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Tong Q, Cai J, Wang Z, Sun Y, Liang X, Xu Q, Mahamoud OA, Qian Y, Qian Z. Recent Advances in the Modification and Improvement of Bioprosthetic Heart Valves. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024; 20:e2309844. [PMID: 38279610 DOI: 10.1002/smll.202309844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/10/2023] [Indexed: 01/28/2024]
Abstract
Valvular heart disease (VHD) has become a burden and a growing public health problem in humans, causing significant morbidity and mortality worldwide. An increasing number of patients with severe VHD need to undergo heart valve replacement surgery, and artificial heart valves are in high demand. However, allogeneic valves from donors are lacking and cannot meet clinical practice needs. A mechanical heart valve can activate the coagulation pathway after contact with blood after implantation in the cardiovascular system, leading to thrombosis. Therefore, bioprosthetic heart valves (BHVs) are still a promising way to solve this problem. However, there are still challenges in the use of BHVs. For example, their longevity is still unsatisfactory due to the defects, such as thrombosis, structural valve degeneration, calcification, insufficient re-endothelialization, and the inflammatory response. Therefore, strategies and methods are needed to effectively improve the biocompatibility and longevity of BHVs. This review describes the recent research advances in BHVs and strategies to improve their biocompatibility and longevity.
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Affiliation(s)
- Qi Tong
- Department of Cardiovascular Surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, #37 Guoxue Alley, Chengdu, Sichuan, 610041, P. R. China
| | - Jie Cai
- Department of Cardiovascular Surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, #37 Guoxue Alley, Chengdu, Sichuan, 610041, P. R. China
| | - Zhengjie Wang
- Department of Cardiovascular Surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, #37 Guoxue Alley, Chengdu, Sichuan, 610041, P. R. China
| | - Yiren Sun
- Department of Cardiovascular Surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, #37 Guoxue Alley, Chengdu, Sichuan, 610041, P. R. China
| | - Xuyue Liang
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, #37 Guoxue Alley, Chengdu, Sichuan, 610041, P. R. China
| | - Qiyue Xu
- School of Basic Medicine, Mudanjiang Medical University, Mudanjiang, Heilongjiang, 157011, P. R. China
| | - Oumar Abdel Mahamoud
- Department of Cardiovascular Surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, #37 Guoxue Alley, Chengdu, Sichuan, 610041, P. R. China
| | - Yongjun Qian
- Department of Cardiovascular Surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, #37 Guoxue Alley, Chengdu, Sichuan, 610041, P. R. China
| | - Zhiyong Qian
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, #37 Guoxue Alley, Chengdu, Sichuan, 610041, P. R. China
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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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Guimarães HP, de Barros E Silva PGM, Liporace IL, Sampaio RO, Tarasoutchi F, Paixão M, Hoffmann-Filho CR, Patriota R, Leiria TLL, Lamprea D, Precoma DB, Atik FA, Silveira FS, Farias FR, Barreto DO, Almeida AP, Zilli AC, de Souza Neto JD, Cavalcante MA, Figueira FAMS, Junior RA, Moisés VA, Mesas CE, Ardito RV, Kalil PSA, Paiva MSMO, Maldonado JGA, de Lima CEB, D'Oliveira Vieira R, Laranjeira L, Kojima F, Damiani L, Nakagawa RH, Dos Santos JRY, Sampaio BS, Campos VB, Saraiva JFK, Fonseca FH, Pinto IM, Magalhães CC, Ferreira JFM, Lopes RD, Pavanello R, Cavalcanti AB, Berwanger O. A randomized clinical trial to evaluate the efficacy and safety of rivaroxaban in patients with bioprosthetic mitral valve and atrial fibrillation or flutter: Rationale and design of the RIVER trial. Am Heart J 2021; 231:128-136. [PMID: 33045224 DOI: 10.1016/j.ahj.2020.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/05/2020] [Indexed: 02/06/2023]
Abstract
The efficacy and safety of rivaroxaban in patients with bioprosthetic mitral valves and atrial fibrillation or flutter remain uncertain. DESIGN: RIVER was an academic-led, multicenter, open-label, randomized, non-inferiority trial with blinded outcome adjudication that enrolled 1005 patients from 49 sites in Brazil. Patients with a bioprosthetic mitral valve and atrial fibrillation or flutter were randomly assigned (1:1) to rivaroxaban 20 mg once daily (15 mg in those with creatinine clearance <50 mL/min) or dose-adjusted warfarin (target international normalized ratio 2.0-30.); the follow-up period was 12 months. The primary outcome was a composite of all-cause mortality, stroke, transient ischemic attack, major bleeding, valve thrombosis, systemic embolism, or hospitalization for heart failure. Secondary outcomes included individual components of the primary composite outcome, bleeding events, and venous thromboembolism. SUMMARY: RIVER represents the largest trial specifically designed to assess the efficacy and safety of a direct oral anticoagulant in patients with bioprosthetic mitral valves and atrial fibrillation or flutter. The results of this trial can inform clinical practice and international guidelines.
