2023, Vol. 27 ›› Issue (7): 1096-1102

Current status and prospects of bioprosthetic heart valves

Chen Shisong, Liu Xiaohong, Xu Zhiyun   

Abstract: BACKGROUND: Heart valve disease is common among cardiac surgical disorders, and prosthetic heart valve replacement surgery is the standard treatment for symptomatic valve disease. Bioprosthetic valves, an essential component of prosthetic heart valves, have made some breakthroughs in materials and therapies, but still have some drawbacks.
OBJECTIVE: To summarize some existing related researches on bioprosthetic valves and prospect the future.
METHODS: The first author searched the relevant literature from January 2012 to March 2022 by computer on CNKI and PubMed databases in March 2022, using “bioprosthetic valves, biomaterials, decellularization, cross-linking agents, endothelialization, TAVR” as the Chinese and English search terms. Finally, 79 articles were included for review.
RESULTS AND CONCLUSION: (1) Bioprosthetic valves have superior biocompatibility and hemodynamic properties, less thrombosis, and no lifelong anticoagulation for patients, but bioprosthetic valves are prone to calcification, leading to structural valve degradation and making them less durable. (2) Bovine and porcine are the primary biomaterials for traditional xenogeneic valves, and new materials are now mainly derived from transgenic pigs and fish bladders. (3) Decellularization techniques can reduce the immunogenicity of biologic valves, while decellularization combination methods can improve decellularization efficiency while protecting the extracellular matrix. (4) Chemical cross-linking agents are cytotoxic leading to calcification. Alternative fixatives or modified cross-linking methods can reduce adverse reactions; natural cross-linking agents are human-compatible and alleviate calcification. (5) Biological valve endothelialization has anticoagulant and anti-inflammatory effects, and a variety of coating techniques can facilitate the progression of endothelialization. (6) A variety of new interventional valves are being developed or put into the clinic and developing rapidly.
Key words: bioprosthetic valve, biomaterial, decellularization, cross-linking agents, glutaraldehyde, polyphenols, endothelialization, TAVR, review