The Pulmonary Bioprosthetic Heart Valve: Its Unsuitability for Use as an Aortic Valve Replacement
Louise M. Jennings PhD, Maya Butterfield PhD, Catherine Booth PhD, Kevin G. Watterson FRACS, John Fisher DEng

The suitability of the porcine pulmonary bioprosthetic valve for aortic valve replacement (AVR) was investigated. Porcine pulmonary and aortic roots were zero pressure-fixed with 0.5% buffered glutaraldehyde, characterized, and compared with fresh porcine pulmonary and aortic roots. The in-vitro analysis included assessment of mechanical properties, hydrodynamic function, geometry of the pulmonary root, and durability. The results highlighted major defects in the fixed pulmonary roots, namely poor reverse flow hydrodynamic function with a gross closed valve regurgitant volume in 50% of all fixed pulmonary roots, and inferior durability. The cause of the closed valve regurgitant volume was identified as a prolapsed anterior leaflet. Three fixed pulmonary roots subjected to accelerated fatigue testing showed signs of leaflet macroscopic damage. It was concluded that the porcine pulmonary bioprosthetic valve was unsuitable for AVR.