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生物人工心脏瓣膜功能修饰与交联的最新进展

Recent progress in functional modification and crosslinking of bioprosthetic heart valves.

作者信息

Zheng Cheng, Yang Li, Wang Yunbing

机构信息

National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China.

出版信息

Regen Biomater. 2023 Nov 6;11:rbad098. doi: 10.1093/rb/rbad098. eCollection 2024.

Abstract

Valvular heart disease (VHD), clinically manifested as stenosis and regurgitation of native heart valve, is one of the most prevalent cardiovascular diseases with high mortality. Heart valve replacement surgery has been recognized as golden standard for the treatment of VHD. Owing to the clinical application of transcatheter heart valve replacement technic and the excellent hemodynamic performance of bioprosthetic heart valves (BHVs), implantation of BHVs has been increasing over recent years and gradually became the preferred choice for the treatment of VHD. However, BHVs might fail within 10-15 years due to structural valvular degeneration (SVD), which was greatly associated with drawbacks of glutaraldehyde crosslinked BHVs, including cytotoxicity, calcification, component degradation, mechanical failure, thrombosis and immune response. To prolong the service life of BHVs, much effort has been devoted to overcoming the drawbacks of BHVs and reducing the risk of SVD. In this review, we summarized and analyzed the research and progress on: (i) modification strategies based on glutaraldehyde crosslinked BHVs and (ii) nonglutaraldehyde crosslinking strategies for BHVs.

摘要

心脏瓣膜病(VHD)临床表现为心脏自身瓣膜的狭窄和反流,是最常见的心血管疾病之一,死亡率很高。心脏瓣膜置换手术已被公认为治疗VHD的金标准。由于经导管心脏瓣膜置换技术的临床应用以及生物人工心脏瓣膜(BHVs)优异的血流动力学性能,近年来BHVs的植入量不断增加,并逐渐成为治疗VHD的首选。然而,由于瓣膜结构退变(SVD),BHVs可能在10至15年内失效,这与戊二醛交联BHVs的缺点密切相关,包括细胞毒性、钙化、组件降解、机械故障、血栓形成和免疫反应。为了延长BHVs的使用寿命,人们致力于克服BHVs的缺点并降低SVD风险。在本综述中,我们总结并分析了以下方面的研究和进展:(i)基于戊二醛交联BHVs的改性策略和(ii)BHVs的非戊二醛交联策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c94/10761211/c31af118a861/rbad098f6.jpg

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