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Affiliation(s)
- Helio P Guimarães
- Research Institute - Heart Hospital (HCor), São Paulo, Brazil; Hospital Israelita Albert Einstein, São Paulo-SP, Brazil.
| | | | | | | | | | - Milena Paixão
- Incor - Instituto do Coração do HCFMUSP, São Paulo, Brazil
| | | | - Rodrigo Patriota
- Hospital Metropolitano Sul Dom Helder Câmara, Cabo de Santo Agostinho, Brazil
| | - Tiago L L Leiria
- Instituto de Cardiologia do Rio Grande do Sul (FUC), Porto Alegre, Brazil
| | | | - Dalton B Precoma
- Sociedade Hospitalar Angelina Caron, Campina Grande do Sul, Brazil
| | - Fernando A Atik
- Instituto de Cardiologia do Distrito Federal, Brasília, Brazil
| | | | | | | | - Adail P Almeida
- Unidade Médico Cirúrgica - Unimec, Vitória da Conquista, Brazil
| | | | | | | | | | - Roque A Junior
- HUPES-Hospital Universitário Prof Edgard Santos, Salvador, Brazil
| | | | - Cezar E Mesas
- Hospital de Universidade Estadual de Londrina, Londrina, Brazil
| | - Roberto V Ardito
- IMC - Instituto de Moléstias Cardiovasculares, São José do Rio Preto, Brazil
| | | | | | - Jaime G A Maldonado
- Serviço de Eletrofisiologia e Marca-Passo do Hospital Universitário Francisca Mendes (HUFM)-Manaus, Brazil
| | | | | | | | - Flávia Kojima
- Research Institute - Heart Hospital (HCor), São Paulo, Brazil
| | - Lucas Damiani
- Research Institute - Heart Hospital (HCor), São Paulo, Brazil
| | | | | | - Bruna S Sampaio
- Research Institute - Heart Hospital (HCor), São Paulo, Brazil
| | | | - Jose F K Saraiva
- Instituto de Pesquisa Clínica de Campinas, Campinas, Brazil; Sociedade de Cardiologia do Estado de São Paulo (SOCESP), Sao Paulo, Brazil
| | - Francisco H Fonseca
- UNIFESP, São Paulo, Brazil; Sociedade de Cardiologia do Estado de São Paulo (SOCESP), Sao Paulo, Brazil
| | - Ibraim M Pinto
- Sociedade de Cardiologia do Estado de São Paulo (SOCESP), Sao Paulo, Brazil
| | - Carlos C Magalhães
- Sociedade de Cardiologia do Estado de São Paulo (SOCESP), Sao Paulo, Brazil
| | - Joao F M Ferreira
- Incor - Instituto do Coração do HCFMUSP, São Paulo, Brazil; Sociedade de Cardiologia do Estado de São Paulo (SOCESP), Sao Paulo, Brazil
| | | | - Ricardo Pavanello
- Research Institute - Heart Hospital (HCor), São Paulo, Brazil; Sociedade de Cardiologia do Estado de São Paulo (SOCESP), Sao Paulo, Brazil
| | | | - Otavio Berwanger
- Research Institute - Heart Hospital (HCor), São Paulo, Brazil; Hospital Israelita Albert Einstein, São Paulo-SP, Brazil; Sociedade de Cardiologia do Estado de São Paulo (SOCESP), Sao Paulo, Brazil
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Porcine versus bovine bioprosthetic valves in mitral position: does choice really matter? Indian J Thorac Cardiovasc Surg 2019; 36:105-113. [PMID: 33061108 DOI: 10.1007/s12055-019-00847-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/26/2019] [Accepted: 06/13/2019] [Indexed: 10/26/2022] Open
Abstract
Background Bioprosthetic valves are increasingly used for surgical mitral valve replacement (MVR). The long-term outcomes of bovine (BoMVR) vs porcine (PoMVR) remain an enigma regarding the durability. This study aims to examine the outcomes of BoMVR vs PoMVR. Methods A retrospective analysis of all bioprosthetic MVRs, with concomitant procedures, at a single tertiary referral institution from January 2005 to December 2008 was conducted. Procedures were classified as BoMVR or PoMVR. The age group was from 40 to 70 years. Results We identified 