Key result
In an in vitro simulator, valve-in-valve implantation of a Sapien XT valve into bioprostheses with small inner diameters increased mean pressure gradients and decreased effective orifice areas.
Why the study?
Does the design of a pre-existing surgical bioprosthesis affect the hydrodynamic performance of a valve-in-valve implanted Sapien XT valve in an in vitro model?
Does the design of a pre-existing surgical bioprosthesis affect the hydrodynamic performance of a valve-in-valve implanted Sapien XT valve in an in vitro model?
In vitro testing suggests that surgical bioprostheses with larger inner diameters and internally mounted leaflets improve the hemodynamics of subsequent valve-in-valve TAVR procedures.
May warrant caution in valve-in-valve for small bioprostheses; leaves open clinical validation in prospective studies.
Objectives: Bioprosthetic aortic heart valves are increasingly implanted in younger patients. Therefore, a strategy for potential valve failure should be developed before implanting the 'first valve'. The goal of this in vitro study was to provide insight into the effects of the design of a bioprosthesis on a valve-in-valve implanted Sapien XT valve. Methods: The hydrodynamic performance of a 23-mm Sapien XT valve implanted in Vascutek Aspire, Edwards Perimount, Medtronic Mosaic and St. Jude Medical Trifecta heart valves was investigated in a left heart simulator. In addition to the hydrodynamic results, the leaflet dynamics were analysed in high-speed video recordings of the tests. Results: All valve-in-valve combinations in this study fulfilled the minimum acceptance criteria defined by relevant approval standards (e.g. ISO 5840) but displayed significant differences in their performances. Small inner diameters of the bioprostheses were associated with increased mean pressure gradients, decreased effective orifice areas and geometric opening areas as well as with pin-wheeling and uneven leaflet motion. In addition, implantation in bioprostheses with internally mounted leaflets was associated with lower paravalvular leakage. Conclusions: The results of this study suggest that a surgical bioprosthesis with a large inner diameter and internally mounted leaflets improves the heamodynamics and potentially the durability of a valve-in-valve combination. These results should give the attending physicians critical information to consider when deciding on a bioprosthesis for younger patients.
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Doose et al. (2016) studied Bioprosthetic aortic heart valve failure (valve-in-valve). 23-mm Sapien XT valve implanted in various bioprostheses vs. Different bioprosthesis designs was evaluated on Hydrodynamic performance (mean pressure gradients, effective orifice areas, geometric opening areas, leaflet dynamics). In an in vitro simulator, valve-in-valve implantation of a Sapien XT valve into bioprostheses with small inner diameters increased mean pressure gradients and decreased effective orifice areas.
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