Document Detail

Valve-in-Valve Hemodynamics of 20-mm Transcatheter Aortic Valves in Small Bioprostheses.
MedLine Citation:
PMID:  21704287     Owner:  NLM     Status:  Publisher    
BACKGROUND: Transcatheter aortic valve (TAV) implantation is a treatment for selected patients with failing bioprostheses. We previously showed that currently available SAPIEN (Edwards Lifesciences, Irvine, CA) TAV sizes did not yield acceptable valve-in-valve (VIV) hemodynamics in small degenerated bioprostheses because optimal TAV function requires full stent expansion to its nominal size. The study objective was to determine (1) if 20-mm TAVs provide acceptable hemodynamics in small degenerated bioprostheses and (2) the effect of TAV spatial orientation on valvular hemodynamics and coronary flows. METHODS: Twelve 20-mm TAVs were created for implantation within 19-mm and 21-mm degenerated Carpentier-Edwards Perimount (Edwards Lifesciences) and porcine bioprostheses. Degenerated valves were sutured into human homograft roots and mounted in a pulse duplicator. TAVs were implanted within bioprostheses as VIV in standard orientation, in which TAV and bioprosthetic commissures were aligned, and later with 60-degree rotation. RESULTS: The 20-mm TAVs migrated retrograde into the left ventricle after VIV in the 21-mm Perimount bioprostheses. However, 20-mm TAVs in 19-mm Perimount (54.9 ± 5.4 to 23.5 ± 3.9 mm Hg, p = 0.006) and 21-mm porcine bioprostheses (35.2 ± 8.9 to 16.8 ± 4.1 mm Hg, p = 0.03) significantly reduced mean gradients. No significant reduction in pressure gradient occurred after VIV in 19-mm degenerated porcine bioprostheses. Mild regurgitation was observed after VIV. VIV with standard and 60-degree TAV orientation did not significantly alter hemodynamics or coronary flows. CONCLUSIONS: Valve-in-valve hemodynamics with 20-mm TAV improved for 19-mm Perimount and 21-mm porcine but not 19-mm porcine bioprostheses. No significant differences in hemodynamics were noted by orientation with TAV and bioprosthesis commissural alignment or 60-degree rotation.
Ali N Azadani; Nicolas Jaussaud; Liang Ge; Sam Chitsaz; Timothy A M Chuter; Elaine E Tseng
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-6-23
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  -     ISSN:  1552-6259     ISO Abbreviation:  -     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-6-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Department of Surgery, University of California at San Francisco Medical Center (UCSF) and San Francisco Veterans Affairs Medical Center (SFVAMC), San Francisco, California.
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