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Biomechanical Behavior of Bioprosthetic Heart Valve Heterograft Tissues: Characterization, Simulation, and Performance

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Abstract

The use of replacement heart valves continues to grow due to the increased prevalence of valvular heart disease resulting from an ageing population. Since bioprosthetic heart valves (BHVs) continue to be the preferred replacement valve, there continues to be a strong need to develop better and more reliable BHVs through and improved the general understanding of BHV failure mechanisms. The major technological hurdle for the lifespan of the BHV implant continues to be the durability of the constituent leaflet biomaterials, which if improved can lead to substantial clinical impact. In order to develop improved solutions for BHV biomaterials, it is critical to have a better understanding of the inherent biomechanical behaviors of the leaflet biomaterials, including chemical treatment technologies, the impact of repetitive mechanical loading, and the inherent failure modes. This review seeks to provide a comprehensive overview of these issues, with a focus on developing insight on the mechanisms of BHV function and failure. Additionally, this review provides a detailed summary of the computational biomechanical simulations that have been used to inform and develop a higher level of understanding of BHV tissues and their failure modes. Collectively, this information should serve as a tool not only to infer reliable and dependable prosthesis function, but also to instigate and facilitate the design of future bioprosthetic valves and clinically impact cardiology.

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Abbreviations

AHA:

American Heart Association

AV:

Aortic valve

BHV:

Bioprosthetic heart valve

BP:

Bovine pericardium

ECM:

Extracellular matrix

FE:

Finite element

GAG:

Glycosaminoglycan

GLBP:

Glutaraldehyde bovine pericardium

GLUT:

Gluraraldehyde treatment

LEHI:

Linear elastic homogeneous incompressible

microCT:

Micro X-ray computed tomography

MRI:

Magnetic resonance images

MV:

Mitral valve

PAV:

Porcine aortic valve

PBS:

Phosphate buffered saline

PD:

Preferred direction

RVE:

Representative volume element

SALS:

Small angle light scattering

TEHV:

Tissue-engineered heart valve

UTS:

Ultimate tensile stregth

VEC:

Valvular endothelial cell

VIC:

Valvular interstitial cell

XD:

Cross-preferred direction

ΔM:

Infinitesimal mass

ΔV:

Infinitesimal volume

ρ:

Mass density

\( \varepsilon \) :

Fiber uniaxial strain (in structural constitutive model)

\( \theta \) :

Fiber orientation angle (in structural constitutive model)

cf :

Volume fraction of fibers (in structural constitutive model)

C :

Left Cauchy-Green stretch tensor

\( D(\varepsilon ) \) :

Fiber recruitment statistical distribution (in structural constitutive model)

E :

Green–Lagrange strain tensor

E ij :

Components of the Green-Lagrange strain tensor

\( I(\theta ) \) :

Angular distribution of scattered light (in SALS analysis)

\( R(\theta ) \) :

Fiber angular distribution (in structural constitutive model)

S :

Second Piola–Kirchhoff stress tensor

Sij :

Components of the second Piola–Kirchhoff stress tensor

\( {\mathbf{S}}^{f} \) :

Second Piola–Kirchhoff stress tensor in the fiber (in structural constitutive model)

\( S_{nn}^{f} \) :

Component of the Piola–Kirchhoff stress tensor in the fiber along fiber direction (in structural constitutive model)

W:

Stored energy function

\( w(\varepsilon ) \) :

Stored energy function of fiber (in structural constitutive model)

Wf :

Stored energy function of the fiber ensemble (in structural constitutive model)

Wm :

Stored energy function of the matrix (in structural constitutive model)

I1, I2, I3 :

Principal invariants of the left Cauchy-Green stretch tensor

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Acknowledgments

National Institute of Health, Award Number R01 HL119297 and R01 HL63954 to MSS. National Institute of Health, Award T32 to KRF. American Heart Association, Post Doctoral Fellowship 14POST18720037 to AA.

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None of the authors have any conflicts of interest to report.

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  1. Center for Cardiovascular Simulation, Institute for Computational Engineering and Sciences, Department of Biomedical Engineering, The University of Texas at Austin, 201 East 24th Street, Stop C0200, Austin, TX, 78712-1129, USA

    Joao S. Soares, Kristen R. Feaver, Will Zhang, David Kamensky, Ankush Aggarwal & Michael S. Sacks

  2. College of Engineering, Swansea University, Bay Campus, Fabian Way, Swansea, SA1 8EN, UK

    Ankush Aggarwal

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  1. Joao S. Soares
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Correspondence to Michael S. Sacks.

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Associate Editor Ajit P. Yoganathan oversaw the review of this article.

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Soares, J.S., Feaver, K.R., Zhang, W. et al. Biomechanical Behavior of Bioprosthetic Heart Valve Heterograft Tissues: Characterization, Simulation, and Performance. Cardiovasc Eng Tech 7, 309–351 (2016). https://doi.org/10.1007/s13239-016-0276-8

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