Evaluation of Hemodynamic Performance of Aortic Valve Bioprostheses in a Model of Oversizing (original) (raw)
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Comparison of eight prosthetic aortic valves in a cadaver model
The Journal of Thoracic and Cardiovascular Surgery, 2007
Proper valve selection is critical to ensure appropriate valve replacement for patients, because implantation of a small valve might place the patient at risk for persistent gradients. Labeled valve size is not the same as millimeter measure of prosthetic valve diameters or the annulus into which it will fit. Studies that use the labeled valve size in lieu of actual measured diameter in millimeters to compare different valves might be misleading. Using human cadaver hearts, we sized the aortic annulus with 8 commonly used prosthetic aortic valve sizers and compared the valves using geometric orifice area. This novel method for comparing prosthetic valves allowed us to evaluate multiple valves for implantation into the same annulus.
2020
TURUN YLIOPISTO Lääketieteellinen tiedekunta ALVAJÄRVI, ARVI Patient-prosthesis mismatch in the context of surgical aortic valve replacement with the Trifecta bioprosthesis Syventävien opintojen kirjallinen työ, 10 s. Kirurgia Marraskuu 2020 ________________________________________________________________________________ Surgical aortic valve replacement (SAVR) is widely used for the treatment of aortic valve diseases. Each valve prosthesis has individual hemodynamic characteristics, which may have implications in the clinical outcome of patients. This review considers the hemodynamic performance of the St. Jude Medical Trifecta biological aortic valve prosthesis early after surgery. An essential method to determine hemodynamic parameters after SAVR is transthoracic echocardiography (TTE) that can be used to measure transvalvular flow velocities and pressure gradients. Patient-prosthesis mismatch (PPM) occurs when the orifice of the implanted prosthesis is too narrow relative to the patient's body surface area. Postoperative PPM is thought to have a negative effect on the outcome after SAVR. The aim of this review is to summarise the current hemodynamic data of the Trifecta biological prosthesis in the aortic position. A systematic review of the literature was conducted through Pubmed, Scopus, Science Direct and Google Scholar with terms ''effective orifice area", "hemodynamic", "gradient" combined with "Trifecta" or "Perimount". This yielded 276 articles, 18 of which were included into a recently conducted meta-analysis. Out of those studies, ten evaluated the hemodynamics and outcome of more than 100 patients with the Trifecta prosthesis. Each of the studies showed excellent early hemodynamic results with relatively small incidence of PPM for the aortic bioprosthesis Trifecta. Moreover, the hemodynamic parameters of the Trifecta bioprosthesis seemed favourable when compared to other widely used biological valves.
Valve-in-Valve Hemodynamics of 20-mm Transcatheter Aortic Valves in Small Bioprostheses
The Annals of Thoracic Surgery, 2011
Background. Transcatheter aortic valve (TAV) implantation is a treatment for selected patients with failing bioprostheses. We previously showed that currently available SAPIEN (Edwards Lifesciences, Irvine, CA) TAV sizes did not yield acceptable valve-in-valve (VIV) hemodynamics in small degenerated bioprostheses because optimal TAV function requires full stent expansion to its nominal size. The study objective was to determine (1) if 20-mm TAVs provide acceptable hemodynamics in small degenerated bioprostheses and (2) the effect of TAV spatial orientation on valvular hemodynamics and coronary flows.
The Journal of heart valve disease, 2004
The aim of this prospective, randomized study was to compare the hemodynamic performance of the Medtronic Mosaic and Edwards Perimount bioprostheses in the aortic position, and to evaluate prosthesis-specific differences in valve sizing and valve-size labeling. Between August 2000 and September 2002, 139 patients underwent isolated aortic valve replacement (AVR) with the Mosaic (n = 67) or Perimount (n = 72) bioprosthesis. Intraoperatively, the internal aortic annulus diameter was measured by insertion of a gauge (Hegar dilator), while prosthesis size was determined by using the original sizers. Transthoracic echocardiography was performed to determine hemodynamic and dimensional data. As the aim of AVR is to achieve a maximal effective orifice area (EOA) within a given aortic annulus, the ratio of EOA to patient aortic annulus area was calculated, the latter being based on annulus diameter measured intraoperatively. Operative mortality was 2.2% (Mosaic 3.0%; Perimount 1.4%; p = NS)...
International journal of cardiology, 2005
Several studies have shown the inferior performance of small prostheses in the narrow aortic root. However, modern low-profile mechanical prostheses have improved hemodynamic performance characteristics. By measuring the transprosthetic pressure gradient in vivo, we were able to characterize the hemodynamic features of two prostheses: the ATS Medical (ATS) and the Medtronic Hall (MH) valves. From October 1994 to April 2002, 113 patients received an aortic valve replacement (AVR) with either an ATS or a MH valve. The transprosthetic pressure gradients, calculated from a simplified Bernoulli equation during immediate postoperative Doppler echocardiographic examination, were compared for differently sized prostheses with respect to body surface area (BSA). The mean pressure gradients and the mean BSAs were: 27.8 +/- 14.8 mm Hg and 1.50 +/- 0.10 m(2) in ATS 19 mm (n = 7), 20.4 +/- 8.5 mm Hg and 1.54 +/- 0.11 m(2) in ATS 21 mm (n = 22), 13.0 +/- 5.7 mm Hg, 1.70 +/- 0.13 m(2) in ATS 23 mm...
Cardiovascular Engineering and Technology, 2016
Surgical aortic valve replacement is the most common procedure of choice for the treatment of severe aortic stenosis. Bioprosthetic valves are traditionally sewed-in the aortic root by means of pledget-armed sutures during open-heart surgery. Recently, novel bioprostheses which include a stent-based anchoring system have been introduced to allow rapid implantation, therefore reducing the duration and invasiveness of the intervention. Different effects on the hemodynamics were clinically reported associated with the two technologies. The aim of this study was therefore to investigate whether the differences in hemodynamic performances are an effect of different anchoring systems. Two commercially available bio-prosthetic aortic valves, one sewed-in with pledget-armed sutures and one rapid-deployment, were thus tested in this study by means of a combined approach of experimental and computational tools. In vitro experiments were performed to evaluate the overall hydrodynamic performance under identical standard conditions; computational fluid dynamics analyses were setup to explore local flow variations due to different design of the anchoring system. The results showed how the performance of cardiac valve substitutes is negatively affected by the presence of pledget-armed sutures. These are causing flow disturbances, which in turn increase the mean pressure gradient and decrease the effective orifice area. The combined approach of experiments and numerical simulations can be effectively used to quantify the detailed relationship between local fluid-dynamics and overall performances associated with different valve technologies.