Influence of completely supra-annular placement of bioprostheses on exercise hemodynamics in patients with a small aortic annulus

Wagner, Ina; Eichinger, Walter; Bleiziffer, Sabine; Botzenhardt, Florian; Gebauer, I; Guenzinger, Ralf; Bauernschmitt, Robert; Lange, Rüediger

doi:10.1016/j.jtcvs.2006.10.074

Cited by 41 publications

(36 citation statements)

References 20 publications

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“…Amino-oleic acid was applied as an anticalcification treatment. 1,4,5,15 It has been in clinical use in Europe since 1994 ( Figure 1B).…”

Section: Bioprosthesesmentioning

confidence: 99%

“…1,8,14,18,19 In the present study, we focus on aortic bioprostheses designed for and implanted in a complete supraannular position. The design of a complete supraannular heart valve prosthesis aims to optimize the area available for the bloodstream through the aortic root orifice.…”

Section: S142 Circulation September 15 2009mentioning

confidence: 99%

“…With this concept, the internal valve diameter should theoretically be equal to the tissue annulus diameter and thus achieve an optimal hemodynamic performance with no obstruction of the blood flow. 1 In fact, the effective orifice area of a valve prosthesis is in the order of 35% to 48% of the geometric annulus area that is theoretically available 2 ; thus, the aim of the supraannular concept can only be to gain as much effective orifice area as possible in relation to the patient's annulus size.…”

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confidence: 99%

“…To evaluate factors other than prosthesis position, which might influence the hemodynamic performance (eg, valve material), we evaluated 5 commercially available bioprostheses for complete supraannular placement (Carpentier Edwards Perimount Magna, 1,3 Medtronic Mosaic, 1,4 -9 Medtronic Mosaic Ultra, 10,11 St Jude Medical Epic Supra, 4,7,12 and Sorin Soprano 1,7,8,13 ).…”

mentioning

confidence: 99%

“…Therefore, we use as a basis for comparisons-as in previous studies-the patient's aortic annulus, which is measured with a standardized sizer during surgery. 1,4,8,13,14 …”

mentioning

confidence: 99%

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The Complete Supraannular Concept

et al. 2009

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Background— Complete supraannular placement of an aortic bioprosthesis is one approach to optimize the hemodynamic result of an aortic valve replacement. It is achieved with the combination of a special valve design and the supraannular sewing technique with noneverted mattress sutures. We evaluated 5 bioprostheses designed for complete supraannular placement to assess potential hemodynamic differences caused by factors (eg, valve material) other than implantation position. Methods and Results— In 336 patients (mean age, 72.0±7.1 years; 143 women), hemodynamics including mean pressure gradients, effective orifice areas, and indices and incidence of patient-prosthesis mismatch were evaluated 6 months after surgery. Annulus diameter was measured during surgery. Patients received the Carpentier Edwards Perimount Magna (Magna, n=169), the Medtronic Mosaic (Mosaic, n=46), the Mosaic Ultra (Ultra, n=17), the SJM Epic Supra (Epic, n=46), and the Sorin Soprano (Soprano, n=58). For small annulus sizes (<23 mm), the mean pressure gradients of the Magna (11.82±4.8 mm Hg) were significantly lower than the Mosaic (16.04±6.1 mm Hg) and the Ultra (22.0±4.1 mm Hg), and the Soprano (13.3±5.2 mm Hg) was hemodynamically superior to the Ultra. For medium (23 to 24 mm) and large (>24 mm) annulus sizes, the mean pressure gradients of the Magna were lower than the Epic (10.0±3.5 mm Hg versus 14.9±6.4 mm Hg; 9.9±4.0 mm Hg versus 18.6±12.7 mm Hg). Furthermore, in patients with large annulus size, the mean pressure gradients of the Soprano (11.4±3.8 mm Hg) were lower compared with the Epic (18.5±12.7 mm Hg). Severe patient-prosthesis mismatch was observed more frequently in patients with the Mosaic (12/46; 26.1%) and the Ultra (3/17; 17.6%) prostheses. Conclusions— Complete supraannular placement cannot prevent high pressure gradients or patient-prosthesis mismatch thoroughly, but the choice of a bovine prosthesis can optimize hemodynamic performance.

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“…Amino-oleic acid was applied as an anticalcification treatment. 1,4,5,15 It has been in clinical use in Europe since 1994 ( Figure 1B).…”

Section: Bioprosthesesmentioning

confidence: 99%

Section: S142 Circulation September 15 2009mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

“…Therefore, we use as a basis for comparisons-as in previous studies-the patient's aortic annulus, which is measured with a standardized sizer during surgery. 1,4,8,13,14 …”

mentioning

confidence: 99%

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