Mechanical valves in the pulmonary position: An international retrospective analysis

Pragt, Hanna; Melle, Joost P. van; Javadikasgari, Hoda; Seo, Dong-Man; Stulak, John M.; Knez, Igor; Hörer, Jürgen; Muñoz-Guijosa, Christian; Dehaki, Mahyar Gholampour; Shin, Hong Ju; Dearani, Joseph A.; Dehaki, Maziar Gholampour; Pieper, Petronella G.; Eulenburg, Christine zu; Dos, Laura; Ebels, Tjark

doi:10.1016/j.jtcvs.2017.04.072

Cited by 41 publications

(26 citation statements)

References 37 publications

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“…Our previous clinical research was underpowered to determine differences between brands. 1 The average rate of valvar thrombosis in the pulmonary position for all valve models was about 1.7% per patient year.…”

Section: Discussionmentioning

confidence: 91%

“…10,11 Recent follow-up suggests, nonetheless, that mechanical valves proved actually to be surprisingly promising for this position, despite the higher propensity for clotting. 1,2 Little is known about the flow behavior of mechanical valves in the pulmonary position under the much lower pulmonary pressures, which will result in less flow through the hinges in closed position. The precise relationship between pressure and flow has not been investigated, let alone for different brands or models.…”

Section: Carbormentioning

confidence: 99%

“…In contrast, prosthetic valvar thrombosis is rare in the aortic position for which these prostheses have been designed so successfully. 1,2 For the most commonly used bileaflet valves, valvar thrombosis in most cases originates from the hinges. 3 These hinges are flushed under aortic circumstances by a pressure gradient of about 80 mm Hg between aorta and the left ventricle that produces small turbulent flows while the valve is in closed position.…”

Section: Introductionmentioning

confidence: 99%

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Influence of Transvalvar Pressure Gradient on Hinge Washing in Closed Mechanical Prosthetic Cardiac Valves Under Pulmonary Pressure Conditions: A Comparative In Vitro Study

Pragt

Melle²,

Mariani³

et al. 2019

World J Pediatr Congenit Heart Surg

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Objective: Hinge washing is a crucial factor in the prevention of mechanical prosthetic valvar thrombosis, especially in the pulmonary valve position. The aim of this laboratory study was to determine the relationship between pressure difference and the amount of hinge washing in the closed position, using the pressures that are normal for the right ventricle and pulmonary artery. Methods: In an in vitro setting, four different bileaflet mechanical valves were tested for hinge washing in closed position. Based on similarity in inner diameter (range: 20.5-21.4 mm), the following valves were tested: Abbott SJM Regent size 23, Cryolife On-X size 23, LivaNova Carbomedics-R size 25, Medtronic Open Pivot (M-OP)-A size 25. Tests were carried out in a range between 3 and 100 mm Hg pressure difference, using water as a test fluid. The amount of leakage per minute through the closed valve was measured. Results: All four valves showed an increase in leakage with increasing transvalvar gradient, and the relationship between pressure and leakage behaves in logarithmic fashion. Leakage under normal pulmonary diastolic pressure conditions (10 mm Hg) was between 23.3% and 29.3% of the leakage under aortic diastolic pressure conditions (80 mm Hg). The Cryolife On-X valve showed the highest closed leakage volume under pulmonary conditions (10 mm Hg) 0.254 + 0.01 (L/min), where the Medtronic MOP showed the lowest leakage volume with 0.125 + 0.014 (mL/min). Conclusion: Hinge washing is related to transvalvar pressure difference in closed position. Valve brands differed significantly from each other in the amount of hinge washing.

