CA2017705C - Human heart valve replacement with porcine pulmonary valve - Google Patents
Human heart valve replacement with porcine pulmonary valve Download PDFInfo
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- CA2017705C CA2017705C CA002017705A CA2017705A CA2017705C CA 2017705 C CA2017705 C CA 2017705C CA 002017705 A CA002017705 A CA 002017705A CA 2017705 A CA2017705 A CA 2017705A CA 2017705 C CA2017705 C CA 2017705C
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- Prior art keywords
- valve
- porcine
- pulmonary
- aortic
- unstented
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Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
- A61F2/2412—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body with soft flexible valve members, e.g. tissue valves shaped like natural valves
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- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
- Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10S623/00—Prosthesis, i.e. artificial body members, parts thereof, or aids and accessories therefor
- Y10S623/902—Method of implanting
- Y10S623/904—Heart
Abstract
A method of treating heart valve dysfunction in a human patient in which the dysfunctioning valve is replaced with a novel bioprosthesis. The novel biopros-thesis comprises a porcine pulmonary valve, which has preferably been treated to fix and also sterilize the valve tissue. The porcine pulmonary valve may either be stent mounted to facilitate its surgical implantation into the patient, or it may be unstented to reduce the possibility of embolism and thrombosis.
Description
~~scRZPTTOrr Human Heart Valve Reo a~'pmon'r With Porcine ~m monary Valve field Of The Tnventson This invention relates to the field of medicine, and in particular to a method of treating heart valve dysfunc tion in a human patient by replacing the existing valve with a porcine pulmonary valve.
Technolomr Review The human heart includes two valued chambers (left and right ventricles) for pumping blood through the body.
Each ventricle has two valves to control flow of the blood into and out of it. In the case of the right ventricle they are the tricuspid and pulmonary valves and in the case of the left ventricle, the mural and aortic valves.
During each cycle of the heart's operation, the mitral and tricuspid valves are simultaneously opened to allow blood to flow into the ventricles while the aortic and pulmonary valves are closed. The ventricles then contract, and the resulting blood pressure than~in closes the mural and tricuspid valves while opening, and forcing blood outward through, the aortic and pulmonary valves. The aortic and pulmonary valves in humans are both trileaflet valves, being si~ailar to one another in both size and anatomy.
This is also true of the aortic and pulmonary valves of a pig. However, in both humans and pigs the pulmonary valve is a more delicate structure with m thinner arterial wall and more flexible, symmetric lgatl~ts than the correspond-ing aortic valve since it functionm on the right side of the heart under lower blood pra~ssurm.
In some individuals one or more valves may not function normally, usually as a result of disease-induced valve damage, degeneration or a congenital defect. In the case of the aortic valve, in particular, dysfunction often results from a narrowing of the valve orifice (stenosis), ~U17705 or from valve incompetence such that the valve does not fully open or close. Severe valve dysfunction is life threatening. For the past 25 years, severe valve dysfunc-- tion has been treated by replacing the valve with a mechanical prosthesis, or alternatively, with a tissue valve (i.e., a valve of human or animal tissue). Tissue valves have the advantage of a lower incidence of blood clotting (thrombosis). Hence patients receiving such a valve, unlike those receiving a mechanical valve, do not l0 require prolonged anticoagulation therapy with it poten-tial clinical complications, expense, and patient incon-venience. In the case of human aortic valve replacement, the most common tissue valves can be categorized as allografts (usually aortic valves from cadavers, sometimes referred to as homogafts) or xenografts (animal heart valves). In addition, some human aortic valves have been replaced with pulmonary autografts, that is a pulmonary valve from the same patient which in turn is than replaced with an allograft (homograft) or tissue valve constructed from non-valvular tissue (e.g. pericardium). The use of pulmonary autografts to replace a patient's aortic valve, is first described by Ross, Lancet, 1967, Vol. 2, 956: and also later described by Matsuki et al., ,~ Thorac and Cardiov~s. Surer , Vol. 95, p. 705 (1988); and "Tissue Heart Valves'°, ed. M.I. Tonescu, publisher Butterworth Inc., Boston, MA, U.S.A. (1979) particularly at pp. 146-172. The foregoing references and all other references cited herein, errs incorporated by reference.
Xenografts are commonly used for human valve replace ment, particularly the porcine aortic valve since it is similar in anatomy to the human aortic valve (both being trileaflet, i.e. tricuspid) and is readily available in a variety of sizes. The porcine aortic x~enograft has been used for human valve replacement, both stented (i.e.
mounted in a frame such as those described in "Tissue Heart Valves", supra., particularly at pp. 32-34, 107-109, and 177), and unstented. Because unstented valves mini-~U1'~705 mize turbulence they should reduce thrombosis and em-bolism. However, they require a more exacting surgical procedure for insertion into a patient than a scented valve and can only be used in the aortic position. It is also known that the porcine aortic valve should first be treated with an agent, typically glutaraldehyde, to fix the valve tissue, sterilize 'it, and decrease its antigenicity.
The porcine aortic valve, is not identical to the human aortic valve. An important distinction is that the porcine aortic valve, unlike the human aortic valve, has a muscle shelf which extends into one of the valve cusps (the right-coronary cusp). The muscle shelf prevents the right coronary cusp from completely opening, thereby partially obstructing blood flow. This obstruction is accentuated with smaller diameter valves. Thus, when a patient's valve is replaced with a porcine aortic valve of the same diameter, blood flow becomes more impeded. This problem is mare severe in patient's with small diameter valves (e.g., children). Attempts have been made to compensate for this problem. For example, in aortic valve replacement, techniques have been advocated to enlarge a patient's aortic annulus (the portion of the heart in which the valve is seated) so that a porcine aortic valve having a diameter greater than that of the patient's aortic valve, could be used. Alternatively, valves have been produced by a technique in which the right coronary cusp of the porcine aortic valve has been replaced with a non-coronary cusp from another porcine aortic valve.
