Abstract 2311: The Complete Supraannular Concept - In-vivo Hemodynamics of Bovine and Porcine Aortic Bioprostheses

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Daniel J Ruzicka ◽  
Walter B Eichinger ◽  
Ina M Hettich ◽  
Andrea Hutter ◽  
Sabine Bleiziffer ◽  
...  
Keyword(s):  
High Pressure ◽  
Aortic Valve ◽  
Pressure Gradients ◽  
Valve Design ◽  
Mean Pressure ◽  
Patient Prosthesis Mismatch ◽  
Size Groups ◽  
Hemodynamic Performance ◽  
Annulus Diameter

Complete supraannular placement of an aortic bioprosthesis is one approach to optimize the hemodynamic result of an aortic valve replacement. It is achieved with the combination of a special valve design and the supraannular sewing technique with non-everted mattress sutures. We evaluated five bioprostheses designed for complete supraannular placement to assess potential hemodynamic differences due to other factors (e.g. valve material) than implantation position. In 336 patients (mean age 72.0 ± 7.1 years; 143 females) hemodynamics including mean pressure gradients (MPG), effective orifice areas (EOA), and indices (EOAi) and incidence of patient-prosthesis-mismatch (PPM) were evaluated 6 months postoperatively. Annulus diameter was measured intraoperatively. Patients received the CE Perimount Magna (Magna n = 169), Medtronic Mosaic (Mosaic n = 46), Mosaic Ultra (Ultra n = 17), SJM Epic Supra (n = 46) and the Sorin Soprano (Soprano n = 58). MPG, EOA and EOA i for all patients divided by annulus size groups are presented in table 1 . Severe PPM was observed more frequently in patients with the Mosaic (12/46; 26.1%) and Ultra (3/17; 17.6%) prostheses. Complete supraannular placement cannot prevent high pressure gradients or patient-prosthesis-mismatch thoroughly, but the choice of a bovine prosthesis can optimize hemodynamic performance.

Randomized (CO)mparison of (TRI)fecta and (P)erimount Magna Ease Supraannular Aortic Xenografts—CO.TRI.P Study

2018 ◽  
Vol 67 (04) ◽  
pp. 266-273
Author(s):  
Arnaud Van Linden ◽  
Mani Arsalan ◽  
Thore Körschgen ◽  
Johannes Blumenstein ◽  
Jörg Kempfert ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Effective Orifice Area ◽  
Exercise Echocardiography ◽  
Obese Patients ◽  
Special Design ◽  
Orifice Area ◽  
Mean Pressure ◽  
Hemodynamic Performance ◽  
Annulus Diameter

Background Modern supraannular aortic xenografts offer a special design, thus providing maximized opening area for improved hemodynamics. The aim of this study was a prospectively randomized comparison of the Trifecta and the Perimount Magna Ease valves based on metric annulus sizing. Methods A total of 100 patients with aortic stenosis undergoing aortic valve replacement (AVR) with or without concomitant procedures were prospectively included. After decalcification of the annulus, stratified intraoperative randomization was performed. The diameter of the aortic annulus was measured using metric Hegar dilators and randomization was based on this metric annulus diameter. Exercise echocardiography was performed at 10-month follow-up. Results Mean age was 69 years, with 36% female. Predominant implanted valve sizes were 23 mm (39%) and 25 mm (32%). Unadjusted mean pressure gradient was significantly lower and effective orifice area larger for the Trifecta group (10.8 ± 5 vs. 13.2 ± 4 mm Hg, p = 0.02 and 1.93 ± 0.39 vs. 1.70 ± 0.30 cm2, p = 0.002) at discharge. In patients with small annuli, based on the metric annulus size there were no significant differences in gradients or the orifice area. At exercise echocardiography follow-up, there were no significant hemodynamic differences between both prostheses. Conclusions The Trifecta and the Perimount Magna Ease prostheses both show excellent hemodynamic performance after AVR. In patients with larger annuli, the Trifecta valve seems to be even superior to the Magna Ease, which may be advantageous in obese patients.

