We compared the hemodynamic performance of the Edwards Perimount Magna (EPM) and the Medtronic Mosaic (MM) bioprostheses according to the patient aortic annulus diameter (AAD). Eighty-six patients undergoing aortic valve replacement were prospectively assigned to receive either an EPM-valve (n=43) or an MM-bioprosthesis (n=43). Randomization was performed after measuring the AAD and patients were grouped according to their AAD: <22 mm (n=12), 22-23 mm (n=31) and >23 mm (n=43). Echocardiographic assessment was performed one year postoperatively. The mean AAD (EPM 23.9+/-2.1 mm vs. MM 23.6+/-2.3 mm) and mean valve size implanted (EPM 22.6+/-2.1 mm vs. MM 23.3+/-2.1 mm) were comparable in both groups. The EPM-group showed significantly lower mean gradient (EPM 10.2+/-3.2 mmHg vs. MM 17.1+/-8.2 mmHg) and larger effective orifice area (EOA) (EPM 1.99+/-0.4 cm(2) vs. MM 1.69+/-0.4 cm(2), P<0.0001). The EPM-valve was superior with respect to mean pressure gradient and EOA in all AAD. This difference was statistically significant in AAD of 22-23 mm (EPM 9.6+/-3.0 mmHg vs. MM 18.2+/-8.6 mmHg; EPM 1.82+/-0.3 cm (2) vs. MM 1.51+/-0.2 cm (2)) and >23 mm (EPM 9.9+/-3.1 mmHg vs. MM 14.2+/-5.6 mmHg; EPM 2.18+/-0.4 cm(2) vs. MM 1.94+/-0.5 cm(2)). Patient-prosthesis mismatch was present in 26.8% (MM) vs. 6.9% (EPM) of the patients (P=0.01). When the same AAD is taken as a reference, the EPM-valve was hemodynamically superior to the MM-bioprosthesis. The EPM-prosthesis significantly reduced the incidence of PPM.

Abdominal aortic aneurysms (AAAs) rupture is one of the main causes of death in the world. This is a very complex phenomenon that usually occurs "without previous warning". Currently, criteria to assess the aneurysm rupture risk (peak diameter and growth rate) can not be considered as reliable indicators. In order to improve the predicting of AAA rupture risk, the theoretical foundation of a simple method, where the main geometric parameters of aneurysms have been linked into six biomechanical factors, which have been combined to obtain a dimensionless rupture risk index, RI(t), is presented in this work. This quantitative indicator, which has been implemented in a tool, is easy to understand, it allows estimating the aneurysms rupture risks, it is expected to be able to identify the one that ruptures even when its peak diameter is less than the threshold value and identify those cases where the rupture should not occur and according to the maximum diameter, the patient is submitted to surgical procedure. The method was validated, preliminarily, with a clinical case and other three cases from the literature. Based on these initial results of the validation test, a broader prospective randomised control study has been carried out with two hundred and one patients at the Clinic Hospital of Valladolid-Spain, which were submitted to surgical repair treatment (EVAR). The results of this study shown that it is possible to carry out a clinical assessment of the AAA rupture risk through its geometric parameters and that the most important geometric biomechanical factors are the deformation rate and saccular index.

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