However, such techniques require additional manipulations of the patient's aortic annulus or the porcine aortic velvet with their attendant difficulties and expense.
~ummarv Of a Invent9n~
The present invention provides a method of treating valve dysfunction in a human patient, by replacing the existing valve with a novel bioprosthesis of the present invention which comprises a porcine pulmonary valve.
Preferably, the porcine pulmonary valve has been treated either in the same manner that porcine aortic valves have previously been treated with glutaraldehyde or with some similar fixing and sterilizing agent prior to implantation into a patient. Such treatment fixes the valve tissue to produce increased valve strength and durability, while at the same time reduces antigenicity of the valve tissue and sterilizes the valve. The porcine pulmonary valve used for the foregoing method, can either be stmt mounted in a manner analogous to that by which porcine aortic valves have previously been stent mounted, or it can be unstented.
The present invention therefore provides a bioprosthesis, comprising a porcine pulmonary valve, which, when unstented, is suitable for replacing the human aortic or pulmonary valves, or which, when stented, is suitable for replacing the human aortic, mitral or tricuspid valves. The method of replacing the human valve with the porcine pulmonary valve, offers all of the advantages of using the porcine aortic valve for such a purpose, but in addition eliminates a major disadvantage of using the latter valve, namely asymmetry of the cusps and the presence of the muscle shelf therein which results in restricted blood flow.
In accordance with one aspect, the invention provides use of a fixed and sterilized whole excised unstented pulmonary porcine valve for treating aortic or pulmonary valve dysfunction in a human patient.
In accordance with another aspect, the invention provides a fixed and sterilized whole unstented pulmonary porcine valve for treating aortic or pulmonary valve dysfunction in a human patient.
~ CA 02017705 2002-07-26 4a In accordance with yet another aspect, the invention provides a method of obtaining a fixed and sterilized whole excised unstented pulmonary porcine valve for treating aortic or pulmonary valve dysfunction in a human patient, which method comprises fixing and sterilizing a whole excised unstented pulmonary porcine valve.
Previously, the porcine pulmonary valve has not been considered as a replacement for a human valve, since the porcine pulmonary valve was regarded as a more delicate structure, and hence perceived to be less durable than the porcine aortic valve. However, it follows that the treatment of the porcine pulmonary valve with fixing, sterilizing and preserving agents will result in a valve of sufficiently increased durability for replacing the human valve, without the attendant disadvantages of a porcine aortic valve replacement.
~U1'l'l U5 Drawings Embodiments of the invention will now be described with reference to the drawings, in whichs Figure 1 is a perspective view of an unscented 5 porcine pulmonary valve with an attached pulmonary aortic artery segment;
Figure 2 is a perspective view similar to Fig. 1, except showing the presence of a sewing skirt which has been sutured adjacent the inflow side of the valve;
Figure 3 is a perspective view of a scent-mounted porcine pulmonary valve.
Figure 4 is a view of a porcine aortic valve from the inflow side, and which shows this valve°s muscle shelf;
and Figure 5 is a view of a porcine pulmonary valve from the inflow side.
b d' s 0 he v o Referring first to Figure 1, there is shown an excised porcine pulmonary valve 2 which essentially consist of three cusps or leaflets 4. Valve 2, in par ticular all three cusps ~ thereof, is attached to pulmonary annulus 6 and swings in the upward direction in Figure 1 when blood is pumped out of the left ventricle.
A segment 8 of the porcine pulmonary artery has been excised with valve 2. At this point the unitary combination of valve 2, pulmonary annulus 6 and segment 8, would be treated with a fixing agent, preferably g?utaraldehyde, to fix the tissue. A bioprosthesis, which can be implanted to replace a human patient's valve, can then be prepared from valve 2 by one of two preferred methods as described below.
In the first method, a flexik~le sewing skirt 10, Preferably made from synthetic polymer such as those sold under the trademarks DACRON or TEFLON' is simply sutured ~5 to pulmonary annulus 6 adjacent the inflow side of valve 2, as shown in Figure 2. The resulting unscented porcine ~U17705 pulmonary valve can then be sterilized and stored in the same manner as known for unstented porcine aortic valves.
In the alternative, second method, segment 8 of the porcine pulmonary artery, including the bifurcation, is removed and the remaining valve structure 2 is sutured to a conventional stent 20 as shown in Figure 3. Stent 20 is preferably made of metal, and has three upstanding, symmetrical and inwardly flexible legs 24, as well as a sewing ring 22. Both the structure of stent 20 and the manner of suturing the porcine pulmonary valve 2 thereto, are analogous to the well known stents and suturing techniques used to prepare a stented porcine aortic valve.
For example, see "Tissue Heart Valves", supra., particularly at pp. 32-34, 107-109 and 177. The resulting stented valve can then be sterilized and stored in the same manner, and under the same conditions, as the unstented valve of Figure 2.
The resulting fixed and sterile porcine pulmonary valve 2, both stented (Fig. 3), and unstented with a sewing skirt (Fig. 2), can then be used to replace a human patient's valve using well known surgical techniques. For example, the unstented porcin. pulmonary valve 2 with sewing skirt 10 (Figure 2) can replace a human aortic valve using essentially the aam~ surgical technique as in the replacement of the human aortic valve with an al-lograft (i.e., homograft). For example, see Ross, ,~s, Card. (1987 Su~'~ts ~ 2 (Supp. ) 179 ) , and "Tissue Heart Valves," sunra<, particularly pp. 146°149. In the case of the stented porcine pulmonary valve of Figure 3, this can, far example, be used to replac~ s human aortic valve by essentially the same surgical technique as used to replace a human aortic valve with a stented porcine aortic valve.
