![]() ![]() Heart Valve Structure and Function in Development and Disease. Correlation between heart valve interstitial cell stiffness and transvalvular pressure: Implications for collagen biosynthesis. Implantation of a contaminated heart valve allograft can occur despite disinfection during processing and can result in endocarditis in the recipient. Merryman W.D., Youn I., Lukoff H.D., Krueger P.M., Guilak F., Hopkins R.A., Sacks M.S. Extracellular Matrix Remodeling and Organization in Developing and Diseased Aortic Valves. ![]() ![]() Hinton R.B., Lincoln J., Deutsch G.H., Osinska H., Manning P.B., Benson D.W., Yutzey K.E. Heart valve development, maintenance, and disease: The role of endothelial cells. Furthermore, we discuss how human diseases, including connective tissue disorders lead to aberrations in the abundance, organization and quality of these matrix proteins, resulting in instability of the valve infrastructure and gross functional impairment.Ĭollagen connective tissue disorders elastin extracellular matrix heart valve proteoglycan. Here, we highlight and review the biology and biomechanical contributions of key components of the heart valve ECM. However, less focus has been on the ECM, shown previously in other systems, to be a promising mechanism-inspired therapeutic target. To date, the majority of studies have focused on delineating valve disease mechanisms at the cellular level, namely the interstitial and endothelial lineages. Therefore, there is a critical need to fully appreciate the pathobiology of biomechanical valve failure in order to develop better, alternative therapies. At present, effective treatment for heart valve dysfunction is limited and frequently ends with surgical repair or replacement, which comes with insuperable complications for many high-risk patients including aged and pediatric populations. The failure of ECM organization compromises biomechanical function, and may lead to obstruction or leaking, which if left untreated can lead to heart failure. Organized in layers that accommodate passive functional movements of the valve leaflets, heart valve ECM is synthesized during embryonic development, and remodeled and maintained by resident cells throughout life. Efficient, coordinated movement of the valve structures during the cardiac cycle is mediated by the intricate and sophisticated network of extracellular matrix (ECM) components that provide the necessary biomechanical properties to meet these mechanical demands. All rights reserved.Heart valves are dynamic structures that, in the average human, open and close over 100,000 times per day, and 3 × 10 9 times per lifetime to maintain unidirectional blood flow. (Safety and Efficacy Study of the Medtronic CoreValve System in the Treatment of Symptomatic Severe Aortic Stenosis in High Risk and Very High Risk Subjects Who Need Aortic Valve Replacement NCT01240902).Īortic stenosis outcomes transcatheter aortic valve replacement.Ĭopyright © 2014 American College of Cardiology Foundation. TAVR with a self-expanding bioprosthesis was safe and effective in patients with symptomatic severe aortic stenosis at prohibitive risk for surgical valve replacement. The frequency of moderate or severe paravalvular aortic regurgitation was lower 12 months after self-expanding TAVR (4.2%) than at discharge (10.7% p = 0.004 for paired analysis). Procedural events at 30 days included life-threatening/disabling bleeding (12.7%), major vascular complications (8.2%), and need for permanent pacemaker placement (21.6%). Individual 30-day and 12-month events included all-cause mortality (8.4% and 24.3%, respectively) and major stroke (2.3% and 4.3%, respectively). The rate of all-cause mortality or major stroke at 12 months was 26.0% (upper 2-sided 95% confidence bound: 29.9%) versus 43.0% with the OPG (p < 0.0001). The primary endpoint was a composite of all-cause mortality or major stroke at 12 months, which was compared with a pre-specified objective performance goal (OPG).Ī total of 41 sites in the United States recruited 506 patients, of whom 489 underwent attempted treatment with the CoreValve THV. We performed a prospective, multicenter, nonrandomized investigation evaluating the safety and efficacy of self-expanding TAVR in patients with symptomatic severe aortic stenosis with prohibitive risks for surgery. Transcatheter aortic valve replacement (TAVR) with a self-expanding bioprosthesis is a potentially effective therapy. Untreated severe aortic stenosis is a progressive disease with a poor prognosis. This study sought to evaluate the safety and efficacy of the CoreValve transcatheter heart valve (THV) for the treatment of severe aortic stenosis in patients at extreme risk for surgery. ![]()
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