Comparison of eight prosthetic aortic valves in a cadaver model (original) (raw)
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Global Journal of Health Science, 2014
We hypothesized that gender, age, aortic root dimension, blood group and Left Ventricular End Diastolic and Systolic Diameters may have a significant correlation with the size of mechanical valve used. Methods: We included 48 patients retrospectively who had been operated at a single tertiary hospital. All patients with aortic stenosis or regurgitation were included in the study. Patients who had undergone previous cardiac surgery or concomitant surgical procedures, such as coronary artery bypass grafting, were excluded from the study. Results: The median size of the valves used in males (23mm) and females (21mm) were significantly different (P = 0.001). Size of the valve used was significantly associated with Left Ventricular End Systolic Diameter (LVESD) (r = 0.327, P = 0.007) and aortic root dimension (r = 0.526, P < 0.001). Moreover, significantly higher values of LVESD were observed in the expired patients (P = 0.023). Conclusion: This study shows that aortic root dimension and gender may be important predictors for the size of the prosthetic aortic valve used in aortic valve replacement. Our study also concludes that LVESD has significant relationship with in-hospital mortality. However, more long term clinical trials should be conducted to confirm these relationships.
The Journal of Thoracic and Cardiovascular Surgery, 2007
Supplemental material is available online. Objectives: The appropriate index of prosthesis internal orifice size and its effect on operative mortality after aortic valve replacement are controversial. We examined the association between several relevant indices and patient size on operative mortality. Indices examined included projected in vivo effective orifice area and geometric orifice area, with patient size defined as body surface area. Methods: A review of the Society of Thoracic Surgeons National Cardiac Database (2000-2004) yielded 48,722 patients who had isolated aortic valve replacement. This analysis is based on the cohort of 42,310 patients with the 8 most prevalent valve types with manufacturer's labeled sizes 19 mm through 29 mm. Multivariable logistic regression models were employed to determine the effects of body surface area, effective orifice area, geometric orifice area, and selected derived indices (eg, effective orifice area/body surface area) on risk-adjusted operative mortality. Results: In separate multivariable models, effective orifice area and geometric orifice area were both inversely correlated with operative mortality. However, an unanticipated finding was that with either effective orifice area or geometric orifice area held constant, body surface area was significantly and inversely correlated with operative mortality. When patients were stratified by effective orifice area, geometric orifice area, or manufacturer's labeled valve size and type, elevations in body surface area were associated with a decrease rather than an increase in operative mortality. Conclusions: Prostheses with small geometric orifice area or small effective orifice area are associated with increased operative mortality after isolated aortic valve replacement. Even for valves with small effective orifice area, however, mortality decreases as body surface area increases. With respect to operative mortality, therefore, our results do not support using arbitrary cutoff values of effective orifice area/body surface area to determine the valve to utilize in a given patient.
Aortic prosthetic size predictor in aortic valve replacement
Journal of Cardiothoracic Surgery
Background Patient-prosthesis mismatch (PPM) is a major concern in aortic valve replacement (AVR) and leads to perioperative morbidity and rehospitalization. Predicting aortic annulus diameter pre-procedurally is crucial to managing patients with high-risk of PPM. Objectives To compare preoperative measurements of aortic annulus from echocardiography and CT scan with surgical sizing and develop an imaging-based algorithm to predict PPM. Methods From January 2017 to December 2020, patients underwent AVR at a teaching hospital were examined. The relationship between imaging measurements with operative values was assesed using scatter plots and Pearson’s correlation coefficient. Univariable linear regression was then used to build the predictive model. Results A total of 144 patients underwent AVR during the study period. Suture types and surgical approaches were not significantly associated with prosthesis size. CT scan-based measurements showed strong correlation with prosthesis size...
Small Prosthesis Size in Aortic Valve Replacement Does Not Affect Mortality
The Annals of Thoracic Surgery, 2011
Background. Small prosthesis size has been associated with poorer postoperative outcomes in aortic valve replacement (AVR). We hypothesized that the use of small aortic valve (AV) prostheses does not independently increase operative mortality following AVR, but that mortality may instead be related to comorbidities.
