Porcine aortic valve bioprostheses: morphologic and functional considerations

Porcine aortic valve (PAV) xenografts are the most frequently used type of bioprosthetic (BP) valve for the replacement of damaged or diseased heart valves. Xenograft tissues are routinely crosslinked during manufacturing using low concentrations (i.e., less than 1%) of glutaraldehyde. Crosslinking of xenograft tissue reduces the antigenicity, the rate of in vivo enzymatic degradation, and results in the loss of cell viability. The purpose of this review is to provide an overview of the morphologic and functional properties of the native aortic valve and the effects of tissue harvesting, fixation, anticalcification treatments, and mounting on PAV structure and function. Although efforts have been undertaken to design bioprostheses having increased durability, primary tissue failure still limits the long-term performance of xenograft replacement heart valves.