Cardiac valve replacement surgery: prostheses and technological considerations

Cardiac valve replacement surgery has advanced considerably over the past 20 years with suitable choices of mechanical prostheses and bioprostheses as valvular substitutes. The extensive developments over the past three decades have been introduced to reduce or eliminate valve related complications, namely thromboembolism, anticoagulant related hemorrhage, and structural failure as well as to optimize hemodynamic performance. The mechanical prostheses have been developed to eliminate structural failure, to facilitate prevention of blood status and thrombus formation, to facilitate intraoperative leaflet positioning and to facilitate radiopacity for evaluation of prosthesis function. The biological valvular prostheses, namely porcine aortic or bovine pericardium, have been developed with tissue preservation, together with stent designs, that contribute to preservation of anatomical characteristics and biomechanical properties of the leaflets. The implantation of the various present generation bioprostheses and mechanical prostheses requires special considerations to support ventricular performance and avoid technical complications.