Discrepancies Between Sizer and Valve Dimensions: Implications for Small Aortic Root

Bartels, Claus; Leyh, Rainer; Bechtel, Matthias; Joubert-Hübner, Elrina; Sievers, Hans‐Hinrich

doi:10.1016/s0003-4975(98)00225-2

Cited by 22 publications

(12 citation statements)

References 5 publications

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“…As was previously stated, a discrepancy exists between the labeled valve size and the internal stent diameter of the prosthesis (47)(48)(49). A reference table, such as provided in Online Appendix 1, should be used to obtain the internal stent diameter of the prosthesis and guide transcatheter valve size selection.…”

Section: Procedural Aspects Of Tav-in-sav Implantationmentioning

confidence: 96%

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Transcatheter Aortic Valve Implantation for Failing Surgical Aortic Bioprosthetic Valve

Piazza

Bleiziffer

Brockmann

et al. 2011

JACC: Cardiovascular Interventions

126

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With an aging population, improvement in life expectancy, and significant increase in the use of bioprosthetic valves, structural valve deterioration will become more and more prevalent. The operative mortality for an elective redo aortic valve surgery is reported to range from 2% to 7%, but this percentage can increase to more than 30% in high-risk and nonelective patients. Because transcatheter aortic valve (TAV)-in-surgical aortic valve (SAV) implantation represents a minimally invasive alternative to conventional redo surgery, it may prove to be safer and just as effective as redo surgery. Of course, prospective comparisons with a large number of patients and long-term follow-up are required to confirm these potential advantages. It is axiomatic that knowledge of the basic construction and dimensions, radiographic identification, and potential failure modes of SAV bioprostheses is fundamental in understanding key principles involved in TAV-in-SAV implantation. The goals of this paper are: 1) to review the classification, physical characteristics, and potential failure modes of surgical bioprosthetic aortic valves; and 2) to discuss patient selection and procedural techniques relevant to TAV-in-SAV implantation.

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Section: Procedural Aspects Of Tav-in-sav Implantationmentioning

confidence: 96%

“…Of particular note, the manufacturer's labeled valve size (in millimeters) does not match the inner base ring diameter or any significant hemodynamic-related dimension of the valve (47)(48)(49). The labeled valve size of most manufacturers, however, corresponds to the outer base ring diameter.…”

Section: Bioprosthetic Savmentioning

confidence: 99%

Transcatheter Aortic Valve Implantation for Failing Surgical Aortic Bioprosthetic Valve

Piazza

Bleiziffer

Brockmann

et al. 2011

JACC: Cardiovascular Interventions

126

View full text Add to dashboard Cite

show abstract

“…Differences in metric versus product-related sizer dimensions have been described previously without any subsequent adjustments to clinical practice. [11][12][13][14][15][16] Now, for the first time to our knowledge, a prospective comparison of true metric aortic annulus diameters to labeled aortic valve diameters becomes available. Not surprisingly there were no significant differences between the 2 xenograft valve types regarding labeled valve diameters implanted in the different aortic annulus diameter groups (Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…Differences in valve sizes and in sizer dimensions exist between the clinically available stented xenografts. [11][12][13][14][15][16] These may lead to misunderstandings, suboptimal valve selection, misinterpretation of clinical results, and significant discrepancies between hemodynamic outcome data. No randomized comparison of different stented xenografts has been published to our knowledge thus far.…”

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confidence: 99%

Prospectively Randomized Evaluation of Stented Xenograft Hemodynamic Function in the Aortic Position

et al. 2004

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Background-Standard stented aortic xenograft valves have not yet been compared regarding their hemodynamic function using a stratified intraoperative randomization protocol. Methods and Results-100 patients were prospectively included after intraoperative metric sizing of the decalcified aortic annulus. They received Mosaic (M) or Perimount (P) aortic valve replacement. Patient age was 73Ϯ5 years, 51 were female, and New York Heart Association (NYHA) functional class was 2.8Ϯ0.5. The 21-mm annulus group consisted of 5 (M)/7 (P) patients, the 23-mm annulus group of 20 (M)/20 (P), the 25-mm annulus group of 18 (M)/19 (P), and the 27-mm annulus group of 4 (M)/7 (P) patients, respectively. Hemodynamic function was evaluated using transthoracic echocardiography before discharge and at follow-up (438Ϯ352 days). Surgery was uncomplicated in all patients. Labeled valve sizes were 0.93 (M) and 1.05 (P) mm smaller than the annulus diameters (pϭNS). In-hospital mortality was 5%, all nonvalve-related. Transvalvular blood flow velocities and transvalvular pressure gradients were significantly lower in the 25 P versus the 25 M group at baseline and in the 23 P and 25 P groups at follow-up. There was a significant regression of left ventricular mass index in all patients at follow-up. However, left ventricular mass regression was more pronounced after P aortic valve replacement. Conclusion-Labeled sizes of prosthetic heart valves implanted are smaller than the true aortic annulus. Both standard aortic xenografts compared in this prospectively randomized trial provide a sufficient hemodynamic and functional outcome.

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“…[1][2][3][4][5][6] Labeled valve size is not the same as a millimeter measure of the prosthetic valve diameter or the aortic annulus into which it will fit. [7][8][9][10][11] Valve sizers are made slightly larger than the corresponding valve to avoid problems seating the valve after sutures have been placed. Studies that use the labeled valve size in lieu of the actual measured diameter in millimeters to compare different valves might be misleading.…”

mentioning

confidence: 99%

Comparison of eight prosthetic aortic valves in a cadaver model

Youdelman

Hirose

Jain

et al. 2007

The Journal of Thoracic and Cardiovascular Surgery

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Discrepancies Between Sizer and Valve Dimensions: Implications for Small Aortic Root

Cited by 22 publications

References 5 publications

Transcatheter Aortic Valve Implantation for Failing Surgical Aortic Bioprosthetic Valve

Transcatheter Aortic Valve Implantation for Failing Surgical Aortic Bioprosthetic Valve

Prospectively Randomized Evaluation of Stented Xenograft Hemodynamic Function in the Aortic Position

Comparison of eight prosthetic aortic valves in a cadaver model

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