Key result
On-X aortic valved conduit linked to ~44% lower viscous energy loss density vs alternative conduits.
Why the study?
It was unknown whether the On-X aortic valved conduit better restores normal valvular and ascending aortic hemodynamics compared to other commonly used bileaflet mechanical valved conduit prostheses.
Does the On-X aortic valved conduit better restore normal valvular and ascending aortic hemodynamics compared to St. Jude Medical and Carbomedics prostheses in patients undergoing the Bentall procedure?
Observational (n=52)
No
Does the On-X aortic valved conduit better restore normal valvular and ascending aortic hemodynamics compared to St. Jude Medical and Carbomedics prostheses in patients undergoing the Bentall procedure?
Absolute Event Rate: 50.6% vs 89.8%
p-value: p=<0.001
The On-X aortic valved conduit produces less aberrant ascending aortic hemodynamics compared to St. Jude Medical and Carbomedics alternatives, though it does not completely restore normal flow patterns.
Should not yet alter prosthesis selection in Bentall procedures; leaves open clinical relevance of hemodynamic differences.
This study aims to assess whether the On-X aortic valved conduit better restores normal valvular and ascending aortic hemodynamics than other commonly used bileaflet mechanical valved conduit prostheses from St. Jude Medical and Carbomedics by using same-day transthoracic echocardiography (TTE) and 4D flow magnetic resonance imaging (MRI) examinations. TTE and 4D flow MRI were performed back-to-back in 10 patients with On-X, six patients with St. Jude (two) and Carbomedics (four) prostheses, and 36 healthy volunteers. TTE evaluated valvular hemodynamic parameters: transvalvular peak velocity (TPV), mean and peak transvalvular pressure gradient (TPG), and effective orifice area (EOA). 4D flow MRI evaluated the peak systolic 3D viscous energy loss rate (VELR) density and mean vorticity magnitude in the ascending aorta (AAo). While higher TPV and mean and peak TPG were recorded in all patients compared to healthy subjects, the values in On-X patients were closer to those in healthy subjects (TPV 1.9 ± 0.3 vs. 2.2 ± 0.3 vs. 1.2 ± 0.2 m/s, mean TPG 7.4 ± 1.9 vs. 9.2 ± 2.3 vs. 3.1 ± 0.9 mmHg, peak TPG 15.3 ± 5.2 vs. 18.9 ± 5.2 vs. 6.1 ± 1.8 mmHg, p < 0.001). Likewise, while higher VELR density and mean vorticity magnitude were recorded in all patients than in healthy subjects, the values in On-X patients were closer to those in healthy subjects (VELR: 50.6 ± 20.1 vs. 89.8 ± 35.2 vs. 21.4 ± 9.2 W/m 3 , p < 0.001) and vorticity (147.6 ± 30.0 vs. 191.2 ± 26.0 vs. 84.6 ± 20.5 s-1, p < 0.001). This study demonstrates that the On-X aortic valved conduit may produce less aberrant hemodynamics in the AAo while maintaining similar valvular hemodynamics to St. Jude Medical and Carbomedics alternatives.
No takes yet. Share an insight, caveat, or question.
Lee et al. (2023) conducted an observational in Aortic valve replacement (Bentall procedure) (n=52). On-X aortic valved conduit vs. St. Jude Medical and Carbomedics prostheses was evaluated on Viscous energy loss rate (VELR) density in the ascending aorta (p=<0.001). The On-X aortic valved conduit produced less aberrant hemodynamics in the ascending aorta, with lower viscous energy loss rate density (50.6 vs. 89.8 W/m3) compared to St. Jude Medical and Carbomedics alternatives.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: