John D. Cleveland, MD, Michael E. Bowdish, MD, Carol E

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Presentation transcript:

Evaluation of Hemodynamic Performance of Aortic Valve Bioprostheses in a Model of Oversizing John D. Cleveland, MD, Michael E. Bowdish, MD, Carol E. Eberhardt, BS, Wendy J. Mack, PhD, James A. Crabtree, BS, Thomas A. Vassiliades, MD, Alan M. Speir, MD, Yogesh A. Darekar, MS, Amy E. Hackmann, MD, Vaughn A. Starnes, MD, Robbin G. Cohen, MD, MMM The Annals of Thoracic Surgery Volume 103, Issue 6, Pages 1866-1876 (June 2017) DOI: 10.1016/j.athoracsur.2016.10.019 Copyright © 2017 Terms and Conditions

Fig 1 (a) Aortic root housing components: (1) 21-mm test annulus, (2) valve and associated stabilization plate, (3) inflow clamping ring, and (4, 5) acrylic housing with gaskets. (b) Fully constructed aortic root housing. The Annals of Thoracic Surgery 2017 103, 1866-1876DOI: (10.1016/j.athoracsur.2016.10.019) Copyright © 2017 Terms and Conditions

Fig 2 Effect of increasing valve-annular mismatch on the tested effective orifice area (EOA) of each bioprosthetic valve: (A) 21-mm valves, (B) 23-mm valves; (C) 25-mm valves. The p valves of all comparisons are provided in Supplemental Tables 1, 2, and 3. (Magna, Edwards Lifesciences, Irvine, CA; Trifecta and Epic, St. Jude, St. Paul, MN; Mosaic and Hancock II, Medtronic, Minneapolis, MN.) The Annals of Thoracic Surgery 2017 103, 1866-1876DOI: (10.1016/j.athoracsur.2016.10.019) Copyright © 2017 Terms and Conditions

Fig 3 Effect of increasing valve-annular mismatch on tested the tested geometric orifice area (GOA) of the bioprosthetic valves: (A) 21-mm valves; (B) 23-mm valves; and (C) 25-mm valves. The p valves of all comparisons are provided in Supplemental Tables 4, 5, and 6. (Magna, Edwards Lifesciences, Irvine, CA; Trifecta and Epic, St. Jude, St. Paul, MN; Mosaic and Hancock II, Medtronic, Minneapolis, MN.) The Annals of Thoracic Surgery 2017 103, 1866-1876DOI: (10.1016/j.athoracsur.2016.10.019) Copyright © 2017 Terms and Conditions

Fig 4 Representative high-speed photographs at maximal valvular opening for all 21-mm valves tested. The geometric orifice area (GOA) was assessed through an internally developed computer program to measure area encompassed by leaflet edges. (Magna, Edwards Lifesciences, Irvine, CA; Trifecta and Epic, St. Jude, St. Paul, MN; Mosaic and Hancock II, Medtronic, Minneapolis, MN.) The Annals of Thoracic Surgery 2017 103, 1866-1876DOI: (10.1016/j.athoracsur.2016.10.019) Copyright © 2017 Terms and Conditions

Fig 5 Representative high-speed photographs at maximal valvular opening for all 23-mm valves tested. The geometric orifice area (GOA) was assessed through an internally developed computer program to measure area encompassed by leaflet edges. (Magna, Edwards Lifesciences, Irvine, CA; Trifecta and Epic, St. Jude, St. Paul, MN; Mosaic and Hancock II, Medtronic, Minneapolis, MN.) The Annals of Thoracic Surgery 2017 103, 1866-1876DOI: (10.1016/j.athoracsur.2016.10.019) Copyright © 2017 Terms and Conditions

Fig 6 Representative high-speed photographs at maximal valvular opening for all 25-mm valves tested. The geometric orifice area (GOA) was assessed through an internally developed computer program to measure area encompassed by leaflet edges. (Magna, Edwards Lifesciences, Irvine, CA; Trifecta and Epic, St. Jude, St. Paul, MN; Mosaic and Hancock II, Medtronic, Minneapolis, MN.) The Annals of Thoracic Surgery 2017 103, 1866-1876DOI: (10.1016/j.athoracsur.2016.10.019) Copyright © 2017 Terms and Conditions

Fig 7 Effect of increasing valve-annular mismatch on measured pressure gradients across all tested bioprosthetic valves: (A) 21-mm valves; (B) 23-mm valves; and (C) 25-mm valves. The p valves of all comparisons are provided in Supplemental Tables 7, 8, and 9. (Magna, Edwards Lifesciences, Irvine, CA; Trifecta and Epic, St. Jude, St. Paul, MN; Mosaic and Hancock II, Medtronic, Minneapolis, MN.) The Annals of Thoracic Surgery 2017 103, 1866-1876DOI: (10.1016/j.athoracsur.2016.10.019) Copyright © 2017 Terms and Conditions

Fig 8 Effect on effective orifice area (EOA) by increasing valve–annular mismatch at four given flow rates (167, 250, 333, and 417 mL/s) used during experimentation. (A) Magna (Edwards Lifesciences, Irvine, CA); (B) Hancock II (Medtronic, Minneapolis, MN); (C) Mosaic (Medtronic); (D) Trifecta (St. Jude, St. Paul, MN), (E) Epic (St. Jude). The p valves of all comparisons are provided in Supplemental Tables 10 to 14. The Annals of Thoracic Surgery 2017 103, 1866-1876DOI: (10.1016/j.athoracsur.2016.10.019) Copyright © 2017 Terms and Conditions

Fig 9 Schematic drawing represents supraannular prosthetic valve placement with (a) proper sizing vs (b) oversizing. In the oversized setting, the valve leaflet hinge point shifts inward. The Annals of Thoracic Surgery 2017 103, 1866-1876DOI: (10.1016/j.athoracsur.2016.10.019) Copyright © 2017 Terms and Conditions