… Precise determination of the size of aortic annulus is very important for the preoperative evaluation before aortic valve replacement. Objectives: To determine the preoperative prosthesis size using echocardiography in patients undergoing aortic valve replacement. Study Design: Prospective observational study. Setting: Ch. Pervaiz Elahi Institute of Cardiology (CPEIC) Multan. Period: January 2013 to October 2014. Methods: (100 patients) Aortic annulus sizes were measured with TTE one week before surgery and with the help of sizer per-operatively. The data was analyzed by using SPSS V16. Quantitative variables were analyzed using mean and standard deviation and percentages were used for qualitative variables. Dependent sample t test was used to see accuracy of TTE in measuring aortic annulus size. Results: Out of hundred patients, 84(84%) were male. Mean age of the patients was 33.77 +13.17 years. 51% patients underwent isolated Aortic valve replacement; redo-operations were done only in 4% patients. In 96% patient's mechanical prosthesis was used and in 4% patient's boiprosthesis was used for valve replacement. We found no significant difference in Aortic annulus measured pre-operatively with the TTE (23.54+ 3.54) and measured per-operative with the sizer (23.96+3.36) with highly insignificant p-value 0.58.Aortic annulus size was almost same measured by these two techniques. Conclusion: Aortic annulus size measured with TTE helps to arrange the optimum size prosthesis before aortic valve replacement surgery.
Evaluation of Hemodynamic Performance of Aortic Valve Bioprostheses in a Model of Oversizing
The Annals of thoracic surgery, 2017
The risk of patient-prosthesis mismatch drives most surgeons to select the largest bioprosthesis possible during aortic valve replacement, but interactions between the native aortic annulus and valve prosthesis remain poorly defined. We examined the hemodynamic and functional consequences of oversizing contemporary bioprostheses in an in vitro model. Three sizes each (21, 23, and 25 mm) of 5 aortic bioprostheses (Magna, Edwards Lifesciences, Irvine, CA; Trifecta and Epic, St. Jude, St. Paul, MN; and Mosaic and Hancock II, Medtronic, Minneapolis, MN) were tested on a mock annulus in a pulsatile aortic simulator. After the annulus was sized to match each valve, the annulus was decreased by 3 mm and then by 6 mm to simulate oversizing. We measured the effective orifice area and the mean pressure gradient. Changes in prosthetic leaflet behavior and geometric orifice area were assessed with slow-motion video. Statistical analysis used mixed-effects models for repeated-measures data, allo...
The Impact of Annular Size on Outcomes After Surgical or Transcatheter Aortic Valve Replacement
The Annals of thoracic surgery, 2018
This analysis evaluates the relationship of annular size to hemodynamics and the incidence of prosthesis-patient mismatch (PPM) in surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) patients. The CoreValve US Pivotal High Risk Trial, described previously, compared TAVR using a self-expanding valve with SAVR. Multislice computed tomography was used to categorize TAVR and SAVR subjects according to annular perimeter-derived diameter: large (≥26 mm), medium (23 to <26 mm), and small (<23 mm). Hemodynamics, PPM, and clinical outcomes were assessed. At all postprocedure visits, mean gradients were significantly lower for TAVR compared with SAVR in small and medium size annuli (p < 0.001). Annular size was significantly associated with mean gradient after SAVR, with small annuli having the highest gradients (p < 0.05 at all timepoints); gradients were similar across all annular sizes after TAVR. In subjects receiving SAVR, the frequency ...