See, for example, ".Tissue Heart valves," supra., par-ticularly at p. 122. However, it will be understood that thg stented porcine pulmonary valve 2 c~f Figure 3 is considered suitable only for replacing the human aortic, mural, or tricuspid valves. The unstented porcine ~~~'~'lU~
pulmonary valve 2 of Figure 2, on the other hand, is considered suitable only for replacing the human aortic or pulmonary valves. Sewing skirt 10, in the case of the unstented valve 2 of Figure 2, and sewing ring 22, in the case of the stent mounted valve 2 of Figure 3, facilitate suturing of the valve to the patient's valve annulus.
In replacing the human aortic or pulmonary valves, it is preferred that the bioprosthesis of Figure 2 (unstented porcine pulmonary valve with sewing skirt) , be used, since it will likely result in lower turbulence and lower incidence of thrombosis. However, as is known, stented heart valves are surgically easier to implant than unstented valves. Thus, the bioprosthesis of Figure 3 (the stented porcine pulmonary valve) may be preferred by some surgeons over the bioprosthesis of Figure 2.
Whether the stented or unstented porcine pulmonary valve is used to replace a human heart valve, a greater blood flow through that bioprosthesis is obtained over a porcine aortic valve of the same diameter. The reason for this can be seen from a comparison of Figures 5 and 4, which respectively show a porcine pulmonary valve 2 used in the bioprosthesis of the present invention, and a porcine aortic valve 32, both viewed from the inflow side.
The porcine aortic valve 32 has 3 cusps as does the porcine pulmonary valve 2. However, porcine aortic valve 32 has a muscle shelf 36 which extends onto one of cusps 3 (in particular, the right coronary cusp) preventing that cusp from opening to the same extent as the remainder of cusps 34. Porcine pulmonary valve 2, which is used in the bioprosthesis of the present invention, can therefore provide superior blood outflow rates with lower turbulence, than can conventional porcine aortic valves of the same diameter.
It will be appreciated that modifications to the embodiments described in detail above, are of course possible. Accordingly, the present invention is not ~U17705 limited to the embodiments which have been described in detail above.
Technolomr Review The human heart includes two valued chambers (left and right ventricles) for pumping blood through the body.
Each ventricle has two valves to control flow of the blood into and out of it. In the case of the right ventricle they are the tricuspid and pulmonary valves and in the case of the left ventricle, the mural and aortic valves.
During each cycle of the heart's operation, the mitral and tricuspid valves are simultaneously opened to allow blood to flow into the ventricles while the aortic and pulmonary valves are closed. The ventricles then contract, and the resulting blood pressure than~in closes the mural and tricuspid valves while opening, and forcing blood outward through, the aortic and pulmonary valves. The aortic and pulmonary valves in humans are both trileaflet valves, being si~ailar to one another in both size and anatomy.
This is also true of the aortic and pulmonary valves of a pig. However, in both humans and pigs the pulmonary valve is a more delicate structure with m thinner arterial wall and more flexible, symmetric lgatl~ts than the correspond-ing aortic valve since it functionm on the right side of the heart under lower blood pra~ssurm.
In some individuals one or more valves may not function normally, usually as a result of disease-induced valve damage, degeneration or a congenital defect. In the case of the aortic valve, in particular, dysfunction often results from a narrowing of the valve orifice (stenosis), ~U17705 or from valve incompetence such that the valve does not fully open or close. Severe valve dysfunction is life threatening. For the past 25 years, severe valve dysfunc-- tion has been treated by replacing the valve with a mechanical prosthesis, or alternatively, with a tissue valve (i.e., a valve of human or animal tissue). Tissue valves have the advantage of a lower incidence of blood clotting (thrombosis). Hence patients receiving such a valve, unlike those receiving a mechanical valve, do not l0 require prolonged anticoagulation therapy with it poten-tial clinical complications, expense, and patient incon-venience. In the case of human aortic valve replacement, the most common tissue valves can be categorized as allografts (usually aortic valves from cadavers, sometimes referred to as homogafts) or xenografts (animal heart valves). In addition, some human aortic valves have been replaced with pulmonary autografts, that is a pulmonary valve from the same patient which in turn is than replaced with an allograft (homograft) or tissue valve constructed from non-valvular tissue (e.g. pericardium). The use of pulmonary autografts to replace a patient's aortic valve, is first described by Ross, Lancet, 1967, Vol. 2, 956: and also later described by Matsuki et al., ,~ Thorac and Cardiov~s. Surer , Vol. 95, p. 705 (1988); and "Tissue Heart Valves'°, ed. M.I. Tonescu, publisher Butterworth Inc., Boston, MA, U.S.A. (1979) particularly at pp. 146-172. The foregoing references and all other references cited herein, errs incorporated by reference.
Xenografts are commonly used for human valve replace ment, particularly the porcine aortic valve since it is similar in anatomy to the human aortic valve (both being trileaflet, i.e. tricuspid) and is readily available in a variety of sizes. The porcine aortic x~enograft has been used for human valve replacement, both stented (i.e.
mounted in a frame such as those described in "Tissue Heart Valves", supra., particularly at pp. 32-34, 107-109, and 177), and unstented. Because unstented valves mini-~U1'~705 mize turbulence they should reduce thrombosis and em-bolism. However, they require a more exacting surgical procedure for insertion into a patient than a scented valve and can only be used in the aortic position. It is also known that the porcine aortic valve should first be treated with an agent, typically glutaraldehyde, to fix the valve tissue, sterilize 'it, and decrease its antigenicity.
