Opening and closing kinematics of fresh and calcified aortic valve prostheses: An in vitro study Farhad Bakhtiary, MD, Omer Dzemali, MD, Ulrich Steinseiffer,

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Presentation transcript:

Opening and closing kinematics of fresh and calcified aortic valve prostheses: An in vitro study Farhad Bakhtiary, MD, Omer Dzemali, MD, Ulrich Steinseiffer, PhD, Christof Schmitz, PhD, Birgit Glasmacher, PhD, Anton Moritz, MD, PhD, Peter Kleine, MD, PhDa The Journal of Thoracic and Cardiovascular Surgery Volume 134, Issue 3, Pages 657-662 (September 2007) DOI: 10.1016/j.jtcvs.2007.02.050 Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Pulsatile artificial circulation system (position of the aortic valve, arrow): To create physiologic pressure and volume courses, flow resistors (15, 17) and programmable wind kettles (14, 16) are used. The flexible left silicone ventricle (9) and the rigid aortic root (11) simulate physiologic geometry. The volume expulsion of the simulated LV is created by electrohydraulic impulsion (18). Additional air within the compression housing (7a) serves as variable ventricular compliance. The computer-controlled volume extrusion allows an exact and reproducible simulation of the physiologic ventricular work. The Journal of Thoracic and Cardiovascular Surgery 2007 134, 657-662DOI: (10.1016/j.jtcvs.2007.02.050) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Systolic pressure difference (transvalvular gradients) for the 2 fresh valves, which are treated valves suitable for patient implantation. Significantly lower values for fresh pericardial valves (0) were observed compared with the porcine prostheses. This difference narrowed during the test period of 6 weeks and was not statistically significant at the 2-, 3-, and 6-week measurements. The Journal of Thoracic and Cardiovascular Surgery 2007 134, 657-662DOI: (10.1016/j.jtcvs.2007.02.050) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 EOA demonstrated significantly larger results for pericardial valves throughout the observation period (P < .05), with some narrowing with progressive degeneration. EOA, Effective orifice area. The Journal of Thoracic and Cardiovascular Surgery 2007 134, 657-662DOI: (10.1016/j.jtcvs.2007.02.050) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Closure volume showed highly significant higher results for pericardial valves at each point (P < .001). The Journal of Thoracic and Cardiovascular Surgery 2007 134, 657-662DOI: (10.1016/j.jtcvs.2007.02.050) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Total energy loss (% of work load) was comparable for pericardial and porcine valves. A higher systolic energy loss for the porcine valves was equalized by lower diastolic energy losses. The Journal of Thoracic and Cardiovascular Surgery 2007 134, 657-662DOI: (10.1016/j.jtcvs.2007.02.050) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 A typical example of leaflet kinematics for both valves, pericardial (A) and porcine (B), after 3 weeks of degeneration. The Journal of Thoracic and Cardiovascular Surgery 2007 134, 657-662DOI: (10.1016/j.jtcvs.2007.02.050) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 7 Incomplete opening of one pericardial leaflet (arrow) after 6 weeks of progressive calcification. Mean pressure gradient in this valve was 18 mm Hg. The Journal of Thoracic and Cardiovascular Surgery 2007 134, 657-662DOI: (10.1016/j.jtcvs.2007.02.050) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions