Trilogy Pericardial Valve: Hemodynamic Performance and Calcification in Adolescent Sheep Willem Flameng, MD, PhD, Bart Meuris, MD, PhD, Geofrey De Visscher,

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Trilogy Pericardial Valve: Hemodynamic Performance and Calcification in Adolescent Sheep Willem Flameng, MD, PhD, Bart Meuris, MD, PhD, Geofrey De Visscher, PhD, Crystal Cunanan, MS, Ernie Lane, BS, Erik Verbeken, MD, PhD, Paul Herijgers, MD, PhD, Marie-Christine Herregods, MD, PhD The Annals of Thoracic Surgery Volume 85, Issue 2, Pages 587-592 (February 2008) DOI: 10.1016/j.athoracsur.2007.09.041 Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Design of the Trilogy valve (Arbor Surgical Technologies Inc) and macro photographs of the inflow and outflow sides of a finished Trilogy valve. The lower picture is the computer-assisted design schematic showing the support elements, including the multilayered frames for each leaflet, called laminates, which suspend each leaflet independently and help absorb the energy of valve opening and closing. The leaflet-laminate assemblies are attached to the valve frame, called the valve crown, which places the structural support elements into the sinuses and out of the blood flow. The Annals of Thoracic Surgery 2008 85, 587-592DOI: (10.1016/j.athoracsur.2007.09.041) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Typical examples of valves explanted after five months in mitral position: gross examination of the explants and their Faxitron (Wheeling, IL) X-ray pictures. Left panels (A, C, E): explanted Perimount valve (Edwards Lifesciences) (atrial side, ventricular side, and X-ray). Right panels (B, D, F) show an explanted Trilogy valve (Arbor Surgical Technologies Inc) (atrial side, ventricular side, and X-ray). Note the clear commissural calcifications in two commissures of the Perimount (arrowheads). The Annals of Thoracic Surgery 2008 85, 587-592DOI: (10.1016/j.athoracsur.2007.09.041) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions