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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
biochemistry, genetics and molecular biology
Prosthetic heart valves: Catering for the few
Biomaterials, Volume 29, No. 4, Year 2008
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Description
Prosthetic heart valves epitomize both the triumphant advance of cardiac surgery in its early days and its stagnation into a retrospective, exclusive first world discipline of late. Fifty-two years after the first diseased heart valve was replaced in a patient, prostheses largely represent the concepts of the 1960s with many of their design-inherent complications. While the sophisticated medical systems of the developed world may be able to cope with sub-optimal replacements, these valves are poorly suited to the developing world (where the overwhelming majority of potential valve recipients reside), due to differences in age profiles and socio-economic circumstances. Therefore, it is the latter group which suffered most from the sluggish pace of developments. While it previously took less than 7 years for mechanical heart valves to develop from the first commercially available ball-in-cage valve to the tilting pyrolytic-carbon disc valve, and another 10 years to arrive at the all-carbon bi-leaflet design, only small incremental improvements have been achieved since 1977. Similarly, bioprosthetic valves saw their last major break-through development in the late 1960s when formalin fixation was replaced by glutaraldehyde cross linking. Since then, poorly understood so-called 'anti-calcification' treatments were added and the homograft concept rediscovered under the catch-phrase 'stentless'. Still, tissue valves continue to degenerate fast in younger patients, making them unsuitable for developing countries. Yet, catheter-delivered prostheses almost exclusively use bioprosthetic tissue, thereby reducing one of the most promising developments for patients of the developing world into a fringe product for the few first world recipients. With tissue-engineered valves aiming at the narrow niche of congenital malformations and synthetic flexible leaflet valves being in their fifth decade of low-key development, heart valve prostheses seem to be destined to remain an unsatisfying and exclusive first world solution for a long time to come. © 2007 Elsevier Ltd. All rights reserved.
Authors & Co-Authors
Zilla, Peter P.
South Africa, Cape Town
Faculty of Health Sciences
Brink, Johan Givan
South Africa, Cape Town
Faculty of Health Sciences
Human, Paul A.
South Africa, Cape Town
Faculty of Health Sciences
Bezuidenhout, Deon
South Africa, Cape Town
Faculty of Health Sciences
Statistics
Citations: 243
Authors: 4
Affiliations: 1
Identifiers
Doi:
10.1016/j.biomaterials.2007.09.033
ISSN:
01429612
Research Areas
Environmental
Health System And Policy
Noncommunicable Diseases
Study Design
Cohort Study