The Complete Supraannular Concept In Vivo Hemodynamics of Bovine and Porcine Aortic Bioprostheses

Article; Proceedings Paper

关键词: PROSTHESIS-PATIENT MISMATCH;    PERIMOUNT MAGNA BIOPROSTHESIS;    VALVE-REPLACEMENT;    EXERCISE HEMODYNAMICS;    PERFORMANCE;    POSITION;    ANNULUS;    IMPACT;    EXPERIENCE;    GRADIENT;   

DOI  :  10.1161/CIRCULATIONAHA.109.844332

来源: SCIE

【 摘 要 】

Background-Complete supraannular placement of an aortic bioprosthesis is one approach to optimize the hemodynamic result of an aortic valve replacement. It is achieved with the combination of a special valve design and the supraannular sewing technique with noneverted mattress sutures. We evaluated 5 bioprostheses designed for complete supraannular placement to assess potential hemodynamic differences caused by factors (eg, valve material) other than implantation position. Methods and Results-In 336 patients (mean age, 72.0 +/- 7.1 years; 143 women), hemodynamics including mean pressure gradients, effective orifice areas, and indices and incidence of patient-prosthesis mismatch were evaluated 6 months after surgery. Annulus diameter was measured during surgery. Patients received the Carpentier Edwards Perimount Magna (Magna, n=169), the Medtronic Mosaic (Mosaic, n=46), the Mosaic Ultra (Ultra, n=17), the SJM Epic Supra (Epic, n=46), and the Sorin Soprano (Soprano, n=58). For small annulus sizes (<23 mm), the mean pressure gradients of the Magna (11.82 +/- 4.8 mm Hg) were significantly lower than the Mosaic (16.04 +/- 6.1 mm Hg) and the Ultra (22.0 +/- 4.1 mm Hg), and the Soprano (13.3 +/- 5.2 mm Hg) was hemodynamically superior to the Ultra. For medium (23 to 24 mm) and large (>24 mm) annulus sizes, the mean pressure gradients of the Magna were lower than the Epic (10.0 +/- 3.5 mm Hg versus 14.9 +/- 6.4 mm Hg; 9.9 +/- 4.0 mm Hg versus 18.6 +/- 12.7 mm Hg). Furthermore, in patients with large annulus size, the mean pressure gradients of the Soprano (11.4 +/- 3.8 mm Hg) were lower compared with the Epic (18.5 +/- 12.7 mm Hg). Severe patient-prosthesis mismatch was observed more frequently in patients with the Mosaic (12/46; 26.1%) and the Ultra (3/17; 17.6%) prostheses. Conclusions-Complete supraannular placement cannot prevent high pressure gradients or patient-prosthesis mismatch thoroughly, but the choice of a bovine prosthesis can optimize hemodynamic performance. (Circulation. 2009; 120[suppl 1]: S139-S145.)

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