Evaluation of Hemodynamic Performance of Aortic Valve Bioprostheses in a Model of Oversizing

Cleveland, Jeanette N.; Bowdish, Michael E.; Eberhardt, Carol; Mack, Wendy J.; Crabtree, James A.; Vassiliades, Thomas A.; Speir, Alan M.; Darekar, Yogesh A.; Hackmann, Amy E.; Starnes, Vaughn A.; Cohen, Robbin G.

doi:10.1016/j.athoracsur.2016.10.019

Cited by 24 publications

(26 citation statements)

References 19 publications

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“…Thus, patients with PPM after the initial aortic valve replacement may also require a root-enlargement procedure during redo replacement. However, Cleveland and colleagues 19 reported that oversizing of bioprosthetic valves resulted in decreased EOAs and geometric orifice areas and increased pressure gradients. The Trifecta valve was the most sensitive to oversizing because of its externally mounted leaflet design.…”

Section: Commentmentioning

confidence: 99%

Early First-Generation Trifecta Valve Failure: A Case Series and a Review of the Literature

Kaneyuki

Nakajima

Asakura

et al. 2020

The Annals of Thoracic Surgery

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Background. The Trifecta valve (Abbott, St Paul, MN) has excellent hemodynamic performance with acceptable rates of freedom from structural valve degeneration. However, some recent studies have reported early Trifecta valve failure. Here, we report a case series of seven Trifecta valve failures with a review of the literature. Methods. Of 107 implantations of Trifecta bioprostheses between 2012 and 2014, we encountered seven Trifecta valve failures (6.5%). Failure of a 19-mm Trifecta valve occurred in 1 patient, failure of a 21-mm Trifecta valve occurred in 5 patients, and failure of a 23-mm Trifecta valve occurred in 1 patient. The mean duration of valve durability was 51 ± 16 months. The mean effective orifice area index on the first echocardiogram after Trifecta valve implantation was 0.96 ± 0.26. The mode of presentation was prosthetic valve stenosis in 3 patients and severe aortic regurgitation in 4 patients.

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Section: Commentmentioning

confidence: 99%

Early First-Generation Trifecta Valve Failure: A Case Series and a Review of the Literature

Kaneyuki

Nakajima

Asakura

et al. 2020

The Annals of Thoracic Surgery

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“…However, in a recent in vitro model study, placing an oversized bioprosthetic valve resulted in reduced haemodynamic valve performance,41 possibly related to abnormal stresses around the hinge point of each leaflet, causing the hinge point to be shifted inwards and reducing the EOA of the valve. Although oversizing the valve has a deleterious effect on valve haemodynamics in vitro, clinical consequences of valve oversizing currently are unknown.…”

Section: Prevention Of Ppmmentioning

confidence: 99%

Patient-prosthesis mismatch following aortic valve replacement

Bilkhu

Jahangiri

Otto

2019

Heart

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Patient-prosthesis mismatch (PPM) occurs when an implanted prosthetic valve is too small for the patient; severe PPM is defined as an indexed effective orifice area (iEOA) <0.65 cm2/m2 following aortic valve replacement (AVR). This review examines articles from the past 10 years addressing the prevalence, outcomes and options for prevention and treatment of PPM after AVR. Prevalence of PPM ranges from 8% to almost 80% in individual studies. PPM is thought to have an impact on mortality, mainly in patients with severe PPM, although severe PPM accounts for only 10–15% of cases. Outcomes of patients with moderate PPM are not significantly different to those without PPM. PPM is associated with higher rates of perioperative stroke and renal failure and lack of left ventricular mass regression. Predictors include female sex, older age, hypertension, diabetes, renal failure and higher surgical risk score. PPM may be a marker of comorbidity rather than a risk factor for adverse outcomes. PPM should be suspected in patients with persistent cardiac symptoms after AVR when there is high prosthetic valve velocity or gradient and a small calculated effective orifice area. After exclusion of other causes of increased transvalvular gradient, re-intervention may be considered if symptoms persist and are unresponsive to medical therapy. However, this decision needs to consider the available options to relieve PPM and whether expected benefits justify the risk of intervention. The only effective intervention is redo surgery with implantation of a larger valve and/or annular enlargement. Therefore, focus needs to be on prevention.

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“…However, unlike in humans, complications in pigs are often a consequence of a size mismatch, as preclinical studies are mostly performed with prototype devices of limited size variations 31,32 . While undersizing of prosthetic valves leads to para-valvular leakage and dislodgment of the prosthesis 33 oversizing significantly impairs hemodynamic performance 34 . As both scenarios have a negative impact on the informative value of the preclinical study results, appropriate annular measurements and prosthesis sizing are considered critical.…”

Section: Discussionmentioning

confidence: 99%

“…Best correlation has shown to be achieved when measurements are done in mid-systole in 25-35% of the heart cycle 48 . Data on the amount of cyclical changes on annular dimensions in pigs, including cross-sectional area, perimeter and subsequently derived diameters however is more conflicting 34 . A dynamic geometry, mainly affecting the maximal diameter but not the minimal diameter, throughout the cardiac cycle is described for the left ventricular outflow tract and the mitral valve in pigs 35,36 .…”

Section: Discussionmentioning

confidence: 99%

Computed Tomography-based evaluation of porcine cardiac dimensions to assist in pre-study planning and optimized model selection for pre-clinical research

Lipiski¹,

Eberhard²,

Fleischmann³

et al. 2020

Sci Rep

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Hatem Alkadhi 2 & nikola cesarovic 1,7 the pig (Sus Scrofa Domestica) is an accepted model for preclinical evaluation of prosthetic heart valves and trans-catheter implantation techniques. Understanding porcine cardiac dimensions through threedimensional computed tomography (ct), increases preclinical study success, leading to higher cost efficiency and to the observance of the obligation to the 3 R principles. Cardiac CT images of twentyfour Swiss large white pigs were segmented; aortic root, mitral valve, pulmonary trunk, tricuspid valve, as well as the aorto-mitral angle and left atrial height were analyzed. Correlation coefficient (r) was calculated in relation to body weight. In Swiss large white pigs, valvular dimensions, length of the pulmonary artery and ascending aorta as well as left atrial height correlate with body weight. Coronary ostia heights and aorto-mitral angle size can be neglected in animal size selection; no changes were found for either of the two parameters with increasing body weight.

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Evaluation of Hemodynamic Performance of Aortic Valve Bioprostheses in a Model of Oversizing

Cited by 24 publications

References 19 publications

Early First-Generation Trifecta Valve Failure: A Case Series and a Review of the Literature

Early First-Generation Trifecta Valve Failure: A Case Series and a Review of the Literature

Patient-prosthesis mismatch following aortic valve replacement

Computed Tomography-based evaluation of porcine cardiac dimensions to assist in pre-study planning and optimized model selection for pre-clinical research

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