Non-stented |
Porcine |
Toronto SPV® |
Abbott® |
Linx AC® (ethanol treatment) |
- Ethanol breaks down cellular membranes, inhibiting calcium nucleation - Increased lipids’ extraction - Reduced free aldehydes - Minimizes cholesterol uptake |
- Stabilizes leaflet collagen - Enhances cuspal resistance to collagenase |
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-82,83 |
Freestyle® |
Medtronic® |
Alpha-amino oleic acid (AOA) |
- Mitigates calcification - Diminishes Ca2+ diffusion |
- Physiologic fixation process: zero pressure with preservation of structure and leaflet function - Soft and flexible leaflets protecting from cycle fatigue - Stentless configuration: larger postoperative effective orifice area |
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-84 |
Bovine |
Solo Smart® |
LivaNova® |
Homocysteic acid |
- Detoxification process with homocysteic acid (neutralizes residues of unbound glutaraldehyde) - Improved endothelial cell proliferation - Aldehyde-free storage |
- No fabric reinforcement - No stent, no synthetic material - One single suture for all the leaflets |
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-85,86 |
Stented |
Conventional - Porcine |
Hancock II® |
Medtronic® |
T6 (sodium dodecyl sulfate) |
- Inhibits calcification of collagen - Higher removal of phospholipids by T6 |
- Acetal homopolymer stent with flexible and lower profile leads to higher stress absorption - Low pressure fixation process minimizes septal muscle shelf |
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(87-89) |
Mosaic® |
Medtronic® |
AOA |
- Surfactant washes and removes phospholipids - Mitigates calcification - Diminishes Ca2+ diffusion - AOA forms covalent bonds with free aldehydes |
- Next generation flexible polymer stent allows higher absorption of stress - Physiologic fixation process minimizes the stress (zero-pressure fixation) - Soft and flexible leaflets protecting from cyclic fatigue) |
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-47,9 |
Epic® |
Abbott® |
Linx® anticalcification |
- Inhibition of Ca2+ nucleation - Higher lipids’ extraction - Reduced free aldehydes - Minimizes cholesterol uptake - Lower cusps water content |
- Flexible polymer stent - Stabilizing leaflet collagen - Enhanced material stability (in vitro increased resistance to collagenase digestion) |
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-82,83 |
Conventional - Bovine |
Perimount® |
Edwards Lifesciences® |
XenoLogiX® treatment |
- Alcohol and surfactant extract phospholipids from pericardial tissue after glutaraldehyde fixation (Bio-Burden reduction) - 8-10 log reduction in microbial levels after sterilization |
- Flexible cobalt-chromium alloy stent reduces leaflet stress - Leaflets matched for thickness and elasticity to reduce stress distribution |
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-91,92 |
Magna Ease® |
Edwards Lifesciences® |
ThermaFix® |
- Phospholipids extraction (as XenoLogiX® treatment) - Mild heat treatment to remove unstable glutaraldehyde moieties - Reduced tissue acid levels, with less potential binding sites for calcium - Maintenance of collagen and elastin structures |
- Flexible cobalt-chromium alloy stent reduces leaflet stress - Three independent pericardial leaflets |
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-92 |
Stented |
Conventional - Bovine |
Inspiris Resilia® |
Edwards Lifesciences® |
RESILIA® |
- Functional group (aldehydes) stable capping, glycerolisation, and ethylene oxide sterilization - Free aldehyde groups blocking in the tissue - Dry glutaraldehyde-free storage (glycerol) |
- Valve structure is built over 3 semi-rings instead of 1 allowing future valve-in-valve |
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-93,94 |
Trifecta GT® |
Abbott® |
Linx® anticalcification Glide Technology |
- Inhibition of Ca2+ nucleation - Higher lipids’ extraction - Reduced free aldehydes - Minimizes cholesterol uptake - Stabilizes leaflet collagen |
- Soft compliant sewing cuff - High-strength titanium stent to reduce stress on leaflets and allowing a cylindrical opening during systole - Pericardial-covered stent to reduce risk abrasion - Computer controlled fiber orientation |
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(82,95,96) |
Avalus® |
Medtronic® |
AOA |
- Surfactant washes and removes phospholipids - AOA forms covalent bonds with free aldehydes - Slows movement of Ca2+ on tissue - Stored in glutaraldehyde solutions to induce covalent bonds on remaining free aldehydes |
- Laser cut leaflets matched for thickness and deflection for a consistent performance - Two-part polymer frame minimizes stress - Uniaxial fixation |
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-97 |
Rapid deployment - Bovine |
Intuity Elite® |
Edwards Lifesciences® |
ThermaFix® |
- Phospholipids' extraction (as XenoLogiX treatment) - Mild heat treatment to remove unstable glutaraldehyde moieties - Reduced tissue acid levels, with less potential binding sites for calcium - Maintenance of collagen and elastin structures |
- Three independent leaflets matched for thickness and elasticity - Flexible alloy wireform reduces shock during cardiac cycle - Stainless steel frame |
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-92 |
Perceval Plus® |
LivaNova® |
FREE® |
- Reduces phospholipids content in the tissues (alcohol mixture) |
- Elastic structure allows stress absorption at the commissures (double sheet design) |
- Coated by a thin layer of turbostratic carbon (CarboFilm®), increasing biocompatibility and encouraging endotheliazation |
(98) |
- Highly effective neutralization of aldehydes (post-sterilization amino acid treatment), with a very low level of aldehydes |
- Stent adapts to the movements of the aorta during cardiac cycle |
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- Completely aldehyde-free storage |
- Inflow ring expands to accommodate valve-in-valve |
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- Removal and neutralization of unbound glutaraldehyde |
- Physiologic fixation to collapse without crimping collagen fibers |
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