Pulmonary versus aortic pressure behavior of a bovine pericardial valve

Pragt, Hanna; Melle, Joost P. van; Verkerke, Gijsbertus Jacob; Mariani, Massimo A.; Ebels, Tjark

doi:10.1016/j.jtcvs.2019.05.084

Cited by 9 publications

(7 citation statements)

References 22 publications

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“…Though the direct quantitative comparison of the above hemodynamic parameters with those from other in vitro studies is limited by the lack of data acquired at corresponding conditions, the quantities of each parameter are still in line with their results (Nagy et al, 2000;Dur et al, 2010;Claiborne et al, 2013;Yamamoto et al, 2018;Pragt et al, 2019). Additionally, the superior performance of the same bileaflet valve design in terms of RF, EOA, pressure gradient, and E L was also found under the aortic flow conditions (Zhu et al, 2019).…”

Section: Impacts Of Prosthetic Valve Design On Hemodynamic Performancementioning

confidence: 55%

In vitro Assessment of the Impacts of Leaflet Design on the Hemodynamic Characteristics of ePTFE Pulmonary Prosthetic Valves

Zhu

Wei

Yuan

et al. 2020

Front. Bioeng. Biotechnol.

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Prosthetic pulmonary valves are widely used in the management procedures of various congenital heart diseases, including the surgical pulmonary valve replacement (PVR) and right ventricular outflow tract reconstruction (RVOT). The discouraging long-term outcomes of standard prostheses, including homografts and bioprosthetic, constrained their indications. Recent developments in the expanded-polytetrafluoroethylene (ePTFE) pulmonary prosthetic valves provide promising alternatives. In this study, the hemodynamic characteristics of bileaflet and trileaflet ePTFE valve designs were experimentally evaluated. The in vitro tests were performed under the right ventricle (RV) flow conditions by using an in vitro RV circulatory system and particle image velocimetry (PIV). The leaflet kinetics, trans-valvular pressure gradients, effective orifice areas, regurgitant fractions, energy losses, velocity fields, and Reynolds shear stress (RSS) in both prostheses were evaluated. The opening of the bileaflet and trileaflet valve takes 0.060 and 0.088 s, respectively. The closing of the former takes 0.140 s, in contrast to 0.176 s of the latter. The trans-valvular pressure is 6.8 mmHg in the bileaflet valve vs. 7.9 mmHg in the trileaflet valve. The effective orifice area is 1.83 cm 2 in the bileaflet valve and 1.72 cm 2 in the trileaflet valve. The regurgitant fraction and energy loss of bileaflet are 7.13% and 82 mJ, which are 7.84% and 101.64 mJ in its bileaflet counterpart. The maximum RSS of 48.0 and 49.2 Pa occur at the systole peak in the bileaflet and trileaflet valve, respectively. A higher average RSS level is found in the bileaflet valve. The results from this preliminary study indicate that the current bileaflet prosthetic valve design is capable of providing a better overall hemodynamic performance than the trileaflet design.

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Section: Impacts Of Prosthetic Valve Design On Hemodynamic Performancementioning

confidence: 55%

In vitro Assessment of the Impacts of Leaflet Design on the Hemodynamic Characteristics of ePTFE Pulmonary Prosthetic Valves

Zhu

Wei

Yuan

et al. 2020

Front. Bioeng. Biotechnol.

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“…The differential effects of prosthetic valve function in the pulmonic position as compared to the aortic position also remain incompletely characterized. 14 28 The majority of these patients (∼80%) underwent PVR using techniques similar to that described in the present study (ie, the standard implant group); the remainder had the prosthesis implanted in a conduit. In contrast to our findings, the study authors noted several early concerns.…”

Section: Commentmentioning

confidence: 79%

“…Given the relatively lower pressures of the right heart, earlier prosthetic valve dysfunction is not uncommon with the off-label use of aortic bioprostheses. 14 In this observational report, we reviewed our institutional experience with PVR using the Inspiris Resilia pericardial aortic bioprosthesis and demonstrated excellent safety and valve hemodynamics at short-term follow-up. Specifically, there were no mortalities or valve-related reinterventions or complications at a post-discharge follow-up of up to three years.…”