154 BoMVR patients and 120 PoMVR patients after matching the two groups with respect to age, sex, valve size and concomitant procedures. Kaplan-Meier survival analysis model was used for corresponding statistical analysis. Freedom from reoperation (all cause), freedom from non-structural valve deterioration, freedom from structural valve deterioration, freedom from heart failure and freedom from infective endocarditis were 96.4 ± 0.08, 97.1 ± 0.07, 96.4 ± 0.08%, 98.2 ± 0.07, and 98.6 ± 0.06% in PoMVR, respectively, and 92.6 ± 0.09, 91.6 ± 0.08, 90.6 ± 0.09, 94 ± 0.08, and 92.8 ± 0.08% in BoMVR groups, respectively, at the end of 10-year follow-up (mean follow up of 6.2 ± 2.3 years). Overall, 20 (12.9%) patients were lost to follow-up in the BoMVR and 15(12.5%) patients in the PoMVR groups for a global follow-up of 87.1%. Conclusions For patients undergoing MVR with a bioprosthetic valve, the choice of PoMVR vs BoMVR favours more in favour of PoMVR as evidenced by the outcome results. Probably long-term follow-up with more patients might throw further light on the debatable topic.
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Schussler O, Lila N, Perneger T, Mootoosamy P, Grau J, Francois A, Smadja DM, Lecarpentier Y, Ruel M, Carpentier A. Recipients with blood group A associated with longer survival rates in cardiac valvular bioprostheses. EBioMedicine 2019; 42:54-63. [PMID: 30878598 PMCID: PMC6491382 DOI: 10.1016/j.ebiom.2019.02.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/12/2019] [Accepted: 02/20/2019] [Indexed: 01/02/2023] Open
Abstract
Background Pigs/bovines share with humans some of the antigens present on cardiac valves. Two such antigens are: the major xenogenic Ag, “Gal” present in all pig/bovine very close to human B-antigen of ABO-blood-group system; the minor Ag, pig histo-blood-group AH-antigen identical to human AH-antigen and present by some animals. We hypothesize that these antigens may modify the immunogenicity of the bioprosthesis and also its longevity. ABO distribution may vary between patients with low (<6 years) and high (≥15 years) bioprostheses longevity. Methods Single-centre registry study (Paris, France) including all degenerative porcine bioprostheses (mostly Carpentier-Edwards 2nd/3rd generation heart valves) explanted between 1985 and 1998 and some bovine bioprostheses. For period 1998–2014, all porcine bioprostheses with longevity ≥13 years (follow-up ≥29 years). Important predictive factors for bioprosthesis longevity: number, site of implantation, age were collected. Blood group and other variables were entered into an ordinal logistic regression analysis model predicting valve longevity, categorized as low (<6 years), medium (6–14.9 years), and high (≥15 years). Findings Longevity and ABO-blood group were obtained for 483 explanted porcine bioprostheses. Mean longevity was 10.2 ± 3.9 years [0–28] and significantly higher for A-patients than others (P = 0.009). Using multivariate analysis, group A was a strong predictive factor of longevity (OR 2.09; P < 0.001). For the 64 explanted bovine bioprosthesis with low/medium longevity, the association, with A-group was even more significant. Interpretation Patients of A-group but not B have a higher longevity of their bioprostheses. Future graft-host phenotyping and matching may give rise to a new generation of long-lasting bioprosthesis for implantation in humans, especially for the younger population. Fund None.
