Key result
In vivo effective orifice areas of aortic bioprostheses were smaller than manufacturer in vitro values, with Edwards, SJM, and Sorin Soprano models demonstrating better hemodynamic profiles.
Why the study?
Does the type of aortic bioprosthesis affect postoperative hemodynamic parameters in patients undergoing aortic valve replacement?
Observational (n=277)
No
Does the type of aortic bioprosthesis affect postoperative hemodynamic parameters in patients undergoing aortic valve replacement?
In vivo hemodynamic performance of aortic bioprostheses varies by manufacturer, with Edwards, SJM Epic, and Sorin Soprano demonstrating superior effective orifice areas and lower gradients compared to others.
In vivo EOA data may inform aortic bioprosthesis selection over manufacturer values; this Level 3 cohort analysis leaves open randomized outcome trials.
Ăvod:Jednou z nejÄastÄji operovanĂ˝ch chlopennĂch vad v dospÄlĂŠ kardiochirurgii je degenerativnĂ aortĂĄlnĂ stenĂłza. ĂÄelem naĹĄĂ studie bylo srovnĂĄnĂ hemodynamickĂ˝ch parametrĹŻ rĹŻznĂ˝ch typĹŻ aortĂĄlnĂch bioprotĂŠz. Soubor a metodika:Od bĹezna 2002 do zĂĄĹĂ 2006 jsme implantovali celkem 277 bioprotĂŠz (70 % z celkovĂŠho poÄtu aortĂĄlnĂch protĂŠz). PouĹžili jsme bioprotĂŠzy vĂ˝robcĹŻ Edwards Lifesciences (typ 2650, 2900, 3000), Medtronic-Hall (Mosaic), SJM (Epic, Epic Supra), Sorin (More, Soprano). Do souboru bylo zaĹazeno 154 muŞů a 123 Ĺžen, prĹŻmÄrnĂ˝ vÄk byl 74 ± 6 let. PeroperaÄnÄ jsme posuvnĂ˝m mÄĹĂtkem mÄĹili zevnĂ a vnitĹnĂ prĹŻmÄr prstence implantovanĂ˝ch chlopnĂ. V pooperaÄnĂm obdobĂ bylo provedeno echokardiografickĂŠ vyĹĄetĹenĂ, v rĂĄmci kterĂŠho byly mÄĹeny gradienty a efektivnĂ plocha ĂşstĂ implantovanĂŠ chlopnÄ. VĂ˝sledky:VĂ˝robcem udĂĄvanĂ˝ rozmÄr bioprotĂŠzy neodpovĂdĂĄ nĂĄmi namÄĹenĂŠmu vnÄjĹĄĂmu ani vnitĹnĂmu prĹŻmÄru implantaÄnĂho prstence. NejvĂce se vĂ˝robnĂ velikosti chlopnÄ pĹibliĹžuje vnitĹnĂ prĹŻmÄr bioprotĂŠzy Sorin Soprano. EfektivnĂ plochy ĂşstĂ bioprotĂŠz mÄĹenĂŠ pomocĂ dopplerometrie jsou vĂ˝raznÄ menĹĄĂ neĹž hodnoty udĂĄvanĂŠ vĂ˝robcem, kterĂŠ jsou zĂskanĂŠ z mÄĹenĂ in vitro. V rĂĄmci celkovĂŠho srovnĂĄnĂ gradientĹŻ a efektivnĂch ploch ĂşstĂ vychĂĄzĂ z naĹĄeho sledovĂĄnĂ nejlĂŠpe bioprotĂŠzy Edwards, Sorin (Soprano) a SJM (Epic). BioprotĂŠzy Medtronic-Hall Mosaic) a Sorin (More) majĂ gradienty vyĹĄĹĄĂ a i efektivnĂ plochu ĂşstĂ jsme namÄĹili menĹĄĂ. OptimĂĄlnĂ plochu aktivnĂho ĂşstĂ bioprotĂŠzy, indexovanou na tÄlesnĂ˝ povrch pacienta, kterĂĄ by byla vÄtĹĄĂ neĹž 0,85 cm2/m2, je obtĂĹžnĂŠ dosĂĄhnout. ZĂĄvÄr:PĹi implantaci aortĂĄlnĂ bioprotĂŠzy je dĹŻleĹžitĂŠ znĂĄt jejĂ pooperaÄnĂ hemodynamickĂŠ parametry. Spektrum chlopnĂ, implantovanĂ˝ch na naĹĄĂ klinice se dĂky rozdĂlĹŻm namÄĹenĂ˝m v tĂŠto studii ÄĂĄsteÄnÄ zmÄnilo.
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Šantavý et al. (2007) conducted an observational in Aortic stenosis requiring valve replacement (n=277). Aortic bioprostheses vs. Different bioprosthesis models (Edwards, Medtronic, SJM, Sorin) was evaluated on Postoperative hemodynamic parameters (effective orifice area and gradients). In vivo effective orifice areas of aortic bioprostheses were smaller than manufacturer in vitro values, with Edwards, SJM, and Sorin Soprano models demonstrating better hemodynamic profiles.
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