MECHANISMS UNDERLYING BIOPROSTHETIC HEART VALVE DYSFUNCTIONS

Abstract

The article presents new insights into the mechanisms underlying bioprosthetic heart valve dysfunctions based on the medical literature analysis. We highlighted the main pathogenetic mechanisms causing dysfunctions of bioprosthetic heart valves among the well-known and recently studied ones. In addition to the process of natural “aging” of the valve tissue that develops during continuous cyclic mechanical loads and is accompanied by the formation of calcification foci (passive and active calcification process), the negative impact of prosthesis- and recipientrelated factors has been evaluated. The prosthesis-related factors contributing to the development of dysfunctions include technological and technical factors, which may produce negative effects on bioprosthetic heart valves during the preimplantation preparation and implantation itself. Main dysmetabolic, immune, hemostasis and hyperproliferative (hyperplastic) mechanisms have been reviewed from the standpoint of the recipient-related factors that may shorten the lifespan of bioprostheses. Therefore, we propose a classification of bioprosthetic heart valve dysfunctions based on the underlying pathogenetic mechanisms and specific morphological patterns.