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Affiliation(s)
- O Schussler
- Division of Cardiovascular Surgery and Cardiovascular Research Laboratory, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | - N Lila
- Laboratory of Biosurgical Research (Alain Carpentier Foundation), University Paris Descartes, Sorbonne Paris Cité, Paris F-75475, France
| | - T Perneger
- Department of Clinical Epidemiology, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - P Mootoosamy
- Division of Cardiovascular Surgery and Cardiovascular Research Laboratory, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - J Grau
- Division of Cardiac Surgery and Research Laboratory, Department of Epidemiology, Ottawa Heart Institute, University of Ottawa Heart, Ottawa, Ontario, Canada
| | - A Francois
- Etablissement Français du Sang (EFS), Ile de France, Immuno-hematology Laboratory, Georges Pompidou Hospital, Paris, France
| | - D M Smadja
- Division of Cardiovascular Surgery and Cardiovascular Research Laboratory, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; AP-HP, Hôpital Européen Georges Pompidou, Hematology Department, Paris Descartes University, Sorbonne Paris Cite, Inserm UMR-S1140, Paris, France
| | - Y Lecarpentier
- Centre de Recherche Clinique, Grand Hôpital de l'Est Francilien (GHEF), Meaux, France
| | - M Ruel
- Division of Cardiac Surgery and Research Laboratory, Department of Epidemiology, Ottawa Heart Institute, University of Ottawa Heart, Ottawa, Ontario, Canada
| | - A Carpentier
- Laboratory of Biosurgical Research (Alain Carpentier Foundation), University Paris Descartes, Sorbonne Paris Cité, Paris F-75475, France; AP-HP, Hôpital Européen Georges Pompidou, Department of Cardiovascular Surgery, Paris, France
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McIntyre V, Butany J, Boles D, Shao T. Recurrent infective endocarditis causing heart valve failure: A case report. HUMAN PATHOLOGY: CASE REPORTS 2017. [DOI: 10.1016/j.ehpc.2016.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Schoen FJ, Gotlieb AI. Heart valve health, disease, replacement, and repair: a 25-year cardiovascular pathology perspective. Cardiovasc Pathol 2016; 25:341-352. [PMID: 27242130 DOI: 10.1016/j.carpath.2016.05.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/04/2016] [Accepted: 05/05/2016] [Indexed: 01/24/2023] Open
Abstract
The past several decades have witnessed major advances in the understanding of the structure, function, and biology of native valves and the pathobiology and clinical management of valvular heart disease. These improvements have enabled earlier and more precise diagnosis, assessment of the proper timing of surgical and interventional procedures, improved prosthetic and biologic valve replacements and repairs, recognition of postoperative complications and their management, and the introduction of minimally invasive approaches that have enabled definitive and durable treatment for patients who were previously considered inoperable. This review summarizes the current state of our understanding of the mechanisms of heart valve health and disease arrived at through innovative research on the cell and molecular biology of valves, clinical and pathological features of the most frequent intrinsic structural diseases that affect the valves, and the status and pathological considerations in the technological advances in valvular surgery and interventions. The contributions of many cardiovascular pathologists and other scientists, engineers, and clinicians are emphasized, and potentially fruitful areas for research are highlighted.
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Affiliation(s)
- Frederick J Schoen
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115; Pathology and Health Sciences and Technology (HST), Harvard Medical School, 75 Francis Street, Boston, MA 02115.
| | - Avrum I Gotlieb
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario M5S 1A8, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario M5S 1A8, Canada; Laboratory Medicine Program, University Health Network, Medical Sciences Building, 1 King's College Circle, Rm. 6275A, Toronto, Ontario M5S 1A8, Canada.
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Dunn DA, Hodge AJ, Lipke EA. Biomimetic materials design for cardiac tissue regeneration. WILEY INTERDISCIPLINARY REVIEWS-NANOMEDICINE AND NANOBIOTECHNOLOGY 2013; 6:15-39. [DOI: 10.1002/wnan.1241] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 07/10/2013] [Accepted: 07/29/2013] [Indexed: 01/12/2023]
Affiliation(s)
- David A. Dunn
- Department of Chemical Engineering, Auburn University, Auburn, AL, USA
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Singhal P, Luk A, Butany J. Bioprosthetic Heart Valves: Impact of Implantation on Biomaterials. ACTA ACUST UNITED AC 2013. [DOI: 10.5402/2013/728791] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Prosthetic heart valves are commonly used in the treatment of valvular heart disease. Mechanical valves are more durable than the bioprosthetic valves; however, the need for long-term anticoagulant therapy renders them unsuitable for some patient groups. In this paper we discuss the different types and models of bioprosthesis, and in particular, pericardial bioprosthesis. We also discuss the preimplantation preparation processes, as well as their postimplantation changes and modes of failure.