The porcine aortic valve, is not identical to the human aortic valve. An important distinction is that the porcine aortic valve, unlike the human aortic valve, has a muscle shelf which extends into one of the valve cusps (the right-coronary cusp). The muscle shelf prevents the right coronary cusp from completely opening, thereby partially obstructing blood flow. This obstruction is accentuated with smaller diameter valves. Thus, when a patient's valve is replaced with a porcine aortic valve of the same diameter, blood flow becomes more impeded. This problem is mare severe in patient's with small diameter valves (e.g., children). Attempts have been made to compensate for this problem. For example, in aortic valve replacement, techniques have been advocated to enlarge a patient's aortic annulus (the portion of the heart in which the valve is seated) so that a porcine aortic valve having a diameter greater than that of the patient's aortic valve, could be used. Alternatively, valves have been produced by a technique in which the right coronary cusp of the porcine aortic valve has been replaced with a non-coronary cusp from another porcine aortic valve.
However, such techniques require additional manipulations of the patient's aortic annulus or the porcine aortic velvet with their attendant difficulties and expense.
~ummarv Of a Invent9n~
The present invention provides a method of treating valve dysfunction in a human patient, by replacing the existing valve with a novel bioprosthesis of the present invention which comprises a porcine pulmonary valve.
Preferably, the porcine pulmonary valve has been treated either in the same manner that porcine aortic valves have previously been treated with glutaraldehyde or with some similar fixing and sterilizing agent prior to implantation into a patient. Such treatment fixes the valve tissue to produce increased valve strength and durability, while at the same time reduces antigenicity of the valve tissue and sterilizes the valve. The porcine pulmonary valve used for the foregoing method, can either be stmt mounted in a manner analogous to that by which porcine aortic valves have previously been stent mounted, or it can be unstented.
The present invention therefore provides a bioprosthesis, comprising a porcine pulmonary valve, which, when unstented, is suitable for replacing the human aortic or pulmonary valves, or which, when stented, is suitable for replacing the human aortic, mitral or tricuspid valves. The method of replacing the human valve with the porcine pulmonary valve, offers all of the advantages of using the porcine aortic valve for such a purpose, but in addition eliminates a major disadvantage of using the latter valve, namely asymmetry of the cusps and the presence of the muscle shelf therein which results in restricted blood flow.
In accordance with one aspect, the invention provides use of a fixed and sterilized whole excised unstented pulmonary porcine valve for treating aortic or pulmonary valve dysfunction in a human patient.
In accordance with another aspect, the invention provides a fixed and sterilized whole unstented pulmonary porcine valve for treating aortic or pulmonary valve dysfunction in a human patient.
~ CA 02017705 2002-07-26 4a In accordance with yet another aspect, the invention provides a method of obtaining a fixed and sterilized whole excised unstented pulmonary porcine valve for treating aortic or pulmonary valve dysfunction in a human patient, which method comprises fixing and sterilizing a whole excised unstented pulmonary porcine valve.
Previously, the porcine pulmonary valve has not been considered as a replacement for a human valve, since the porcine pulmonary valve was regarded as a more delicate structure, and hence perceived to be less durable than the porcine aortic valve. However, it follows that the treatment of the porcine pulmonary valve with fixing, sterilizing and preserving agents will result in a valve of sufficiently increased durability for replacing the human valve, without the attendant disadvantages of a porcine aortic valve replacement.
~U1'l'l U5 Drawings Embodiments of the invention will now be described with reference to the drawings, in whichs Figure 1 is a perspective view of an unscented 5 porcine pulmonary valve with an attached pulmonary aortic artery segment;
Figure 2 is a perspective view similar to Fig. 1, except showing the presence of a sewing skirt which has been sutured adjacent the inflow side of the valve;
Figure 3 is a perspective view of a scent-mounted porcine pulmonary valve.
Figure 4 is a view of a porcine aortic valve from the inflow side, and which shows this valve°s muscle shelf;
and Figure 5 is a view of a porcine pulmonary valve from the inflow side.
b d' s 0 he v o Referring first to Figure 1, there is shown an excised porcine pulmonary valve 2 which essentially consist of three cusps or leaflets 4. Valve 2, in par ticular all three cusps ~ thereof, is attached to pulmonary annulus 6 and swings in the upward direction in Figure 1 when blood is pumped out of the left ventricle.
A segment 8 of the porcine pulmonary artery has been excised with valve 2. At this point the unitary combination of valve 2, pulmonary annulus 6 and segment 8, would be treated with a fixing agent, preferably g?utaraldehyde, to fix the tissue. A bioprosthesis, which can be implanted to replace a human patient's valve, can then be prepared from valve 2 by one of two preferred methods as described below.
In the first method, a flexik~le sewing skirt 10, Preferably made from synthetic polymer such as those sold under the trademarks DACRON or TEFLON' is simply sutured ~5 to pulmonary annulus 6 adjacent the inflow side of valve 2, as shown in Figure 2. The resulting unscented porcine ~U17705 pulmonary valve can then be sterilized and stored in the same manner as known for unstented porcine aortic valves.
In the alternative, second method, segment 8 of the porcine pulmonary artery, including the bifurcation, is removed and the remaining valve structure 2 is sutured to a conventional stent 20 as shown in Figure 3. Stent 20 is preferably made of metal, and has three upstanding, symmetrical and inwardly flexible legs 24, as well as a sewing ring 22. Both the structure of stent 20 and the manner of suturing the porcine pulmonary valve 2 thereto, are analogous to the well known stents and suturing techniques used to prepare a stented porcine aortic valve.
For example, see "Tissue Heart Valves", supra., particularly at pp. 32-34, 107-109 and 177. The resulting stented valve can then be sterilized and stored in the same manner, and under the same conditions, as the unstented valve of Figure 2.
The resulting fixed and sterile porcine pulmonary valve 2, both stented (Fig. 3), and unstented with a sewing skirt (Fig. 2), can then be used to replace a human patient's valve using well known surgical techniques. For example, the unstented porcin. pulmonary valve 2 with sewing skirt 10 (Figure 2) can replace a human aortic valve using essentially the aam~ surgical technique as in the replacement of the human aortic valve with an al-lograft (i.e., homograft). For example, see Ross, ,~s, Card. (1987 Su~'~ts ~ 2 (Supp. ) 179 ) , and "Tissue Heart Valves," sunra<, particularly pp. 146°149. In the case of the stented porcine pulmonary valve of Figure 3, this can, far example, be used to replac~ s human aortic valve by essentially the same surgical technique as used to replace a human aortic valve with a stented porcine aortic valve.
