Carrel Thierry, Vogt Paul R, Obrist Dominique, Schaff Hartzell
Department of Cardiac Surgery, University Hospital Basel, Switzerland.
Hirslanden Clinic, Zürich, Switzerland.
Front Cardiovasc Med. 2023 Sep 29;10:1220633. doi: 10.3389/fcvm.2023.1220633. eCollection 2023.
The aortic valve is the most frequently diseased valve and aortic stenosis (AS) is the most prevalent valvular heart disease in developed countries. The diseased native aortic valve can be replaced by either a biological or mechanical valve prosthesis. The main concerns relate to durability, the need for oral anticoagulants and the incidence of complications related to this medication. Experimental, computational and biomolecular blood flow studies have demonstrated that the systolic forward flow but also the reverse flow phase at the end of the systole and leakage during the diastolic phase is mainly responsible for platelet activation and thrombosis. Better design of mechanical prosthetic heart valves must ensure smooth closing during flow deceleration and must eliminate high-shear hinge flow during diastole to prevent life-threatening thrombosis. A novel tri-leaflet valve should combine the favorable hemodynamics and the durability of existing mechanical heart valves and eliminate the less favorable characteristics, including the extremely rapid closing. In this paper, we discuss some issues of current mechanical heart valve prostheses and present a new valve design with the potential for significant innovation in the field. The TRIFLO Heart Valve, is a rigid, three-leaflet central flow heart valve prosthesis consisting of an alloyed titanium housing, and three rigid polymer (PEEK) cusps. This valve has a physiological operating mode. During the forward flow phase, the intraventricular pressure opens the leaflets so that blood can freely flow through with little obstruction, and with the deceleration of the blood flow, the leaflets close early and smoothly, minimizing blood flow regurgitation, blood cell damage, and activation of the coagulation cascade. Pre-clinical studies have shown pretty favorable results and a first-in-man study should start very soon.
主动脉瓣是最常患病的瓣膜，在发达国家，主动脉瓣狭窄（AS）是最普遍的心脏瓣膜疾病。病变的天然主动脉瓣可以用生物瓣膜或机械瓣膜假体进行置换。主要问题涉及耐久性、口服抗凝剂的需求以及与此药物相关的并发症发生率。实验、计算和生物分子血流研究表明，收缩期的正向血流以及收缩期末的反向血流阶段和舒张期的反流主要是导致血小板活化和血栓形成的原因。更好地设计机械人工心脏瓣膜必须确保在血流减速期间平稳关闭，并且必须消除舒张期的高剪切铰链血流，以防止危及生命的血栓形成。一种新型三叶瓣瓣膜应结合现有机械心脏瓣膜良好的血流动力学性能和耐久性，并消除不利特性，包括极其快速的关闭。在本文中，我们讨论了当前机械心脏瓣膜假体的一些问题，并提出了一种新的瓣膜设计，该设计在该领域具有重大创新潜力。TRIFLO心脏瓣膜是一种刚性三叶中央血流心脏瓣膜假体，由合金钛外壳和三个刚性聚合物（聚醚醚酮）瓣叶组成。该瓣膜具有生理工作模式。在正向血流阶段，心室内压力打开瓣叶，使血液能够几乎无阻碍地自由流过，随着血流减速，瓣叶提前且平稳地关闭，将血流反流、血细胞损伤和凝血级联反应的激活降至最低。临床前研究已显示出相当不错的结果，首例人体研究应很快启动。
