Does the type of suture technique affect the fluid-dynamic performance of bioprostheses implanted in small aortic roots? Results from an in vitro study

Abstract

Our data show that the type of suture technique can influence bioprosthesis performance and that it is reasonable to assume that this is especially true in small annuli (≤ 21 mm). Thus, to optimize prosthesis performance and reduce the incidence of patient-prosthesis mismatch, the role of the suture technique should not be disregarded.

Hemodynamic Comparison Between Trifecta and Freestyle Aortic Valve During Exercise in Patients with Small Aortic Root

“…This feature, along with an effective sizing strategy, increases the chance of implanting a valve size that meets the hemodynamic requirements of the patient, thereby determining a very low gradient at rest. We implanted the Trifecta by means of a simple interrupted suture, which might have favorably influenced the results …”

A novel passive left heart platform for device testing and research

“…saline, did not mimic the blood rheology. Indeed, despite the use of saline is widely reported in the literature [28,38,39] it potentially introduces a bias in our findings. Anyway, the mock loop is capable of working with any fluid, including blood.…”

“…However, beating heart models are significantly more complex and expensive than classical in vitro platforms, thus often representing an effective but inefficient solution either for the evaluation of devices during their early development phase, or for training/educational purposes. With regard to the in vitro approach involving passive biological samples, the integration of excised structures into mock circulatory loops is currently evolving from the sole use of excised valves, either aortic [18,[26][27][28] or mitral [19,29], toward the design of platforms able to house entire passive hearts [20][21][22]. Indeed, the use of entire heart samples ensures a good preservation of the whole cardiac anatomy and allows the testing and analysis of a wider spectrum of devices.…”

Pledget-Armed Sutures Affect the Haemodynamic Performance of Biologic Aortic Valve Substitutes: A Preliminary Experimental and Computational Study

“…It is well known that the fluid-dynamic performance of a bioprosthesis depends on frame design, type and position of the leaflets. 7 , 17 , 30 However, the recent introduction of rapid-deployment valves has highlighted the potential hemodynamic improvements related to the absence of sutures. Clinical studies comparing rapid-deployment and conventional sewed-in aortic heart valves reported differences regarding MPG and EOA, seemingly confirming this positive tendency.…”

“… 1 A recently published in vitro study supports this hypothesis. 30 However, in current clinical studies, the influence of the suture technique is still under debate. 29 , 33 …”