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Section: Discussionmentioning

confidence: 91%

Section: Carbormentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Influence of Transvalvar Pressure Gradient on Hinge Washing in Closed Mechanical Prosthetic Cardiac Valves Under Pulmonary Pressure Conditions: A Comparative In Vitro Study

Pragt

Melle²,

Mariani³

et al. 2019

World J Pediatr Congenit Heart Surg

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“…As late pulmonary valve replacement by transcatheter valves has shown to be associated with continuing risk of endocarditis of 1-3% per year, surgical solutions associated with a minimum of long-term morbidity are of continued interest [30]. We should strive for a pulmonary valve prosthesis specifically designed for that very position [36].…”

Section: Cardiac Surgerymentioning

confidence: 99%

New developments in adult congenital heart disease

et al. 2020

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Congenital heart disease (CHD) affects 0.8% of live births and over the past decades technical improvements and large-scale repair has led to increased survival into adulthood of over 95% of the newborn. A new group of patients, those who survived their congenital heart defect, has emerged but late complications including heart failure, pulmonary hypertension (PH), arrhythmias, aneurysms and endocarditis appeared numerous, with a huge impact on mortality and morbidity. However, innovations over the past years have changed the landscape of adult CHD dramatically. In the diagnostic process important improvements have been made in the use of MRI, biomarkers, e-health concepts and 3D visualisation of anatomy. Care is now concentrated in specialised centres, with a continuous emphasis on education and the introduction of weekly multidisciplinary consultations on diagnosis and intervention. Surgery

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“…Although mechanical valves are not preferred in pulmonary position, they are also fraught with inherent problems of thromboembolic episodes and bleeding related to anticoagulation, even in modern era. [5] While bioprosthetic valve avoids this problem to a large extent, their structural damage over a period of follow-up equals its benefit accrued over years of freedom from thromboembolic episodes and bleeding related to anticoagulation. [6] Moreover, the bioprosthetic valve is created from tissue of xenogeneic origin; hence, it degrades with calcification and stenosis.…”

Section: Introductionmentioning

confidence: 99%

Assessment of untreated fresh autologous pericardium as material for construction of heart valve: Result at 5 years

et al. 2019

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Introduction: Tetralogy of Fallot requiring transannular repair of the right ventricular outflow tract (RVOT) are exposed to free pulmonary insufficiency and hence inevitable right ventricular dysfunction. This study analyzes the function and structure of untreated autologous pericardium monocusp used to create a competent pulmonary valve. Materials and Methods: This is a retrospective analysis of 52 cases operated between December 2006 and December 2012. Untreated autologous pericardium was used for creating a competent pulmonary valve following a transannular patch. They are followed for functional and structural assessment of the pulmonary valve by echocardiography. Positron emission tomography (PET) with 18 fluorodeoxyglucose was performed in two cases for profiling the pulmonary valve. Results: Median age was 10.5 years (1–38). The follow-up was complete for 42 (80.76%) patients for 3 years and 25 (48.07%) patients for 5 years. The RVOT gradient was 42 mmHg (16–96) in the year of surgery, which reduced to 26 mmHg (10–58) and pulmonary insufficiency that was present in 8.3% of patients in 1 st year was witnessed in 22.7% in the 5 th year of follow-up. The monocusp patch was successful in creating a competent valve while maintaining its structure at 3 years; however, it became distorted and retracted at 5 years of follow-up. There was no calcification in any of the patients. PET-computed tomography confirmed the uptake of glucose by monocusp at 1 year of follow-up. Conclusion: The untreated autologous pericardium functioned well when it was used to create a competent pulmonary valve at short term and midterm. Although it changed in its structure; there was no calcification at 5 years of follow-up.

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Mechanical valves in the pulmonary position: An international retrospective analysis

Abstract: Mechanical PVR is associated with a limited risk of valvular thrombosis. Thrombolysis was an effective treatment in the majority.

Cited by 41 publications

References 37 publications

Influence of Transvalvar Pressure Gradient on Hinge Washing in Closed Mechanical Prosthetic Cardiac Valves Under Pulmonary Pressure Conditions: A Comparative In Vitro Study

Influence of Transvalvar Pressure Gradient on Hinge Washing in Closed Mechanical Prosthetic Cardiac Valves Under Pulmonary Pressure Conditions: A Comparative In Vitro Study

New developments in adult congenital heart disease

Assessment of untreated fresh autologous pericardium as material for construction of heart valve: Result at 5 years

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