Haemodynamic Performance of Transcatheter Heart Valve in Bileaflet Mechanical Valve: An In-vitro Study

Q: What is the clinical evidence from this study?

Population: Mechanical heart valve failure. Intervention: Valve-in-MHV configuration (CoreValve THV within SJM mechanical heart valve annulus) vs. Standalone mechanical heart valve (MHV) and CoreValve THV. Primary outcome: Mean transvalvular pressure gradient (PG) at cardiac output of 5 L/min (p=<0.001).

Q: What does this research mean for the field?

Implanting a transcatheter heart valve within a mechanical heart valve (Valve-in-MHV) generates a more physiological central jet but results in higher pressure gradients, increased turbulence, and a smaller effective orifice area compared to standalone transcatheter or mechanical valves. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Chiara Catalano; Salvatore Pasta; Paul Potratz; Eric Buffle; Matthias Siepe; Dominik Obrist

doi:10.1093/icvts/ivaf265

November 1, 2025Interdisciplinary CardioVascular and Thoracic SurgeryOpen Access

Haemodynamic Performance of Transcatheter Heart Valve in Bileaflet Mechanical Valve: An In-vitro Study

View Full Paper

Ask AI

Bookmark

Share

Key result

Valve-in-MHV increases mean pressure gradient by ~4 mmHg compared to standalone mechanical valves.

P<0.001

Figures

Graphical abstract published by Interdisciplinary CardioVascular and Thoracic Surgery — Graphical abstract · Published by Interdisciplinary CardioVascular and Thoracic Surgery · CC BY-NC

Why the study?

To evaluate the haemodynamic performance of a novel hybrid Valve-in-MHV configuration with a CoreValve transcatheter heart valve implanted within a composite valved graft annulus after leaflet removal.

Does a Valve-in-MHV configuration provide comparable haemodynamic performance to standalone THV or MHV in an in vitro model?

Structured PICO

Does a Valve-in-MHV configuration provide comparable haemodynamic performance to standalone THV or MHV in an in vitro model?

P

Population

In vitro left heart mock circulatory loop modeling systemic resistance, assessing 3 aortic valve configurations.

I

Intervention

Hybrid Valve-in-MHV configuration (26-mm Medtronic CoreValve transcatheter heart valve implanted within a 3D-printed 21-mm St Jude Medical mechanical heart valve ring after leaflet removal)

C

Comparator

Standalone 21-mm St Jude Medical bi-leaflet mechanical heart valve (MHV) and standalone 26-mm Medtronic CoreValve THV

O

Outcome

Haemodynamic performance including mean transvalvular pressure gradient (PG), effective orifice area (EOA), turbulent kinetic energy (TKE), and Reynolds shear stress (RSS) at cardiac outputs of 3 and 5 L/minsurrogate

Main Result

Absolute Event Rate: 15.53% vs 11.5%

p-value: p=<0.001

Limitations

Use of a 3D-printed annulus ring instead of a full mechanical Bentall graft
Backlight PIV setup restricts measurements to a 2D plane
Coronary flow assessment was not included
Did not investigate varying implantation depths, device sizes, or device typologies
No adjustment for multiple testing
Used a 3D-printed annulus ring instead of a full mechanical Bentall graft
No prespecified primary end-point and no adjustment for multiple testing
Did not investigate factors such as implantation depth, device size, and typology
Backlight PIV setup restricts measurement to a 2-dimensional plane

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

An in vitro model of Valve-in-MHV demonstrated elevated transvalvular pressure gradients and increased turbulence compared to standalone valves, suggesting a potential for higher thrombogenicity that necessitates careful patient selection and device sizing.

Abstract

OBJECTIVES: This study evaluates the haemodynamic performance of a novel hybrid configuration-Valve-in-MHV-where a CoreValve transcatheter heart valve is implanted within the annulus of a composite valved graft after leaflet removal. METHODS: In vitro testing was performed using left heart mock loop combined with backlight particle image velocimetry. Three configurations were assessed: (i) mechanical heart valve (MHV), (ii) CoreValve THV, and (iii) Valve-in-MHV. Flow parameters were measured at cardiac outputs of 3 and 5 L/min. RESULTS: At 5 L/min, the Valve-in-MHV showed the highest PG (15.5 mmHg) and TKE (0.53 m2/s2), compared to the THV (10.9 mmHg, 0.31 m2/s2) and MHV (11.5 mmHg, 0.26 m2/s2). Effective orifice area was smallest for the Valve-in-MHV (1.44 cm2). The Valve-in-MHV generated a more physiological central jet than the MHV, but with increased turbulence and higher peak velocities (up to 2.66 m/s). CONCLUSIONS: Examining the mechanistic implications of Valve-in-MHV may offer valuable insights into the likelihood of adverse effects such as leaflet thrombosis and the development of pronounced pressure gradients in patients who are candidates for Valve-in-MHV.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Catalano et al. (2025) studied Mechanical heart valve failure. Valve-in-MHV configuration (CoreValve THV within SJM mechanical heart valve annulus) vs. Standalone mechanical heart valve (MHV) and CoreValve THV was evaluated on Mean transvalvular pressure gradient (PG) at cardiac output of 5 L/min (p=<0.001).

synapsesocial.com/papers/6a387b8741436a8b20ce6e89 https://doi.org/10.1093/icvts/ivaf265

View Full Paper

Ask AI

Bookmark

Share

Haemodynamic Performance of Transcatheter Heart Valve in Bileaflet Mechanical Valve: An In-vitro Study

Figures

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Haemodynamic Performance of Transcatheter Heart Valve in Bileaflet Mechanical Valve: An In-vitro Study

Figures

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading