TY - JOUR
T1 - The complete supraannular concept in vivo hemodynamics of bovine and porcine aortic bioprostheses
AU - Ruzicka, Daniel J.
AU - Hettich, Ina
AU - Hutter, Andrea
AU - Bleiziffer, Sabine
AU - Badiu, Catalin C.
AU - Bauernschmitt, Robert
AU - Lange, Ruediger
AU - Eichinger, Walter B.
PY - 2009
Y1 - 2009
N2 - Background-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 noneverted mattress sutures. We evaluated 5 bioprostheses designed for complete supraannular placement to assess potential hemodynamic differences caused by factors (eg, valve material) other than implantation position. Methods and Results-In 336 patients (mean age, 72.0±7.1 years; 143 women), hemodynamics including mean pressure gradients, effective orifice areas, and indices and incidence of patient-prosthesis mismatch were evaluated 6 months after surgery. Annulus diameter was measured during surgery. Patients received the Carpentier Edwards Perimount Magna (Magna, n=169), the Medtronic Mosaic (Mosaic, n=46), the Mosaic Ultra (Ultra, n=17), the SJM Epic Supra (Epic, n=46), and the Sorin Soprano (Soprano, n=58). For small annulus sizes (<23 mm), the mean pressure gradients of the Magna (11.82±4.8 mmHg) were significantly lower than the Mosaic (16.04±6.1 mmHg) and the Ultra (22.0±4.1 mm Hg), and the Soprano (13.3±5.2 mm Hg) was hemodynamically superior to the Ultra. For medium (23 to 24 mm) and large (>24 mm) annulus sizes, the mean pressure gradients of the Magna were lower than the Epic (10.0±3.5 mm Hg versus 14.9±6.4 mm Hg; 9.9±4.0 mm Hg versus 18.6± 12.7 mm Hg). Furthermore, in patients with large annulus size, the mean pressure gradients of the Soprano (11.4±3.8 mm Hg) were lower compared with the Epic (18.5±12.7 mmHg). Severe patient-prosthesis mismatch was observed more frequently in patients with the Mosaic (12/46; 26.1%) and the Ultra (3/17; 17.6%) prostheses. Conclusions-Complete supraannular placement cannot prevent high pressure gradients or patient-prosthesis mismatch thoroughly, but the choice of a bovine prosthesis can optimize hemodynamic performance,
AB - Background-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 noneverted mattress sutures. We evaluated 5 bioprostheses designed for complete supraannular placement to assess potential hemodynamic differences caused by factors (eg, valve material) other than implantation position. Methods and Results-In 336 patients (mean age, 72.0±7.1 years; 143 women), hemodynamics including mean pressure gradients, effective orifice areas, and indices and incidence of patient-prosthesis mismatch were evaluated 6 months after surgery. Annulus diameter was measured during surgery. Patients received the Carpentier Edwards Perimount Magna (Magna, n=169), the Medtronic Mosaic (Mosaic, n=46), the Mosaic Ultra (Ultra, n=17), the SJM Epic Supra (Epic, n=46), and the Sorin Soprano (Soprano, n=58). For small annulus sizes (<23 mm), the mean pressure gradients of the Magna (11.82±4.8 mmHg) were significantly lower than the Mosaic (16.04±6.1 mmHg) and the Ultra (22.0±4.1 mm Hg), and the Soprano (13.3±5.2 mm Hg) was hemodynamically superior to the Ultra. For medium (23 to 24 mm) and large (>24 mm) annulus sizes, the mean pressure gradients of the Magna were lower than the Epic (10.0±3.5 mm Hg versus 14.9±6.4 mm Hg; 9.9±4.0 mm Hg versus 18.6± 12.7 mm Hg). Furthermore, in patients with large annulus size, the mean pressure gradients of the Soprano (11.4±3.8 mm Hg) were lower compared with the Epic (18.5±12.7 mmHg). Severe patient-prosthesis mismatch was observed more frequently in patients with the Mosaic (12/46; 26.1%) and the Ultra (3/17; 17.6%) prostheses. Conclusions-Complete supraannular placement cannot prevent high pressure gradients or patient-prosthesis mismatch thoroughly, but the choice of a bovine prosthesis can optimize hemodynamic performance,
KW - Complete supraannular aortic valve prostheses
UR - http://www.scopus.com/inward/record.url?scp=70349785750&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.109.844332
DO - 10.1161/CIRCULATIONAHA.109.844332
M3 - Article
C2 - 19752359
AN - SCOPUS:70349785750
SN - 0009-7322
VL - 120
SP - S139-S145
JO - Circulation
JF - Circulation
IS - SUPPL. 1
ER -