Influence of completely supra-annular placement of bioprostheses on exercise hemodynamics in patients with a small aortic annulus Ina M. Wagner, MD,

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Presentation transcript:

Influence of completely supra-annular placement of bioprostheses on exercise hemodynamics in patients with a small aortic annulus Ina M. Wagner, MD, Walter B. Eichinger, MD, Sabine Bleiziffer, MD, Florian Botzenhardt, MD, Isabel Gebauer, MD, Ralf Guenzinger, MD, Robert Bauernschmitt, MD, Ruediger Lange, MD The Journal of Thoracic and Cardiovascular Surgery Volume 133, Issue 5, Pages 1234-1241 (May 2007) DOI: 10.1016/j.jtcvs.2006.10.074 Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Mean systolic pressure gradients and stroke volumes at rest and during exercise. The Journal of Thoracic and Cardiovascular Surgery 2007 133, 1234-1241DOI: (10.1016/j.jtcvs.2006.10.074) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 EOF, the independent index for valve performance, of the stented bioprostheses as percentages in the diagram. The mean EOAs (inner black circle) in relation to the annulus areas (outer white circle). EOA, effective orifice area. The Journal of Thoracic and Cardiovascular Surgery 2007 133, 1234-1241DOI: (10.1016/j.jtcvs.2006.10.074) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Incidence of PPM calculated with the Doppler-derived EOA 6 months postoperatively. ■ severe PPM moderate PPM □ no PPM. PPM, Patient–prosthesis mismatch; EOA, effective orifice area. The Journal of Thoracic and Cardiovascular Surgery 2007 133, 1234-1241DOI: (10.1016/j.jtcvs.2006.10.074) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Two aortic root anatomies with an identical TAD. A more bulbar-shaped root (right). This is the ideal situation for completely supra-annular placement in which the tissue annulus diameter corresponds to the internal orifice diameter of the prosthesis (TAD = IOD). Small aortic root (left). Despite the same tissue annular diameter, the valve of the same size (black) does not fit. Thus, the surgeon has to choose a smaller valve (white), with the consequence that despite implantation of a completely supra-annular prosthesis, the stent and sewing ring material impair the bloodstream because the shape of the aortic root does not allow the implantation of a valve large enough to ensure that the IOD corresponds to the TAD. This illustrates the hypothesis that a completely supra-annular prosthesis placement does not ensure a hemodynamic benefit in every aortic root. Even after implantation of a completely supra-annular prosthesis, flow obstruction caused by the stent and sewing ring material may occur if there is a narrow aortic root. TAD, Tissue annulus diameter; IOD, internal orifice diameter; ESRD, external sewing ring diameter. The Journal of Thoracic and Cardiovascular Surgery 2007 133, 1234-1241DOI: (10.1016/j.jtcvs.2006.10.074) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions