- Have significantly low regurgitation over the full range of physiological heart function
- Eg: absolute functional envelope of cardiac output vs heart rate
- Transvalvular pressure gradient is considerably small
- Non or minimally thrombogenic
Polymer based scaffolds tissue-engineered heart valve
Natural tissue-engineered heart valve
Mechanical artificial heart valve
Polymer Based Scaffolds Tissue-Engineered Heart Valve
Consist a matrix which used to construct neotissue, which:- Enable three-dimensional cell growth
- Provide a mode of cell delivery
- Facilitate nutrient and waste transportation
- Provide the necessary biomechanical support
Trileaflet polymeric heart valve
Polymeric heart valve fabricated from polyurethane/polysiliconeurethane
Tissue-Engineered Heart Valve
Tissue-engineered heart valve used polyesters
- Biocompatible
- Biodegradable
- Well characterized
- Approved by Food and Drug Administration for human implantation
Molecular structure of polylactic acid (left) and polyglycolic acid (right)
Tissue-engineered heart valve used thermoplastic polyesters
- Can be isolated from naturally occurring bacteria or synthesized in the laboratory
- Biocompatible
- Biomechanical profile more closely resembled the native heart valve
- Improved function
Molecular structure of polyhydroxyalkanoate
Tissue-engineered heart valve used polyhydroxyoctanoate
- Possess higher stiffness
Tissue-engineered heart valve used poly-4-hydroxybutyrate
- Inflow surface of leaflets:
- Loose, spongy layer containing elastin and glycosoaminoglycans
- Outflow surface of leaflets:
- More fibrous layer containing collagen
Molecular structure of poly-4-hydroxybutyrate
Natural Tissue-Engineered Heart Valve
- More biocompatible and less immunogenic
- Suitable for women who desire pregnancy and in patients older than 70 years
- A low risk of thromboembolism
- Only a small amount of blood thinner is needed to be taken by the patient to avoid clotting of the blood
- Blood-thinning drugs are needed only for the first few months after surgery
- The patient does not required to use Coumadin after surgery
- The bileaflet valves have greater effective opening area
- The valves do not click
Tissue-engineered heart valve generated from human marrow stromal cells
A typical porcine heart valve
- Tissue-engineered heart valve using xeno- or allograft matrices (composed of valves devoid of cells with preservation of the extracellular matrix):
- Help to maintain the valve's structural components
- Biomechanical profile is maintained
- A readily available and abundant scaffold material is obtained
- Tissue-engineered heart valve using autologous cells:
- Prevent immunological reaction that could cause rejection
- Practicable due to endothelial cells and myofibroblasts enthusiastically developed in culture
- Potential to bank autologous pluripotent cells which is significant in bringing tissue-engineered heart valves to clinical fruition
Mechanical Artificial Heart Valve
- Very durable because they are made of strong materials like carbon, titanium, Teflon, polyester and Dacron
- Can last 30 years or more after implant
- Patient threat for future valve replacement re-operation is decreased
- Suitable for children, young adults, and patients who have a high risk at re-operation
- Good hemodynamic performance
- New design features projected lower thromboembolic rates without loss of durability
- No or less structural valve failure disc in terms of structural integrity
Mechanical heart valve Starr-Edwards model 1260
Model 6120 cardiac valvular prostheses
Medtronic-Hall aortic (left) and mitral (right) cardiac valvular prostheses
St. Jude Medical cardiac valvular prosthesis
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