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Affiliation(s)
- Pooja Singhal
- Department of Pathology, Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4
| | - Adriana Luk
- Division of Cardiology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jagdish Butany
- Department of Pathology, Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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Flexible Leaflet Polymeric Heart Valves. CARDIOVASCULAR AND CARDIAC THERAPEUTIC DEVICES 2013. [DOI: 10.1007/8415_2013_166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Butany J, Feng T, Suri R, Law K, Christakis G. Mitroflow pericardial bioprosthesis: structured failure at 4.5 years. Cardiovasc Pathol 2012; 21:506-10. [DOI: 10.1016/j.carpath.2012.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 01/24/2012] [Accepted: 01/24/2012] [Indexed: 10/27/2022] Open
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VanderLaan PA, Padera RF, Schoen FJ. Practical Approach to the Evaluation of Prosthetic Mechanical and Tissue Replacement Heart Valves. Surg Pathol Clin 2012; 5:353-69. [PMID: 26838108 DOI: 10.1016/j.path.2012.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Mechanical and bioprosthetic substitute heart valves have dramatically improved life expectancy and quality of life in patients with valvular heart disease. Complications of substitute heart valves are a relatively infrequent occurrence, often due to thrombosis, infection, or structural/mechanical failure. It is important to accurately identify and systematically evaluate prosthetic heart valves when encountered as surgical pathology specimens or in the autopsy setting.
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Affiliation(s)
- Paul A VanderLaan
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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Modes of Failure in Explanted Mitroflow Pericardial Valves. Ann Thorac Surg 2011; 92:1621-7. [DOI: 10.1016/j.athoracsur.2011.06.092] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Revised: 06/27/2011] [Accepted: 06/29/2011] [Indexed: 11/23/2022]
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Schleicher M, Sammler G, Schmauder M, Fritze O, Huber AJ, Schenke-Layland K, Ditze G, Stock UA. Simplified Pulse Reactor for Real-Time Long-Term In Vitro Testing of Biological Heart Valves. Ann Biomed Eng 2010; 38:1919-27. [DOI: 10.1007/s10439-010-9975-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Accepted: 02/16/2010] [Indexed: 11/25/2022]
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Sun JCJ, Davidson MJ, Lamy A, Eikelboom JW. Antithrombotic management of patients with prosthetic heart valves: current evidence and future trends. Lancet 2009; 374:565-76. [PMID: 19683642 DOI: 10.1016/s0140-6736(09)60780-7] [Citation(s) in RCA: 148] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Over 4 million people worldwide have received a prosthetic heart valve, and an estimated 300,000 valves are being implanted every year. Prosthetic heart valves improve quality of life and survival of patients with severe valvular heart disease, but the need for antithrombotic therapy to prevent thrombotic complications in valve recipients poses challenges for clinicians and patients. Here, we review antithrombotic therapies for patients with prosthetic heart valves and management of thromboembolic complications. Advances in antithrombotic therapy and valve technologies are likely to improve the management of patients with prosthetic heart valves in developed countries, but the most important unmet need and potential for benefit from these new therapies is in developing countries where a massive and rapidly increasing burden of valvular heart disease exists.
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Affiliation(s)
- Jack C J Sun
- Division of Cardiac Surgery, McMaster University, Hamilton, ON, Canada.