See, for example, ".Tissue Heart valves," supra., par-ticularly at p. 122. However, it will be understood that thg stented porcine pulmonary valve 2 c~f Figure 3 is considered suitable only for replacing the human aortic, mural, or tricuspid valves. The unstented porcine ~~~'~'lU~
pulmonary valve 2 of Figure 2, on the other hand, is considered suitable only for replacing the human aortic or pulmonary valves. Sewing skirt 10, in the case of the unstented valve 2 of Figure 2, and sewing ring 22, in the case of the stent mounted valve 2 of Figure 3, facilitate suturing of the valve to the patient's valve annulus.
In replacing the human aortic or pulmonary valves, it is preferred that the bioprosthesis of Figure 2 (unstented porcine pulmonary valve with sewing skirt) , be used, since it will likely result in lower turbulence and lower incidence of thrombosis. However, as is known, stented heart valves are surgically easier to implant than unstented valves. Thus, the bioprosthesis of Figure 3 (the stented porcine pulmonary valve) may be preferred by some surgeons over the bioprosthesis of Figure 2.
Whether the stented or unstented porcine pulmonary valve is used to replace a human heart valve, a greater blood flow through that bioprosthesis is obtained over a porcine aortic valve of the same diameter. The reason for this can be seen from a comparison of Figures 5 and 4, which respectively show a porcine pulmonary valve 2 used in the bioprosthesis of the present invention, and a porcine aortic valve 32, both viewed from the inflow side.
The porcine aortic valve 32 has 3 cusps as does the porcine pulmonary valve 2. However, porcine aortic valve 32 has a muscle shelf 36 which extends onto one of cusps 3 (in particular, the right coronary cusp) preventing that cusp from opening to the same extent as the remainder of cusps 34. Porcine pulmonary valve 2, which is used in the bioprosthesis of the present invention, can therefore provide superior blood outflow rates with lower turbulence, than can conventional porcine aortic valves of the same diameter.
It will be appreciated that modifications to the embodiments described in detail above, are of course possible. Accordingly, the present invention is not ~U17705 limited to the embodiments which have been described in detail above.
Claims (9)
1. Use of a fixed and sterilized whole excised unstented pulmonary porcine valve for treating aortic or pulmonary valve dysfunction in a human patient.
2. Use according to claim 1 wherein the porcine valve includes a section of porcine pulmonary artery associated with the porcine valve.
3. Use according to claim 1 wherein said porcine valve has attached thereto a flexible sewing skirt extending from the inlet side of the porcine valve to facilitate suturing of the valve in the patient.
4. A fixed and sterilized whole unstented pulmonary porcine valve for treating aortic or pulmonary valve dysfunction in a human patient.
5. A porcine valve according to claim 4 that includes a section of porcine pulmonary artery associated with the porcine valve.
6. A porcine valve according to claim 4 that has attached thereto a flexible sewing skirt extending from the inlet side of the porcine valve to facilitate suturing of the valve in the patient.
7. A method of obtaining a fixed and sterilized whole excised unstented pulmonary porcine valve for treating aortic or pulmonary valve dysfunction in a human patient, which method comprises fixing and sterilizing a whole excised unstented pulmonary porcine valve.
8. A method according to claim 7 wherein the porcine valve includes a section of porcine pulmonary artery associated with the porcine valve.
9. A method according to claim 7 which includes the step of attaching to the porcine valve a flexible sewing skirt extending from the inlet size of the porcine valve to facilitate suturing the valve in the patient.
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US359,478 | 1989-05-31 | ||
| US07/359,478 US5352240A (en) | 1989-05-31 | 1989-05-31 | Human heart valve replacement with porcine pulmonary valve |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| CA2017705A1 CA2017705A1 (en) | 1990-11-30 |
| CA2017705C true CA2017705C (en) | 2002-10-15 |
Family
ID=23413966
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA002017705A Expired - Fee Related CA2017705C (en) | 1989-05-31 | 1990-05-29 | Human heart valve replacement with porcine pulmonary valve |
Country Status (4)
| Country | Link |
|---|---|
| US (1) | US5352240A (en) |
| EP (1) | EP0402036B1 (en) |
| CA (1) | CA2017705C (en) |
| DE (1) | DE69026308T2 (en) |
Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN109331227A (en) * | 2018-09-18 | 2019-02-15 | 武汉纺织大学 | A method of improving heart valve mechanical property |
Families Citing this family (96)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US5197979A (en) * | 1990-09-07 | 1993-03-30 | Baxter International Inc. | Stentless heart valve and holder |
| IT1245750B (en) * | 1991-05-24 | 1994-10-14 | Sorin Biomedica Emodialisi S R | CARDIAC VALVE PROSTHESIS, PARTICULARLY FOR REPLACING THE AORTIC VALVE |