Brazilian Journal of Cardiovascular Surgery, 2016
Introduction: Replacement of the aortic valve in patients with a small aortic annulus is associated with increased morbidity and mortality. A prosthesis-patient mismatch is one of the main problems associated with failed valves in this patient population. Objective: To evaluate the long-term mortality predictors in patients with a small aortic annulus undergoing aortic valve replacement with a bioprosthesis. Methods: In this retrospective observational study, a total of 101 patients undergoing aortic valve replacement from January 2000 to December 2010 were studied. There were 81 (80.19%) women with a mean age of 52.81±18.4 years. Severe aortic stenosis was the main indication for surgery in 54 (53.4%) patients. Posterior annulus enlargement was performed in 16 (15.8%) patients. Overall, 54 (53.41%) patients underwent concomitant surgery: 28 (27.5%) underwent mitral valve replacement, and 13 (12.7%) underwent coronary artery bypass graft surgery. Results: Mean valve index was 0.82±0.08 cm²/m 2. Overall, 17 (16.83%) patients had a valve index lower than 0.75 cm²/m 2 , without statistical significance for mortality (P=0.12). The overall 10-year survival rate was 83.17%. The rate for patients who underwent isolated aortic valve replacement was 91.3% and 73.1% (P=0.02) for patients who underwent concomitant surgery. In the univariate analysis, the main predictors of mortality were preoperative ejection fraction (P=0.02; HR 0.01) and EuroSCORE II results (P=0.00000042; HR 1.13). In the multivariate analysis, the main predictors of mortality were age (P=0.01, HR 1.04) and concomitant surgery (P=0.01, HR 5.04). Those relationships were statistically significant. Conclusion: A valve index of < 0.75 cm²/m 2 did not affect 10-year survival. However, concomitant surgery and age significantly affected mortality.
Aortic valve replacement: Is valve size important?
The Journal of Thoracic and Cardiovascular Surgery, 2000
large-sized prosthesis seems preferable. On the other hand, aortic root enlargement may complicate an operation for aortic valve replacement. 1,4-11 Furthermore, patients with small annular size may be small individuals, and the small valve size may be matched to their cardiac output needs. In addition to this uncertainty with respect to the small aortic root, there is also controversy about valve size and efficiency in general. Both the use of stentless aortic valve prostheses and the use of aortic root-enlarging procedures are strategies based in large part on the thesis that hemodynamic performance, and thus valve size, favorably influence late outcome. 12 The purpose of this study was to ascertain the relation of prosthesis size to survival after aortic valve replacement. Materials and methods Patients. To obtain a relatively pure relation of prosthesis size to survival, we identified adult patients (≥18 years of age) operated on at The Cleveland Clinic Foundation from 1978 T here is uncertainty as to the optimum management of patients with a small aortic anulus. 1 Small aortic prostheses may leave higher residual pressure gradients across the valve and are associated with less rapid and less complete regression of left ventricular hypertrophy. 2,3 Thus a Objective: We sought to determine whether aortic prosthesis size adversely influences survival after aortic valve replacement. Methods: A total of 892 adults receiving a mechanical (n = 346), pericardial (n = 463), or allograft (n = 83) valve for aortic stenosis were observed for up to 20 years (mean, 5.0 ± 3.9 years) after primary isolated aortic valve replacement. We used multivariable propensity scores to adjust for valve selection factors, multivariable hazard function analyses to identify risk factors for all-cause mortality, and bootstrap resampling to quantify the reliability of the results. Results: Twenty-five percent of patients had indexed internal orifice areas of less than 1.5 cm 2 /m 2 and more than 2 SDs (Z-value) below predicted normal aortic valve size. Mechanical valve orifices were smaller (1.3 ± 0.29 cm 2 /m 2 , Z =-2.2 ± 1.16) than pericardial (1.9 ± 0.36 cm 2 /m 2 , Z =-0.40 ± 1.01) or allograft valves (2.1 ± 0.50, Z = 0.24 ± 1.17). The overall survival was 98%, 96%, 86%, 69%, and 49% at 30 days and 1, 5, 10, and 15 years postoperatively. Univariably, survival was weakly and inversely related to manufacturer valve size (P = .16) and internal orifice diameter (P = .2) but completely unrelated to indexed valve area (P = .6) or Z-value (P = .8). These, and univariable differences among valve types (P = .004), were accounted for by different prevalences in patient risk factors and not by valve size or type per se. Bootstrap resampling indicated that these findings had a less than 15% chance of being incorrect. Conclusions: Survival after aortic valve replacement is strongly related to patient risk factors but appears not to be adversely affected by moderate patient-prosthesis mismatch (down to about 4 SDs below normal). Aortic root enlargement to accommodate a large prosthesis may be required in few situations.