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Long-Term Stability and Biocompatibility of Pericardial Bioprosthetic Heart Valves
Frontiers in Cardiovascular Medicine ( IF 3.6 ) Pub Date : 2021-09-13 , DOI: 10.3389/fcvm.2021.728577
David F Williams 1, 2 , Deon Bezuidenhout 1, 3 , Jandre de Villiers 1 , Paul Human 4 , Peter Zilla 1, 3, 4
Affiliation  

The use of bioprostheses for heart valve therapy has gradually evolved over several decades and both surgical and transcatheter devices are now highly successful. The rapid expansion of the transcatheter concept has clearly placed a significant onus on the need for improved production methods, particularly the pre-treatment of bovine pericardium. Two of the difficulties associated with the biocompatibility of bioprosthetic valves are the possibilities of immune responses and calcification, which have led to either catastrophic failure or slow dystrophic changes. These have been addressed by evolutionary trends in cross-linking and decellularization techniques and, over the last two decades, the improvements have resulted in somewhat greater durability. However, as the need to consider the use of bioprosthetic valves in younger patients has become an important clinical and sociological issue, the requirement for even greater longevity and safety is now paramount. This is especially true with respect to potential therapies for young people who are afflicted by rheumatic heart disease, mostly in low- to middle-income countries, for whom no clinically acceptable and cost-effective treatments currently exist. To extend longevity to this new level, it has been necessary to evaluate the mechanisms of pericardium biocompatibility, with special emphasis on the interplay between cross-linking, decellularization and anti-immunogenicity processes. These mechanisms are reviewed in this paper. On the basis of a better understanding of these mechanisms, a few alternative treatment protocols have been developed in the last few years. The most promising protocol here is based on a carefully designed combination of phases of tissue-protective decellularization with a finely-titrated cross-linking sequence. Such refined protocols offer considerable potential in the progress toward superior longevity of pericardial heart valves and introduce a scientific dimension beyond the largely disappointing ‘anti-calcification’ treatments of past decades.



中文翻译:

心包生物人工心脏瓣膜的长期稳定性和生物相容性

用于心脏瓣膜治疗的生物假体的使用在几十年来逐渐发展,外科手术和经导管装置现在都非常成功。经导管概念的迅速扩展显然对改进生产方法的需求提出了重大责任,特别是牛心包的预处理。与生物瓣膜生物相容性相关的两个困难是免疫反应和钙化的可能性,这导致灾难性失败或缓慢的营养不良变化。这些问题已通过交联和脱细胞技术的发展趋势得到解决,并且在过去二十年中,这些改进导致了某种程度上更高的耐用性。然而,由于考虑在年轻患者中使用生物瓣膜已成为一个重要的临床和社会学问题,因此对更长寿命和安全性的要求现在至关重要。对于患有风湿性心脏病的年轻人来说,尤其如此,他们大多生活在中低收入国家,目前尚无临床上可接受且具有成本效益的治疗方法。为了将寿命延长到这个新水平,有必要评估心包生物相容性的机制,特别强调交联、脱细胞和抗免疫原性过程之间的相互作用。本文对这些机制进行了综述。在更好地理解这些机制的基础上,过去几年开发了一些替代治疗方案。这里最有前途的方案是基于精心设计的组织保护性脱细胞阶段与精细滴定的交联序列的组合。这种完善的方案为延长心包心脏瓣膜的使用寿命提供了巨大的潜力,并引入了超越过去几十年令人失望的“抗钙化”治疗的科学维度。

更新日期:2021-09-13
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