| DE4234127C2 (en) * | 1992-10-09 | 1996-02-22 | Herbert Dr Vetter | Heart valve prosthesis |
| US5824060A (en) * | 1993-09-29 | 1998-10-20 | Medtronic, Inc. | Natural tissue heart valve fixation |
| US5554184A (en) * | 1994-07-27 | 1996-09-10 | Machiraju; Venkat R. | Heart valve |
| US5549666A (en) * | 1994-09-02 | 1996-08-27 | Baxter International Inc. | Natural tissue valve prostheses having variably complaint leaflets |
| AU6280396A (en) * | 1995-06-20 | 1997-01-22 | Efstathios A. Agathos | Human valve replacement with marine mammal valve |
| US5716399A (en) * | 1995-10-06 | 1998-02-10 | Cardiomend Llc | Methods of heart valve repair |
| US5830239A (en) * | 1995-11-15 | 1998-11-03 | Medtronic, Inc. | Natural tissue heart valve fixation apparatus and method |
| WO1998010719A1 (en) * | 1996-09-13 | 1998-03-19 | Medtronic, Inc. | Prosthetic heart valve with suturing member having non-uniform radial width |
| US6186972B1 (en) * | 1996-09-16 | 2001-02-13 | James A. Nelson | Methods and apparatus for treating ischemic heart disease by providing transvenous myocardial perfusion |
| US5655548A (en) * | 1996-09-16 | 1997-08-12 | Circulation, Inc. | Method for treatment of ischemic heart disease by providing transvenous myocardial perfusion |
| WO1998017202A1 (en) * | 1996-10-22 | 1998-04-30 | Emory University | Method and apparatus for endovascular venous transplantation |
| GB9701479D0 (en) | 1997-01-24 | 1997-03-12 | Aortech Europ Ltd | Heart valve |
| GB2324729B (en) | 1997-04-30 | 2002-01-02 | Bradford Hospitals Nhs Trust | Lung treatment device |
| US6117979A (en) * | 1997-08-18 | 2000-09-12 | Medtronic, Inc. | Process for making a bioprosthetic device and implants produced therefrom |
| US6166184A (en) * | 1997-08-18 | 2000-12-26 | Medtronic Inc. | Process for making a bioprosthetic device |
| US5954766A (en) | 1997-09-16 | 1999-09-21 | Zadno-Azizi; Gholam-Reza | Body fluid flow control device |
| US6027530A (en) * | 1997-12-24 | 2000-02-22 | Baxter International Inc. | System, apparatus and method for chemical fixation of stentless cardiac valvular bioprostheses |
| US6001126A (en) * | 1997-12-24 | 1999-12-14 | Baxter International Inc. | Stentless bioprosthetic heart valve with coronary protuberances and related methods for surgical repair of defective heart valves |
| DE19807599C1 (en) * | 1998-02-17 | 2000-08-10 | Klaus Affeld | Valve for insertion in artificial blood pump used in artificial heart or heart support system involves one or more flow distributors which during throughflow phase divert flushing flow part of blood flow |
| US6254564B1 (en) | 1998-09-10 | 2001-07-03 | Percardia, Inc. | Left ventricular conduit with blood vessel graft |
| US6524339B1 (en) | 1999-01-27 | 2003-02-25 | David H. Adams | Cryopreserved homografts and other stentless bioprosthetic heart valves having natural tissue sewing rings |
| US6312464B1 (en) | 1999-04-28 | 2001-11-06 | NAVIA JOSé L. | Method of implanting a stentless cardiac valve prosthesis |
| US6293951B1 (en) * | 1999-08-24 | 2001-09-25 | Spiration, Inc. | Lung reduction device, system, and method |
| US6598307B2 (en) | 1999-11-17 | 2003-07-29 | Jack W. Love | Device and method for assessing the geometry of a heart valve |
| DE10010074B4 (en) | 2000-02-28 | 2005-04-14 | Fraunhofer-Gesellschaft zur Förderung der angewandten Forschung e.V. | Device for fastening and anchoring heart valve prostheses |
| DE10010073B4 (en) | 2000-02-28 | 2005-12-22 | Fraunhofer-Gesellschaft zur Förderung der angewandten Forschung e.V. | Anchoring for implantable heart valve prostheses |
| US6679264B1 (en) | 2000-03-04 | 2004-01-20 | Emphasys Medical, Inc. | Methods and devices for use in performing pulmonary procedures |
| US8474460B2 (en) | 2000-03-04 | 2013-07-02 | Pulmonx Corporation | Implanted bronchial isolation devices and methods |
| US6904909B2 (en) | 2000-03-04 | 2005-06-14 | Emphasys Medical, Inc. | Methods and devices for use in performing pulmonary procedures |
| US7798147B2 (en) | 2001-03-02 | 2010-09-21 | Pulmonx Corporation | Bronchial flow control devices with membrane seal |
| US20040074491A1 (en) * | 2001-03-02 | 2004-04-22 | Michael Hendricksen | Delivery methods and devices for implantable bronchial isolation devices |
| US7011094B2 (en) | 2001-03-02 | 2006-03-14 | Emphasys Medical, Inc. | Bronchial flow control devices and methods of use |
| US6425902B1 (en) | 2001-05-04 | 2002-07-30 | Cardiomend Llc | Surgical instrument for heart valve reconstruction |
| FR2828263B1 (en) | 2001-08-03 | 2007-05-11 | Philipp Bonhoeffer | DEVICE FOR IMPLANTATION OF AN IMPLANT AND METHOD FOR IMPLANTATION OF THE DEVICE |
| US20030050648A1 (en) * | 2001-09-11 | 2003-03-13 | Spiration, Inc. | Removable lung reduction devices, systems, and methods |
| CA2458595C (en) | 2001-10-11 | 2007-12-04 | Peter M. Wilson | Bronchial flow control devices and methods of use |
| US6592594B2 (en) | 2001-10-25 | 2003-07-15 | Spiration, Inc. | Bronchial obstruction device deployment system and method |
| WO2003068108A1 (en) * | 2002-02-14 | 2003-08-21 | St. Jude Medical, Inc. | Heart valve structures |