Abstract 15322: Trifecta vs. Mitroflow: Superior Hemodynamics Despite Similar Design

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Mahmoud Diab ◽  
Gloria Faerber ◽  
Ivliane Tsanava ◽  
Martin Breuer ◽  
Mario Walther ◽  
...  
Keyword(s):  
Aortic Annulus ◽  
Special Consideration ◽  
Pressure Gradients ◽  
Valve Design ◽  
Innovative Design ◽  
Mean Pressure ◽  
The Difference ◽  
Different Diameters

Purpose: Hemodynamic results of stented tissue valves are influenced by both valve design and sizing strategy. The Mitroflow and the Trifecta have an innovative design where the pericardium is wrapped around the stent. The goal of this study was to compare both valves giving special consideration to the suggested sizing strategies. Methods: We obtained pressure gradients from discharge echocardiograms from all patients having received an isolated Trifecta (n=104) or Mitroflow (n=246) between 01/2007 and 01/2014. We compared the results by size label and by the most likely selected size according to the suggested sizing strategy. This is important because the prostheses, despite having a similar design, have different diameters for the same size label and different sizing strategies. Results: The majority of implanted valves were size labels 21 and 23 (82.7% of the Trifecta and 74.8% of the Mitroflow). Mean pressure radients were lowest with Trifecta (Trifecta vs. Mitroflow, label-21: 11.4±4.65 vs 13.6±5.23 mmHg, label-23: 9.23±3.38 vs. 11.8±4.42 mmHg, p< 0.05, and label-25: 11.2±4.97 vs 12.0±4.46 mmHg, n.s.). The sizers for the Trifecta are metric, while those for the Mitroflow are 2-3 mm larger than the corresponding size label. It is therefore likely that for a patient with a 23 mm aortic annulus, a 23 Trifecta but often only a 21 Mitroflow is selected. Thus, comparing the Trifecta to the Mitroflow not by size label but by selected valve (e.g., 23 vs. 21) would therefore only increase the difference. Conclusion: The Trifecta shows a hemodynamic advantage over the Mitroflow which is not likely associated with the applied sizing strategy.

scholarly journals Impact of Patient-Prosthesis Mismatch and Aortic Valve Design on Coronary Flow Reserve After Aortic Valve Replacement

2007 ◽  
Vol 49 (7) ◽  
pp. 790-796 ◽  
Author(s):  
Farhad Bakhtiary ◽  
Mirko Schiemann ◽  
Omer Dzemali ◽  
Selami Dogan ◽  
Volker Schächinger ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Coronary Flow Reserve ◽  
Coronary Flow ◽  
Valve Design ◽  
Flow Reserve ◽  
Patient Prosthesis Mismatch

Reconstruction of aortic valve by autologous pericardium (Ozaki’s procedure): Single center experience in Vietnam

2020 ◽  
pp. 021849232098146
Author(s):  
Hung Thanh Ngo ◽  
Huu Cong Nguyen ◽  
Thuy Tran Nguyen ◽  
Thanh Ngoc Le ◽  
Lionel Camilleri ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Aortic Valve Area ◽  
Pressure Gradients ◽  
Autologous Pericardium ◽  
Single Center Experience ◽  
Mean Pressure ◽  
Valve Reconstruction