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Zhang H, Deng X, Cianciulli TF, Zhang Z, Chappard D, Lax JA, Saccheri MC, Redruello HJ, Jordana JL, Prezioso HA, King M, Guidoin R. Pivoting system fracture in a bileaflet mechanical valve: A case report. J Biomed Mater Res B Appl Biomater 2009; 90:952-61. [DOI: 10.1002/jbm.b.31324] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Liao KK, Li X, John R, Amatya DM, Joyce LD, Park SJ, Bianco R, Bolman RM. Mechanical Stress: An Independent Determinant of Early Bioprosthetic Calcification in Humans. Ann Thorac Surg 2008; 86:491-5. [DOI: 10.1016/j.athoracsur.2008.03.061] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Revised: 03/21/2008] [Accepted: 03/25/2008] [Indexed: 11/28/2022]
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Khait L, Hecker L, Blan NR, Coyan G, Migneco F, Huang YC, Birla RK. Getting to the Heart of Tissue Engineering. J Cardiovasc Transl Res 2008; 1:71-84. [DOI: 10.1007/s12265-007-9005-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Accepted: 12/21/2007] [Indexed: 10/22/2022]
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Butany J, Zhou T, Leong SW, Cunningham KS, Thangaroopan M, Jegatheeswaran A, Jeggatheeswaran A, Feindel C, David TE. Inflammation and infection in nine surgically explanted Medtronic Freestyle® stentless aortic valves. Cardiovasc Pathol 2007; 16:258-67. [PMID: 17868876 DOI: 10.1016/j.carpath.2007.01.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2006] [Revised: 01/02/2007] [Accepted: 01/29/2007] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The Medtronic Freestyle valve is fixed in glutaraldehyde at zero pressure on the cusps and treated with alpha-amino oleic acid. This valve reportedly has excellent clinical and hemodynamic results, but little has been reported about its long-term pathology. METHODS AND RESULTS Nine Freestyle valves explanted between 2003 and 2005 were reviewed to assess the reasons for bioprosthesis failure (six implanted at our institution). All valves were examined in detail, using histochemistry and immunohistochemistry to identify the cellular response. One Freestyle valve, explanted for mitral valve endocarditis on the fifth postoperative day, was excluded from analysis. Average implant duration was 52.8+/-35.5 months. Four valves were explanted for infective endocarditis, three for aortic insufficiency, two for aortic stenosis with cusp calcification seen in five valves, pannus and thrombus in all valves and a chronic inflammatory reaction involving the xenograft arterial wall seen in eight of nine valves. This was associated with significant damage to the porcine aortic wall in seven cases, and cusp myocardial shelf damage in six cases. CONCLUSIONS In this series of valves, we found (1) infective endocarditis; (2) pannus, thrombus, and calcification; and (3) unusual and significant inflammatory reaction and aortic tissue damage, which could by itself lead to aortic incompetence.
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Affiliation(s)
- Jagdish Butany
- Department of Pathology, Toronto General Hospital/University Health Network, Toronto, Canada.
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Hecker L, Birla RK. Engineering the heart piece by piece: state of the art in cardiac tissue engineering. Regen Med 2007; 2:125-44. [PMID: 17465746 DOI: 10.2217/17460751.2.2.125] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
According to the National Transplant Society, more than 7000 Americans in need of organs die every year owing to a lack of lifesaving organs. Bioengineering 3D organs in vitro for subsequent implantation may provide a solution to this problem. The field of tissue engineering in its most rudimentary form is focused on the developed of transplantable organ substitutes in the laboratory. The objective of this article is to introduce important technological hurdles in the field of cardiac tissue engineering. This review starts with an overview of tissue engineering, followed by an introduction to the field of cardiovascular tissue engineering and finally summarizes some of the key advances in cardiac tissue engineering; specific topics discussed in this article include cell sourcing and biomaterials, in vitro models of cardiac muscle and bioreactors. The article concludes with thoughts on the utility of tissue-engineering models in basic research as well as critical technological hurdles that need to be addressed in the future.
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Affiliation(s)
- Louise Hecker
- Cell and Developmental Biology, The University of Michigan, Ann Arbor, MI 48109, USA
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21
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Butany J, Leong SW, Cunningham KS, D'Cruz G, Carmichael K, Yau TM. A 10-year comparison of explanted Hancock-II and Carpentier–Edwards supraannular bioprostheses. Cardiovasc Pathol 2007; 16:4-13. [PMID: 17218209 DOI: 10.1016/j.carpath.2006.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2005] [Revised: 03/16/2006] [Accepted: 06/12/2006] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Bioprosthetic heart valves are more frequently being used in valve replacement procedures today. Although second-generation bioprosthetic valves have improved functionality over their first-generation counterparts, they still often fail due to primary tissue degeneration. METHODS This study examines two second-generation porcine valves after surgical explantation, the Hancock-II (HAN; Medtronic Heart Valve Division, Irvine, CA, USA) and the Carpentier-Edwards supraannular (CE-SAV; Baxter Healthcare Corporation, now Edwards LifeSciences, Irvine, CA, USA), with special attention to morphological/histological changes and reasons for valve failure. A total of 98 HAN and 65 CE-SAV valves were explanted and seen over a 10-year period. RESULTS CE-SAV valves had a longer average implant duration than HAN valves (13.9+/-3.9 years vs. 10.0+/-5.1 years). Compared with HAN valves, CE-SAV valves also had a higher incidence of stent deformation (41.5% vs. 14.3%), calcification (75.4% vs. 54.1%), and pannus (100% vs. 91.8%). CONCLUSIONS The greater degenerative changes seen with CE-SAV valves over HAN valves may be due to the longer implant duration of CE-SAV valves in this series. To our knowledge, the present study is the first direct morphological comparison of these two valve models.
