Challenging the Chronic Perverse Bias in Prosthetic Valve Design: A Pathway Opens for Advanced Mechanical Valves.

Objective- In vitro evaluation of several prototype mechanical valves compared to present-day controls. Method- simulated normal cardiac pressures and flows - gravity pressure head column tester flows. - recorded valve hydrodynamics and kinematics Results- valves superior in performance to clinical controls Conclusions- Prototype MHV candidates outperform the closing performance of present day SAVR prosthetic valves, including bioprosthetic control. Competing InterestsNone declared Financial DisclosureThis research was performed on a pro bono basis by indicted coauthors*, in part, to assist coauthor and Ph.D. candidate Dylan Goode. CENTRAL MESSAGEIn-vitro dynamics of optimized prototype mechanical heart valves (MHVs) outperformed those of current clinical prosthetic SAVR valves. -Achieving the objective of an anticoagulation-free and durable MHV is directly related to mitigation of detrimental valve closing hydrodynamics and kinematics. PERSPECTIVEImprovements in prosthetic valve performance and durability notwithstanding, the objective of an anti-coagulation free device with durability exceeding the projected life expectancy of all recipients has not been achieved. Our work identifies a design and development void that may have significantly delayed progress toward this objective. SIGNIFICANCEOur results challenge a longstanding bias in valve design, shifting the focus towards crucial behavior during valve closure. This study paves the way for advanced mechanical valves bringing us closer to the elusive goal of anticoagulation-free performance--a long-awaited milestone in the evolution of prosthetic valves.