Aim We aimed to report the experience of aortic valve reconstruction with autologous pericardium using Ozaki’s procedure in Vietnam. Methods The study included consecutive patients with isolated aortic valve disease who underwent Ozaki’s procedure in our hospital between June 2017 and August 2019. Aortic valve leaflets were reconstructed with autologous pericardium using Ozaki’s procedure. Results Sixty-one patients were included (mean age 55.8 years; 41 were male): 24 with aortic stenosis, 17 with aortic regurgitation, and 20 with both. Of the 61 patients, 16 had a bicuspid aortic valve, and 5 had infective endocarditis. The preoperative peak and mean gradient pressure gradients were 91.7 ± 16.1 mm Hg and 55.3 ± 10.3 mm Hg, respectively. Surgery was performed via a full or partial sternotomy. The procedure was successful in 59 cases. Two patients were converted to prosthetic valve replacement. The aortic crossclamp time was 110.9 ± 20.5 minutes. Intraoperative transesophageal echocardiography showed a mean pressure gradient of 8 ± 2 mm Hg and an aortic valve area of 3.04 ± 0.44 cm2. The mean follow-up period was 18.5 ± 5.7 months. One patient died in hospital due to cardiac tamponade. One patient underwent reoperation due to infective endocarditis 6 months after surgery. Another died at 8 months after surgery due to a mediastinal abscess. The surviving patients had no aortic regurgitation or mild aortic regurgitation at the last follow-up visits. Conclusions Aortic valve reconstruction with autologous pericardium provided good outcomes in our study.

SAVR versus TAVI: What about the Hemodynamic Performance? An In Vivo and In Vitro Analysis

2019 ◽  
Vol 68 (07) ◽  
pp. 608-615 ◽  
Author(s):  
Parwis Baradaran Rahmanian ◽  
Kaveh Eghbalzadeh ◽  
Daniel Giese ◽  
Elmar W. Kuhn ◽  
Ilija Djordjevic ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Surgical Aortic Valve Replacement ◽  
4D Flow ◽  
Transcatheter Aortic Valve ◽  
Contrast Magnetic Resonance ◽  
Hemodynamic Performance ◽  
Vitro Analysis ◽  
Rapid Deployment

Abstract Background Surgical aortic valve replacement (SAVR) is nowadays discussed whether it remains the gold standard of treatment. In the last decade, there has been a tremendous increase in transcatheter aortic valve implantation (TAVI) due to the growing expertise and excellent results of the catheter-based approach. We, therefore, retrospectively compared the rapid deployment valve (RDV), the Edwards Intuity valve (IEV), with the Edwards Sapien 3 (S3V) with regard to post-procedural hemodynamics. Methods A total of 246 patients treated with TAVI or SAVR between February 2009 and November 2015 were included. One-hundred twenty-five patients were analyzed in the SAVR group and compared with 121 patients undergoing TAVI. Transvalvular pressure gradients (PGs) and the incidence and extent of aortic regurgitation (AR) were compared post-procedurally by echocardiography for each valve size. In vitro hemodynamics were analyzed by placing both valves into an aortic silicone phantom connected to a pulsatile flow pump and measured using phase-contrast magnetic resonance imaging (4D flow MRI). Results Post-procedurally, mean transvalvular PGs for the 23 mm valves were 9 (7;11.5) versus 13 (9;18) (p < 0.001), whereas maximum PGs were 16.5 (14;22) versus 25.5 mm Hg (17.5;34) (p < 0.001) in IEV and S3V patients, respectively. The 21 mm IEV showed significantly lower transvalvular PGs compared with the 23 mm S3V: mean PGs: 11 (8;13) versus 13 (9;18) (p < 0.05); maximum PG: 19.5 (13;24) versus 25.5 (18;34) mm Hg (p < 0.05). Analysis revealed significantly lower post-procedural transvalvular PGs for larger valves sizes. With respect to AR, the incidence of AR was significantly lower in IEV group (p < 0.05). In vitro velocities and turbulent kinetic energy values showed similar results between both valves. Conclusion Implanted RDVs presented a lower incidence of paravalvular regurgitation and were associated with significantly lower post-procedural transvalvular PGs, especially for small valve sizes. Our data might support the application of rapid deployment aortic valves in patients with small aortic annulus in the TAVI era.

scholarly journals Aortic Valve Replacement in Elderly Patients With Small Aortic Annulus: Results With Three Different Bioprostheses

2019 ◽  
Vol 14 (1) ◽  
pp. 27-36 ◽  
Author(s):  
Giovanni A. Chiariello ◽  
Piergiorgio Bruno ◽  
Emmanuel Villa ◽  
Annalisa Pasquini ◽  
Natalia Pavone ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Clinical Outcome ◽  
Aortic Valve Replacement ◽  
Left Ventricular Mass ◽  
Valve Replacement ◽  
Left Ventricular ◽  
Aortic Annulus ◽  
Pressure Gradients ◽  
Annulus Diameter