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Affiliation(s)
- Jagdish Butany
- Department of Pathology, Toronto General Hospital/University Health Network, Toronto, Canada.
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22
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Butany J, Nair V, Leong SW, Soor GS, Feindel C. Carpentier-Edwards Perimount Valves?Morphological Findings in Surgical Explants. J Card Surg 2007; 22:7-12. [PMID: 17239203 DOI: 10.1111/j.1540-8191.2007.00336.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jagdish Butany
- Department of Pathology, Toronto General Hospital/University Health Network, Toronto, Canada.
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23
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Jegatheeswaran A, Butany J. Pathology of infectious and inflammatory diseases in prosthetic heart valves. Cardiovasc Pathol 2006; 15:252-255. [PMID: 16979031 DOI: 10.1016/j.carpath.2006.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2006] [Accepted: 05/02/2006] [Indexed: 12/19/2022] Open
Abstract
Prosthetic heart valves, both mechanical and biological (xenograft valves, stented or unstented), show an inflammatory reaction (infective endocarditis), associated predominantly with bacterial/fungal infection. Somewhat surprisingly, no immune-mediated reaction has been reported thus far. This may, among other reasons, be related to the fact that the tissues are "fixed" with aldehydes and are virtually isolated from host circulation, separated by synthetic material (the valve stent and the fabric covering it). Stentless valves (especially these without fabric covering them), however, have no such "isolation" from the host circulation. While the Toronto-Stentless Porcine Valve has a covering of fabric, the Medtronic Freestyle valve has no such covering. It is perhaps not so surprising therefore that at the intermediate time point of 5 to 6 years, some valves are beginning to show such an immune reaction.
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Affiliation(s)
- Anusha Jegatheeswaran
- Department of Cardiovascular Surgery, University Health Network/Toronto General Hospital, Toronto, Ontario, Canada M5G 2C4; University of Toronto, Toronto, Ontario, Canada
| | - Jagdish Butany
- Department of Pathology, University Health Network/Toronto General Hospital, Toronto, Ontario, Canada M5G 2C4; University of Toronto, Toronto, Ontario, Canada.
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Butany JW, Naseemuddin A, Nair V, Borger MA, Daniel L. Infective Endocarditis in a Hancock Bioprosthetic Heart Valve. J Card Surg 2005; 20:389-92. [PMID: 15985148 DOI: 10.1111/j.1540-8191.2005.200484.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Contemporary prosthetic heart valves (PHV) are a good mode of treatment of valvular heart disease. They last for an average of 5 to 10 years and bioprostheses fail due to the tissue degeneration. Infective endocarditis of the prosthetic valve is a relatively rare complication occurring in 0.5% to 1% of cases per year, and its late occurrence is even less common. Patients with PHV who undergo interventional or surgical procedures under adequate antibiotic coverage, infective endocarditis should not occur. We present a case of a 54-year-old woman who developed infective endocarditis on a porcine bioprosthesis, implanted 15 years earlier. The microorganism was Streptococcus viridans and the vegetations were surprisingly large and led to prosthesis obstruction.
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Affiliation(s)
- Jagdish W Butany
- Department of Pathology, University Health Network, Toronto, Ontario, Canada.
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25
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Butany J, Collins MJ. Analysis of prosthetic cardiac devices: a guide for the practising pathologist. J Clin Pathol 2005; 58:113-24. [PMID: 15677529 PMCID: PMC1770567 DOI: 10.1136/jcp.2004.020271] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Pathologists all over the world increasingly encounter prosthetic cardiac devices. A good evaluation of these devices is a valuable source of information, which can contribute to patient care and the appreciation and understanding of the pathobiology involved in the changes occurring between the host and the implanted prosthetic device. This article summarises the considerations underlying the analysis of prosthetic devices (particularly prosthetic heart valves), including the identification of the devices, the major morphological features of the devices, their modes of failure, and some technical details about evaluation and pitfalls.
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Affiliation(s)
- J Butany
- Department of Pathology, Toronto General Hospital/University Health Network, Toronto Medical Laboratories, Toronto, ON M5G 2C4, Canada.
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