possible advancement for tissue valves

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pekster11

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Apr 20, 2011
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The future of heart valve replacements is likely to be driven forward in a number of different directions in the coming decades.

Mechanical valves will probably be developed that do not damage blood cells that pass through them and no longer need anti-coagulation.
Artificial valves made from polymers will be developed that will replicate native valves
Genetically engineered human valve technology may be developed..

But what about the future of non-human tissue valves ??

Well, we know the main reason why, esp in younger patients, these calcify and inflame comparatively quickly, is due to the aldehyde preservative and the pig anti-gens on the valve causing a human anti-body response..

the recent paper below describes a method of using genetically modified pigs (which like this anti-gen) to harvest for human heart valve replacements..

This may at least partially solve the early degeneration of tissue valves in younger patients

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3336842/
 
Wow. Pretty cool articles. Thanks for the links. I like the NIH article as it provides some interesting numbers for failures, etc. And the other article covers interesting way on tissue engineering.
 
Thanks for that link.

While at it I have been looking for a study that I found which compared blood flow dynamics of the ATS and On-X valve. You don't happen to have a link to that one do you?

The article found that the on-x valve had better opening angle and better opening flow velocities but that the ATS valve had superior closing properties. Further it found that the ATS valve was overall less likely to trigger blood velocity based clotting
 
i'll post more links to current research articles when i find them.
Hope to have a good look over xmas period..

i'm going to need an aortic valve replacement with a repair on the ascending aorta in the next few years.
I'm leaning more towards a tissue valve in my valve choice, as I dont think I can go without playing soccer ! And at age 38 still have plenty of football left in me i think !lol

The advances that look likely to take place in the next decade or so, make me think by the time I need the tissue valve replaced, a near perfect replacement valve may be avaliable
 
Pekster, I'd love to read more on any research that you do. I remember when I found out in 2000 that I will maybe have a decade before we need replacement I was very optimistic ;) LOL. Right around then (year 2000) they announced Percutaneous aortic valves and trials and my cardiologist said that major developments would happen and that in a decade I could be looking at a much easier surgery if my native valve can hold out that long. So, here we are 12 years later and my choices were still same as they were in 1990, 2000, and 2010. Notice, me listing the years 10 years apart. Every decade there is something new, but you do not see it in use until at least another decade later.

There have been plenty new developments and research, and everyone seems to have improved the existing valves, both tissue (last significantly longer) and mechanical (need slightly less anti-coagulation, and/or overall slightly safer than before). If you ask me, these new things we are reading about will be in trials in 10-15 years, and possibly in use in 20-30 years. Calculate backwards from that to make your decisions easier when the time for the surgery comes.

There is an interesting post that pellicle wrote where he talks about surgeries themselves (each repeating surgery) being a gamble, I sort of share that opinion, it makes sense for people to calculate all the risks, assign things a probability and go with what makes sense for them, be it a tissue valve first and mechanical or some other choice later or something else. Heck, 10+ years ago I was wishing for TAVI and did not realize that they will last same or less than a tissue valve. Today, I am thinking whatever one can get that will minimize probability of repeat "interventions" is probably the best choice overall, but of course, it is a candidate dependent choice.
 
pekster11 said:
The advances that look likely to take place in the next decade or so, make me think by the time I need the tissue valve replaced, a near perfect replacement valve may be avaliable
Click to expand...

Well, 10 years from now we may see great advancement in techniques for replacing valves, but in terms of the perfection of the replacement valve itself, I think that easily could be much more of a 20 year type of number. Both are important, of course, but in some ways they have independent time frames.

From a technique standpoint, TAVI of course gets all the headlines, particular now that it has FDA approval here in the US for highest risk patients, not just otherwise inoperable. But there's an even more intriguing concept, I think, that is much more quietly starting to move forward into the clinical trial stage: ValveXchange. If you're not familiar, it's basically a "serviceable" tissue valve, and there's been some discussion of it here before: http://www.valvereplacement.org/forums/showthread.php?38493-ValveXchange-Lifetime-Tissue-Valve-Platform. I've had some worries about the viability of the manufacturer, but who knows, maybe it will become the little valve company that could...

In any case, the key point to always remember about the technique side of things is that there is a very successful and pretty low risk procedure already in place (open heart surgery) that is actually going to be hard to match. Certainly TAVI still has a very long way to go from that standpoint, and while the ValveXchange concept seems to present less hurdles in that regard, no one can say for sure at this early stage. So, while patients may have more options in 10 years, it may inevitably become also more a question of balancing recovery vs risk.

Now, back to that "perfect valve". I started a thread somewhat on that topic about a year ago that may also be of interest: http://www.valvereplacement.org/forums/showthread.php?39779-Nano-Nano-The-Valve-of-the-Future. Whether it is the tissue engineering mentioned here, or the nanotechnology mentioned there, it is all pretty amazing stuff, no matter how long it takes. Yes, perhaps many of us here will never actually benefit, but certainly the next generation will, so always exciting to read about the changing world of valve replacement.
 
thanks for the replies guys !

I'm meeting with the surgeon likely to lead my valve replacement (when I need it) on the 8th Jan.
I'll discuss with him the options available, possible advancements in the future, and report back on this thread what he says..

Enjoy the rest of the Xmas holidays !
 
Thank you for sharing this link. Too bad I didn't see this before going to the cardio back in Decemeber, but will see him this late spring. I will show this to him. Hugs for today.
 
Here's what I see happening -- probably not in my lifetime, but perhaps sooner than we think.

There's technology out there today - ultrasonography, possibly other scans, that make it possible to accurately measure the size and shape of your valves. I can see a time when they can make an accurate 3-dimensional image of the valve and associated structures.

Once they have that model - captured non-invasively - they will eventually be able to create a 3-D model of the valves, and possibly of arteries and veins, that will perform as if they were healthy, perfectly functioning components. Advances in 3-dimensional printing may lead technologists (this may open up a whole new specialty) to actually 'printing' new valves and arteries -- possibly even from your own tissue. (Alternatively, they may be able to create a 3-dimensional valve and grow your own cells on top of it -- once it's at a state where it can be implanted, they may even be able to position the 'replacement' or 'supplemental' valve non-invasively.

Right now, it's sci-fi, but I can see a time when this won't seem so crazy.
 
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