Objectives Aortic valve replacement (AVR) in patients with small aortic annulus (diameter ≤21 mm) is considered a challenging scenario because of technical aspects and the high risk of patient-prosthesis mismatch (PPM). The choice of the appropriate prosthesis is crucial, and at the moment, an ideal device has yet to be identified. We compare clinical and hemodynamic results after AVR with three bioprostheses with different design and characteristics. Methods We retrospectively evaluated 76 consecutive patients from two cardiac surgery centers who underwent AVR (Trifecta = 24; Edwards INTUITY Elite valve system = 26, and Perceval = 26) for severe aortic stenosis between 2013 and 2017. Patients selected were older than 75 years and with an annulus diameter ≤21 mm at preoperative echocardiogram. Reinterventions and combined procedures were excluded. Minimally invasive AVR was performed in 44 (57.8%) patients. Telephonic interview was obtained at 2.9 ± 0.5 years and echocardiographic follow-up at 2.2 ± 0.8 years. Results Clinical outcome was similar in the three groups. At follow-up, Trifecta patients presented significantly higher peak and mean transprosthetic pressure gradients ( P = 0.04 and 0.01). Effective orifice area and left ventricular mass regression were comparable, although an advantage was observed in Perceval patients without reaching the statistical significance. Incidence of moderate ( P = 0.2) and severe PPM ( P = 0.7) was comparable. Conclusions Despite higher postoperative pressure gradients observed with the Trifecta valve, all three prostheses (Trifecta, Edwards INTUITY Elite, and Perceval) have proven to be reliable when implanted in small aortic annuli, with good clinical outcome and favorable left ventricular mass regression.

P6482Stress echocardiography in the assessment of long-term outcomes results of aortic valve replacement with mechanical prostheses of small size

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T G Nikityuk ◽  
L N Ivanova ◽  
V A Ivanov ◽  
E V Ivanova
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Stress Echocardiography ◽  
Effective Orifice Area ◽  
Pressure Gradients ◽  
Orifice Area ◽  
Mechanical Prostheses ◽  
Mean Pressure

Abstract Relevance Evaluation of the function of aortic mechanical prostheses of small size in the long-term period is an topical problem, due to the fact that a narrow fibrous ring occurs in 20–35% of cases of patients with aortic stenosis. Objective To study clinical and hemodynamic parameters of small size aortic prostheses using stress echocardiography in the long-term period after valve replacement Materials and methods The study included 89 patients (54 women, 35 men) who underwent aortic valve replacement with a landing diameter of 21 mm or less. The average was 48,1±11,3 years. BSA of 1,8 m2 (1.3 to 2.2). The following models of prostheses were used: On-X, ATS-AP, Carbomedics, St. Jude Medical. All patients after surgical correction in the long-term period (an average of 5,9±3,3 years from 1 to 11 years) underwent a comprehensive clinical and instrumental examination, including an ECG and stress - echocardiography with bicycle exercise. Results In the long-term period after aortic valve replacement of mechanical prostheses of small size, the ECG showed regression of hypertrophy and overload of the left ventricle. According to stress-echocardiography, there was a significant increase in load tolerance. At the peak of the load, the following were recorded: improvement of the pumping function and cardiac performance (stroke volume, cardiac output, cardiac index), improvement of myocardial work index (Tei - index), increase in speed parameters on the aortic valve prosthesis no more than 30% of the initial values. In repose, the maximum and mean pressure gradients were 26.3±9 mm Hg and 14.3±5.4 mm Hg, effective orifice area (EOA) 1,7±0,3 cm2, index effective orifice area (EOAi) 0,93±0,2 cm2/m2. When the submaximal load levels were reached, the maximum and mean pressure gradients were 33,5±6,0 mm Hg and 17,1±4,0 mm Hg, EOA - 1,5±0,4 cm2, EOAi - 0,79±0,6 cm2/m2. Conclusions The findings suggest that modern models of aortic prostheses with an increased effective orifice area provide good clinical results in the long term. Stress echocardiography is a necessary and highly informative method for assessing the parameters of mechanical aortic prostheses and heart function.

