Document Detail


Valve-in-Valve Hemodynamics of 20-mm Transcatheter Aortic Valves in Small Bioprostheses.
MedLine Citation:
PMID:  21704287     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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.
Authors:
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.
Affiliation:
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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