Bioprosthetic heart valves: the need for a quantum leap.
More than 250,000 bioprosthetic heart valves are being implanted annually. Although the majority of recipients are elderly developed-world patients, the most urgent need for tissue valves is in younger patients, where rapid degeneration of contemporary prostheses remains a serious obstacle. After decades of empirical and mostly futile attempts to extend the longevity of tissue valve prostheses, new insights and solutions are on the horizon. Aetiologically, a shift of focus from mineralization to immune responses and inflammation emerges. On the development side, new engineering approaches to both selective extraction of tissue components and cross-links are increasingly defining the new direction. In order to dramatically improve the performance of bioprosthetic heart valves, these new developments need to lead to a broad consensus for a paradigm shift in a hitherto rather stagnant field of medical research.
Christiaan Barnard Department of Cardiothoracic Surgery, University of Cape Town Medical School and Groote Schuur Hospital, Christian Barnard Building, Anzio Road, 7925 Observatory/Cape Town, South Africa. peter.zilla@uct.ac.za
Peter
P
Zilla
Paul
P
Human
Deon
D
Bezuidenhout
D000818:Animals; D001705:Bioprosthesis / Q000009:adverse effects* / Q000639:trends*; D002114:Calcinosis / Q000209:etiology* / Q000517:prevention & control; D019544:Equipment Failure Analysis / Q000379:methods*; D006084:Graft Rejection / Q000209:etiology / Q000517:prevention & control; D006331:Heart Diseases / Q000209:etiology* / Q000517:prevention & control; D006350:Heart Valve Prosthesis / Q000009:adverse effects* / Q000639:trends*; D006801:Humans; D011475:Prosthesis Failure