The Sorin Pericardial Bioprosthesis: The Stentless Aortic Valve with Excellent Hemodynamic Performance

Swiss Surgery ◽  
2003 ◽  
Vol 9 (5) ◽  
pp. 247-252 ◽  
Author(s):  
Gegouskov ◽  
Eckstein ◽  
Kipfer ◽  
Berdat ◽  
Immer ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Koronare Herzkrankheit ◽  
Eine Hohe ◽  
Hemodynamic Performance

Fragestellung: Die Sorin PericarbonTM Freedom Stentless Aortenklappe verfügt über eine sehr gute hämodynamische Funktion und eine hohe Widerstandsfähigkeit. In dieser Studie stellen wir die früh- und mittelfristigen Resultate mit dieser Klappenprothese vor. Methodik: 31 konsekutive Patienten (16 Frauen und 15 Männer) wurden nach Implantation einer Sorin PericarbonTM Freedom Stentless Aortenklappe untersucht. Das mittlere Lebensalter betrug 64 +/- 17 Jahre. Präoperativ litten fünf Patienten an einer isolierten Aortenklappenstenose, drei Patienten an einer isolierten Aortenklappeninsuffizienz, ein Patient wies ein kombiniertes Aortenvitium auf. Drei Patienten hatten zusätzlich eine Mitralklappeninsuffizienz, 14 Patienten eine koronare Herzkrankheit und ein Patient eine kongenitale Aortenisthmusstenose. Bei drei Patienten bestand eine akute Aortenklappenendokarditis. 18 Patienten wurden als Hoch-Risiko-Patienten (EuroSCORE 9 +/- 2) klassifiziert. Die mittlere linksventrikuläre Auswurfsfraktion betrug 52.5 +/- 15.0%. Ergebnisse: Alle implantierten Klappenprothesen wurden, bezogen auf die intraoperative Anulusausmessung, um 2mm grösser gewählt. 16 Patienten erhielten isolierte Klappenersatzoperationen. Als Zusatzeingriffe wurden drei Mitralklappenrekonstruktionen, 12 aorto-koronare Bypass-Operationen und eine Resektion einer Aortenisthmusstenose in Kombination mit einem VSD-Verschluss durchgeführt. Drei Eingriffe waren Re-Operationen. Die postoperative Früh-Mortalität war 6.4% (zwei Hoch-Risiko-Patienten). Beide Todesfälle waren nicht klappenbedingt. Vier Patienten entwickelten postoperativ ein Low-Output-Syndrom und erhielten eine intra-aortale Ballon-Pumpe. Die sechs Monate postoperativ durchgeführte Echokardiographie erbrachte tiefe transvalvuläre Mean- und Peak-Gradienten (9.6 +/- 4.4 bzw. 20.6 +/- 5.9mmHg) sowie eine signifikante Regression der linksventrikulären Hypertrophie(linksventrikulärer Massenindex 126.5 +/- 27.3 vs. 189.6 +/- 45.3g/m2, p = 0.0313) und eine Verbesserung der systolischen Auswurfsfraktion (58 +/- 9.8 vs. 52.5 +/- 15.0%, p = 0.9749). Schlussfolgerungen: Die Sorin PericarbonTM Freedom Stentless Aortenklappe zeigte eine hervorragende hemodynamische Funktion, die nach sechs Monaten durch tiefe transvalvulären Gradienten, Regression der linksventrikulären Hypertrophie sowie Anstieg der systolischen Auswurfsfraktion charakterisiert ist. Aussagen bezüglich Lebensdauer und Abnützung des biologischen Gewebes können erst nach Durchführung von Langzeit-Untersuchungen erhoben werden.

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