Section: Commentmentioning

confidence: 99%

Early Outcomes of Pulmonary Valve Replacement With the Edwards Inspiris Resilia Pericardial Bioprosthesis

Sengupta,

Pastuszko,

Zaidi

et al. 2023

World J Pediatr Congenit Heart Surg

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Background Controversy regarding the optimal pulmonary valve substitute remains, with no approved surgical valve for pulmonary valve replacement (PVR). Furthermore, unfavorable anatomy often precludes transcatheter PVR in patients with congenital heart disease. We therefore sought to evaluate the feasibility of the Edwards Inspiris pericardial aortic bioprosthesis in the pulmonary position in pediatric and adult patients requiring PVR. Methods Data from consecutive patients who underwent PVR from February 2019 to February 2021 at our institution were retrospectively reviewed. Postoperative adverse events included paravalvular or transvalvular leak, endocarditis, explant, thromboembolism, valve thrombosis, valve-related bleeding, hemolysis, and structural valve degeneration. Progression of valve gradients was assessed from discharge to 30 days and one year. Results Of 24 patients with median age of 26 years (interquartile range [IQR]: 17-33; range: 4-60 years), 22 (91.7%) patients had previously undergone tetralogy of Fallot repair and 2 (8.3%) patients had undergone double-outlet right ventricle repair in the neonatal period or infancy. All patients had at least mild right ventricular (RV) dilatation (median RV end-diastolic volume index 161.4, IQR: 152.3-183.5 mL/m2) and at least moderate pulmonary insufficiency (95.8%) or stenosis (8.3%). Median cardiopulmonary bypass and cross-clamp times were 71 (IQR: 63-101) min and 66 (IQR: 60-114) min, respectively. At a median postoperative follow-up of 2.5 years (IQR: 1.4-2.6; range: 1.0-3.0 years), there were no mortalities, valve-related reoperations, or adverse events. Postoperative valve gradients and the severity of pulmonary regurgitation did not change significantly over time. Conclusions At short-term follow-up, the bioprosthesis in this study demonstrated excellent safety and effectiveness for PVR. Further studies with longer follow-up are warranted.

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“…2 The mechanism for pulmonary regurgitation was unclear, but the authors found that upsizing the pulmonary valve was a factor in the development of structural valve deterioration. The findings of the study by Pragt and colleagues 1 add another level of evidence that perhaps we should reconsider the concept of placing the largest possible prosthesis when faced with patients who require pulmonary valve replacement. At the very least, hopefully this study will lead to more intensive investigation of bioprosthetic valves in the pulmonary circulation and stimulate more interest in developing a stented bioprosthesis specifically designed for the pulmonary circulation.…”

mentioning

confidence: 96%

“…In this issue of the Journal, Dr Pragt and colleagues 1 report an important experimental analysis looking at the function of the Carpentier Edwards (Irvine, Calif) Perimount Magna Ease heart valve. Because it was originally designed for systemic semilunar valve replacement, a central element of the experimental model was to assess the function of the valve under the physiologic conditions of the pulmonary circulation.…”

mentioning

confidence: 99%

Commentary: Is prosthesis oversizing warranted for pulmonary valve replacement in patients with congenital heart disease?

Bryant

2020

The Journal of Thoracic and Cardiovascular Surgery

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Pulmonary versus aortic pressure behavior of a bovine pericardial valve

Cited by 9 publications

References 22 publications

In vitro Assessment of the Impacts of Leaflet Design on the Hemodynamic Characteristics of ePTFE Pulmonary Prosthetic Valves

In vitro Assessment of the Impacts of Leaflet Design on the Hemodynamic Characteristics of ePTFE Pulmonary Prosthetic Valves

Early Outcomes of Pulmonary Valve Replacement With the Edwards Inspiris Resilia Pericardial Bioprosthesis

Commentary: Is prosthesis oversizing warranted for pulmonary valve replacement in patients with congenital heart disease?

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