Complete supraannular placement of the bovine Magna prosthesis resulted in lower mean pressure gradients (11.82 vs 16.04 mm Hg) compared to the Mosaic prosthesis in small annuli at 6 months.
Observational (n=336)
Does the choice of bioprosthesis affect hemodynamics and patient-prosthesis mismatch in patients undergoing complete supraannular aortic valve replacement?
Complete supraannular placement of aortic bioprostheses does not entirely prevent high pressure gradients or patient-prosthesis mismatch, but bovine prostheses like the Magna may offer superior hemodynamic performance.
BACKGROUND: Complete supraannular placement of an aortic bioprosthesis is one approach to optimize the hemodynamic result of an aortic valve replacement. It is achieved with the combination of a special valve design and the supraannular sewing technique with noneverted mattress sutures. We evaluated 5 bioprostheses designed for complete supraannular placement to assess potential hemodynamic differences caused by factors (eg, valve material) other than implantation position. METHODS AND RESULTS: In 336 patients (mean age, 72.0+/-7.1 years; 143 women), hemodynamics including mean pressure gradients, effective orifice areas, and indices and incidence of patient-prosthesis mismatch were evaluated 6 months after surgery. Annulus diameter was measured during surgery. Patients received the Carpentier Edwards Perimount Magna (Magna, n=169), the Medtronic Mosaic (Mosaic, n=46), the Mosaic Ultra (Ultra, n=17), the SJM Epic Supra (Epic, n=46), and the Sorin Soprano (Soprano, n=58). For small annulus sizes (24 mm) annulus sizes, the mean pressure gradients of the Magna were lower than the Epic (10.0+/-3.5 mm Hg versus 14.9+/-6.4 mm Hg; 9.9+/-4.0 mm Hg versus 18.6+/-12.7 mm Hg). Furthermore, in patients with large annulus size, the mean pressure gradients of the Soprano (11.4+/-3.8 mm Hg) were lower compared with the Epic (18.5+/-12.7 mm Hg). Severe patient-prosthesis mismatch was observed more frequently in patients with the Mosaic (12/46; 26.1%) and the Ultra (3/17; 17.6%) prostheses. CONCLUSIONS: Complete supraannular placement cannot prevent high pressure gradients or patient-prosthesis mismatch thoroughly, but the choice of a bovine prosthesis can optimize hemodynamic performance.
Ruzicka et al. (Mon,) conducted a observational in Aortic valve replacement (n=336). Supraannular bioprostheses (Magna, Mosaic, Ultra, Epic, Soprano) vs. Compared against each other was evaluated on Hemodynamics including mean pressure gradients, effective orifice areas, and incidence of patient-prosthesis mismatch. Complete supraannular placement of the bovine Magna prosthesis resulted in lower mean pressure gradients (11.82 vs 16.04 mm Hg) compared to the Mosaic prosthesis in small annuli at 6 months.
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