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It is generally accepted that <jats:styled-content style=\"fixed-case\">SVD<\/jats:styled-content> is due to chemical processes between glutaraldehyde and free calcium ions in the blood. Valve companies have made significant progress in decreasing <jats:styled-content style=\"fixed-case\">SVD<\/jats:styled-content> from calcification through various valve chemical treatments. However, there are still groups of patients (e.g., children and young adults) that have accelerated <jats:styled-content style=\"fixed-case\">SVD<\/jats:styled-content> of <jats:styled-content style=\"fixed-case\">GBHV<\/jats:styled-content>. Unfortunately, these patients are not ideal patients for valve replacement with mechanical heart valve prostheses as they are at high long\u2010term risk from complications of the mandatory anticoagulation that is required. Thus, there is no \u201cideal\u201d heart valve replacement for children and young adults. <jats:styled-content style=\"fixed-case\">GBHV<\/jats:styled-content>s represent a form of xenotransplantation, and there is increasing evidence that <jats:styled-content style=\"fixed-case\">SVD<\/jats:styled-content> seen in these valves is at least in part associated with xenograft rejection. We review the evidence that suggests that xenograft rejection of <jats:styled-content style=\"fixed-case\">GBHV<\/jats:styled-content>s is occurring, and that calcification of the valve may be related to this rejection. Furthermore, we review recent research into the transplantation of live porcine organs in non\u2010human primates that may be applicable to <jats:styled-content style=\"fixed-case\">GBHV<\/jats:styled-content>s and consider the potential use of genetically modified pigs as sources of bioprosthetic heart valves.<\/jats:p>","DOI":"10.1111\/xen.12080","type":"journal-article","created":{"date-parts":[[2014,1,21]],"date-time":"2014-01-21T12:30:51Z","timestamp":1390307451000},"page":"1-10","source":"Crossref","is-referenced-by-count":90,"title":["Bioprosthetic heart valves of the future"],"prefix":"10.1111","volume":"21","author":[{"given":"Rizwan A.","family":"Manji","sequence":"first","affiliation":[{"name":"Department of Surgery University of Manitoba Winnipeg MB Canada"},{"name":"Cardiac Sciences Program Winnipeg Regional Health Authority and St. Boniface Hospital Winnipeg MB Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burcin","family":"Ekser","sequence":"additional","affiliation":[{"name":"Thomas E. 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