Hemodynamic Comparison of Bioprostheses for Complete Supra-Annular Position in Patients With Small Aortic Annulus

Abstract

In patients with an aortic annulus of 18 to 20 mm in diameter, hemodynamic performance is independent of the implanted stented valve type and the annular position. Root enlargement or stentless valves may be beneficial alternatives. Patients with annulus diameter 21 to 23 mm benefit from the Magna in complete supra-annular position leading to superior hemodynamic results.

Prosthetic Heart Valves

“…Indeed, it is generally superior in newer compared with older generations of prostheses, in mechanical compared with stented bioprosthetic valves, 16 in stentless compared with stented bioprosthetic valves, 17,18 and in supraannular compared with intra-annular stented bioprostheses. 19,20 A recent meta-analysis 18 shows that, compared with stented bioprostheses, stentless valves provide larger EOAs, reduced transprosthetic gradients, and greater left ventricular (LV) mass regression, but at the expense of prolonged cardiopulmonary bypass time.…”

The Complete Supraannular Concept

“…1,8,14,18,19 In the present study, we focus on aortic bioprostheses designed for and implanted in a complete supraannular position. The design of a complete supraannular heart valve prosthesis aims to optimize the area available for the bloodstream through the aortic root orifice.…”

“…By positioning the prosthesis on top of the annulus (complete supraannular position), the stent of the prosthesis is meant not to protrude into the orifice and ideally does not impair the bloodstream (Figure 2). 1,4,8,13 The advantage of complete supraannular placement is of special importance in patients with a small aortic annulus. 1,7,8,20 -23 In our collective, the focus was not set on a special annulus size but on a normal distribution of annulus sizes within the patient group.…”

“…To evaluate factors other than prosthesis position, which might influence the hemodynamic performance (eg, valve material), we evaluated 5 commercially available bioprostheses for complete supraannular placement (Carpentier Edwards Perimount Magna, 1,3 Medtronic Mosaic, 1,4 -9 Medtronic Mosaic Ultra, 10,11 St Jude Medical Epic Supra, 4,7,12 and Sorin Soprano 1,7,8,13 ).…”

“…Therefore, we use as a basis for comparisons-as in previous studies-the patient's aortic annulus, which is measured with a standardized sizer during surgery. 1,4,8,13,14 …”