOI: 10.1016/j.biomaterials.2014.09.013] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 09/12/2014] [Indexed: 11/18/2022]
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Rozeik MM, Wheatley DJ, Gourlay T. The aortic valve: structure, complications and implications for transcatheter aortic valve replacement. Perfusion 2014; 29:285-300. [DOI: 10.1177/0267659114521650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aortic valve operates in a complex haemodynamic environment, opening and closing over 100,000 times a day. When complications arise, such as aortic stenosis, prognosis can be very poor, leading to death within the first few years. Surgical valve replacement is currently the standard treatment for aortic stenosis. A thorough understanding of the anatomy and function of the native valve is imperative when developing a prosthetic replacement that can withstand the complex demands of the heart. This review focuses on the anatomy, structure and disease of the aortic valve and the implications for a transcatheter aortic valve replacement (TAVR). Current complications with TAVR, such as major vascular bleeding, conduction disturbances and patient-prosthesis mismatch (PPM), can be overcome by reducing the delivery profile and through the use of more accurate imaging technologies to work towards a fully functional and durable prosthesis.
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Affiliation(s)
- MM Rozeik
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - DJ Wheatley
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - T Gourlay
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
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Substitute Heart Valves. Biomater Sci 2013. [DOI: 10.1016/b978-0-08-087780-8.00067-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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