| US6929637B2 (en) * | 2002-02-21 | 2005-08-16 | Spiration, Inc. | Device and method for intra-bronchial provision of a therapeutic agent |
| AU2003220124A1 (en) * | 2002-03-08 | 2003-09-22 | Emphasys Medical, Inc. | Methods and devices for inducing collapse in lung regions fed by collateral pathways |
| US20030181922A1 (en) * | 2002-03-20 | 2003-09-25 | Spiration, Inc. | Removable anchored lung volume reduction devices and methods |
| US20030216769A1 (en) | 2002-05-17 | 2003-11-20 | Dillard David H. | Removable anchored lung volume reduction devices and methods |
| US20030195385A1 (en) * | 2002-04-16 | 2003-10-16 | Spiration, Inc. | Removable anchored lung volume reduction devices and methods |
| US20040010209A1 (en) * | 2002-07-15 | 2004-01-15 | Spiration, Inc. | Device and method for measuring the diameter of an air passageway |
| US20040059263A1 (en) * | 2002-09-24 | 2004-03-25 | Spiration, Inc. | Device and method for measuring the diameter of an air passageway |
| AU2003256798A1 (en) | 2002-07-26 | 2004-02-16 | Emphasys Medical, Inc. | Bronchial flow control devices with membrane seal |
| WO2004043273A2 (en) * | 2002-11-13 | 2004-05-27 | Rosengart Todd K | Apparatus and method for cutting a heart valve |
| US7814912B2 (en) | 2002-11-27 | 2010-10-19 | Pulmonx Corporation | Delivery methods and devices for implantable bronchial isolation devices |
| US7717115B2 (en) * | 2002-11-27 | 2010-05-18 | Pulmonx Corporation | Delivery methods and devices for implantable bronchial isolation devices |
| JP4473861B2 (en) | 2003-03-20 | 2010-06-02 | エイオアテック、インターナショナル、ピーエルシー | valve |
| CH696185A5 (en) * | 2003-03-21 | 2007-02-15 | Afksendiyos Kalangos | Intraparietal reinforcement for aortic valve and reinforced valve has rod inserted in biological tissue or organic prosthesis with strut fixed to one end |
| US7100616B2 (en) | 2003-04-08 | 2006-09-05 | Spiration, Inc. | Bronchoscopic lung volume reduction method |
| US7533671B2 (en) | 2003-08-08 | 2009-05-19 | Spiration, Inc. | Bronchoscopic repair of air leaks in a lung |
| US8206684B2 (en) | 2004-02-27 | 2012-06-26 | Pulmonx Corporation | Methods and devices for blocking flow through collateral pathways in the lung |
| US7771472B2 (en) | 2004-11-19 | 2010-08-10 | Pulmonx Corporation | Bronchial flow control devices and methods of use |
| US9211181B2 (en) | 2004-11-19 | 2015-12-15 | Pulmonx Corporation | Implant loading device and system |
| DE102005003632A1 (en) | 2005-01-20 | 2006-08-17 | Fraunhofer-Gesellschaft zur Förderung der angewandten Forschung e.V. | Catheter for the transvascular implantation of heart valve prostheses |
| US8876791B2 (en) | 2005-02-25 | 2014-11-04 | Pulmonx Corporation | Collateral pathway treatment using agent entrained by aspiration flow current |
| US7927369B2 (en) * | 2005-03-01 | 2011-04-19 | Leman Cardiovascular Sa | Intraparietal reinforcing device for biological cardiac prosthesis and reinforced biological heart valve prosthesis |
| DE102005051849B4 (en) | 2005-10-28 | 2010-01-21 | JenaValve Technology Inc., Wilmington | Device for implantation and attachment of heart valve prostheses |
| DE102005052628B4 (en) | 2005-11-04 | 2014-06-05 | Jenavalve Technology Inc. | Self-expanding, flexible wire mesh with integrated valvular prosthesis for the transvascular heart valve replacement and a system with such a device and a delivery catheter |
| US20070213813A1 (en) | 2005-12-22 | 2007-09-13 | Symetis Sa | Stent-valves for valve replacement and associated methods and systems for surgery |
| US7691151B2 (en) | 2006-03-31 | 2010-04-06 | Spiration, Inc. | Articulable Anchor |
| GR1005718B (en) | 2006-07-12 | 2007-11-07 | Ευσταθιος-Ανδρεας Αγαθος | Human cardiac valve replacement with seal aortic or pulmonary valve |
| US9138315B2 (en) | 2007-04-13 | 2015-09-22 | Jenavalve Technology Gmbh | Medical device for treating a heart valve insufficiency or stenosis |
| US7896915B2 (en) | 2007-04-13 | 2011-03-01 | Jenavalve Technology, Inc. | Medical device for treating a heart valve insufficiency |
| EP3150171A1 (en) | 2007-05-15 | 2017-04-05 | JenaValve Technology, Inc. | Handle for manipulating a catheter tip, catheter system and medical insertion system for inserting a self-expandalbe heart valve stent |
| US7815677B2 (en) * | 2007-07-09 | 2010-10-19 | Leman Cardiovascular Sa | Reinforcement device for a biological valve and reinforced biological valve |
| US8043301B2 (en) | 2007-10-12 | 2011-10-25 | Spiration, Inc. | Valve loader method, system, and apparatus |
| EP2641572B1 (en) | 2007-10-12 | 2019-07-24 | Spiration Inc. | Valve loader method, system, and apparatus |
| WO2009052207A2 (en) | 2007-10-17 | 2009-04-23 | Hancock Jaffe Laboratories | Biological valve for venous valve insufficiency |
| US8317858B2 (en) | 2008-02-26 | 2012-11-27 | Jenavalve Technology, Inc. | Stent for the positioning and anchoring of a valvular prosthesis in an implantation site in the heart of a patient |
| US8398704B2 (en) | 2008-02-26 | 2013-03-19 | Jenavalve Technology, Inc. | Stent for the positioning and anchoring of a valvular prosthesis in an implantation site in the heart of a patient |
