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Flexible Leaflet Polymeric Heart Valves

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Cardiovascular and Cardiac Therapeutic Devices

Part of the book series: Studies in Mechanobiology, Tissue Engineering and Biomaterials ((SMTEB,volume 15))

Abstract

Lifelong function and durability without the need for anticoagulation remains the holy grail of replacement heart valves. The use of polymers to produce flexible leaflet valves that have the positive attributes of current commercial bioprosthetic and mechanical valve types without any of their drawbacks, has been a focus of research since the mid 1950s. Although many different polymers have been considered, thermoplastic polyurethanes were by far the most prevalent due to their processability, general chemico-physical properties, and advances in their formulation that resulted in improved biocompatibility and stability. While accelerated in vitro durability of 600–1,000 million cycles has been achieved using polycarbonate urethanes, resistance to degradation, calcification and thrombosis in vivo has been shown with a new generation of polysiloxane-based polyurethanes. Despite these advances, however, polymeric valves have remained relegated to use in temporary ventricular assist devices for bridging heart failure to transplantation, where decreased exposure and resultant requirements are less stringent than with permanently implanted devices. As recent studies suggest a greater degree of instability in thermoplastic materials than hitherto believed, the remaining challenge remains the achievement of a combination of durability and biocompatibility in valve design and polymer formulation. This would allow polymeric valves to become a clinical reality for surgical implantation, as well as suitable candidates for use in applications where minimally invasive, transcatheter procedures are used to replace diseased valves. As polymers are amenable to relatively inexpensive mass production techniques, attainment of this goal could potentially benefit millions of patients in developing and emerging countries, who currently have no access to treatment of rheumatic heart disease so prevalent in these areas.

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Acknowledgments

The authors would like to thank Dr Art Coury for advice, suggestions and helpful discussions during the finalization of this review.

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  1. Cardiovascular Research Unit, Christian Barnard Division of Cardiothoracic Surgery, Faculty of Health Sciences, University of Cape Town, 203 Cape Heart Centre, Anzio Road, Observatory, Cape Town, 7925, South Africa

    Deon Bezuidenhout & Peter Zilla

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    Thomas Franz

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Bezuidenhout, D., Zilla, P. (2013). Flexible Leaflet Polymeric Heart Valves. In: Franz, T. (eds) Cardiovascular and Cardiac Therapeutic Devices. Studies in Mechanobiology, Tissue Engineering and Biomaterials, vol 15. Springer, Berlin, Heidelberg. https://doi.org/10.1007/8415_2013_166

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