| BR112012021347A2 (en) | 2008-02-26 | 2019-09-24 | Jenavalve Tecnology Inc | stent for positioning and anchoring a valve prosthesis at an implantation site in a patient's heart |
| US9044318B2 (en) | 2008-02-26 | 2015-06-02 | Jenavalve Technology Gmbh | Stent for the positioning and anchoring of a valvular prosthesis |
| US9168130B2 (en) | 2008-02-26 | 2015-10-27 | Jenavalve Technology Gmbh | Stent for the positioning and anchoring of a valvular prosthesis in an implantation site in the heart of a patient |
| US8465540B2 (en) | 2008-02-26 | 2013-06-18 | Jenavalve Technology, Inc. | Stent for the positioning and anchoring of a valvular prosthesis |
| US20100292779A1 (en) | 2009-05-15 | 2010-11-18 | Helmut Straubinger | Device for compressing a stent and a system as well as a method for loading a stent into a medical delivery system |
| FR2951549B1 (en) | 2009-10-15 | 2013-08-23 | Olivier Schussler | PROCESS FOR OBTAINING IMPLANTABLE MEDICAL BIOPROTHESES |
| US9420770B2 (en) | 2009-12-01 | 2016-08-23 | Indiana University Research & Technology Corporation | Methods of modulating thrombocytopenia and modified transgenic pigs |
| US10856978B2 (en) | 2010-05-20 | 2020-12-08 | Jenavalve Technology, Inc. | Catheter system |
| US11278406B2 (en) | 2010-05-20 | 2022-03-22 | Jenavalve Technology, Inc. | Catheter system for introducing an expandable heart valve stent into the body of a patient, insertion system with a catheter system and medical device for treatment of a heart valve defect |
| CN103002833B (en) | 2010-05-25 | 2016-05-11 | 耶拿阀门科技公司 | Artificial heart valve and comprise artificial heart valve and support through conduit carry interior prosthese |
| US8795241B2 (en) | 2011-05-13 | 2014-08-05 | Spiration, Inc. | Deployment catheter |
| JP6005168B2 (en) | 2011-10-21 | 2016-10-12 | イエナバルブ テクノロジー インク | Catheter system for introducing an expandable heart valve stent into a patient's body, insertion system equipped with a catheter system, and medical device for treating heart valve defects |
| WO2013120082A1 (en) | 2012-02-10 | 2013-08-15 | Kassab Ghassan S | Methods and uses of biological tissues for various stent and other medical applications |
| DE202013011734U1 (en) | 2012-05-16 | 2014-04-29 | Fraunhofer-Gesellschaft zur Förderung der angewandten Forschung e.V. | A catheter delivery system for inserting an expandable heart valve prosthesis and a medical device for treating a valvular defect |
| US9132171B2 (en) | 2012-05-23 | 2015-09-15 | Wisconsin Alumni Research Foundation | Test of insulin as a drug to reduce restenosis of vessels |
| US20140115728A1 (en) | 2012-10-24 | 2014-04-24 | A. Joseph Tector | Double knockout (gt/cmah-ko) pigs, organs and tissues |
| EP2953580A2 (en) | 2013-02-11 | 2015-12-16 | Cook Medical Technologies LLC | Expandable support frame and medical device |
| JP6563394B2 (en) | 2013-08-30 | 2019-08-21 | イェーナヴァルヴ テクノロジー インコーポレイテッド | Radially foldable frame for an artificial valve and method for manufacturing the frame |
| JP6767388B2 (en) | 2015-05-01 | 2020-10-14 | イェーナヴァルヴ テクノロジー インコーポレイテッド | Devices and methods to reduce the proportion of pacemakers in heart valve replacement |
| EP4183371A1 (en) | 2016-05-13 | 2023-05-24 | JenaValve Technology, Inc. | Heart valve prosthesis delivery system and method for delivery of heart valve prosthesis with introducer sheath and loading system |
| WO2018138658A1 (en) | 2017-01-27 | 2018-08-02 | Jenavalve Technology, Inc. | Heart valve mimicry |
Family Cites Families (7)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| DK229077A (en) * | 1977-05-25 | 1978-11-26 | Biocoating Aps | HEARTBALL PROSTHET AND PROCEDURE FOR MANUFACTURING IT |
| GB2056023B (en) * | 1979-08-06 | 1983-08-10 | Ross D N Bodnar E | Stent for a cardiac valve |
| US4372743A (en) * | 1981-06-22 | 1983-02-08 | American Hospital Supply Corp. | Low-pressure fixation of valvular tissue intended for implantation |
| US4443895A (en) * | 1981-06-22 | 1984-04-24 | American Hospital Supply Corporation | Low-pressure fixation of valvular tissue intended for implantation |
| US4350492A (en) * | 1981-08-24 | 1982-09-21 | Vascor, Inc. | Method for preparing tissue heart valve |
| US4477930A (en) * | 1982-09-28 | 1984-10-23 | Mitral Medical International, Inc. | Natural tissue heat valve and method of making same |
| US4790844A (en) * | 1987-01-30 | 1988-12-13 | Yoel Ovil | Replacement of cardiac valves in heart surgery |
-
1989
- 1989-05-31 US US07/359,478 patent/US5352240A/en not_active Expired - Lifetime
-
1990
- 1990-05-29 CA CA002017705A patent/CA2017705C/en not_active Expired - Fee Related
- 1990-05-31 EP EP90305913A patent/EP0402036B1/en not_active Revoked
- 1990-05-31 DE DE69026308T patent/DE69026308T2/en not_active Revoked
Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN109331227A (en) * | 2018-09-18 | 2019-02-15 | 武汉纺织大学 | A method of improving heart valve mechanical property |
Also Published As
| Publication number | Publication date |
|---|---|
| EP0402036A1 (en) | 1990-12-12 |
| CA2017705A1 (en) | 1990-11-30 |
| DE69026308T2 (en) | 1996-10-31 |
| EP0402036B1 (en) | 1996-04-03 |
| DE69026308D1 (en) | 1996-05-09 |
| US5352240A (en) | 1994-10-04 |
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