Stentless bioprostheses improve postoperative coronary flow more than stented prostheses after valve replacement for aortic stenosis

Bakhtiary, Farhad; Schiemann, Mirko; Dzemali, Omer; Wittlinger, Thomas; Doss, Mirko; Ackermann, H.; Moritz, Anton; Kleine, Peter

doi:10.1016/j.jtcvs.2005.10.055

Cited by 45 publications

(46 citation statements)

References 20 publications

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“…Long-term patient outcomes after prosthetic heart valve replacement might be improved as a result, as outcomes are known to be strongly associated with valve design and the adequacy of the match between the implanted valve to the individual patient's anatomy and flow conditions (25,26).…”

Section: Discussionmentioning

confidence: 99%

In vitro assessment of flow patterns and turbulence intensity in prosthetic heart valves using generalized phase‐contrast MRI

Kvitting

Dyverfeldt

Sigfridsson

et al. 2010

Magnetic Resonance Imaging

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Purpose: To assess in vitro the three-dimensional mean velocity field and the extent and degree of turbulence intensity (TI) in different prosthetic heart valves using a generalization of phase-contrast MRI (PC-MRI). Materials and Methods:Four 27-mm aortic valves (Björk-Shiley Monostrut tilting-disc, St. Jude Medical Standard bileaflet, Medtronic Mosaic stented and Freestyle stentless porcine valve) were tested under steady inflow conditions in a Plexiglas phantom. Three-dimensional PC-MRI data were acquired to measure the mean velocity field and the turbulent kinetic energy (TKE), a direction-independent measure of TI. Conclusion:The TI downstream from a prosthetic heart valve is dependent on the specific valve design. Generalized PC-MRI can be used to quantify velocity and TI downstream from prosthetic heart valves, which may allow assessment of these aspects of prosthetic valvular function in postoperative patients.

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Section: Discussionmentioning

confidence: 99%

In vitro assessment of flow patterns and turbulence intensity in prosthetic heart valves using generalized phase‐contrast MRI

Kvitting

Dyverfeldt

Sigfridsson

et al. 2010

Magnetic Resonance Imaging

View full text Add to dashboard Cite

show abstract

“…In fact, valve-related chronic coronary hypoperfusion and reduced CFR may cause angina pectoris, arrhythmia, deteriorating LV function, 54 and sudden cardiac death, and were shown to be independent predictors of cardiovascular prognosis. 55 Given that CF is determined by the diastolic flow pattern within the sinus of Valsalva, restoration of postoperative CFR depends on the turbulence downstream of the valve, which in turn, is fundamentally dependent on prosthesis design and orientation.…”

Section: 53mentioning

confidence: 99%

The Freedom SOLO bovine pericardial stentless valve

Stanger¹,

Tevaearai²,

Carrel³

2014

RRCC

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Abstract:The third-generation bovine pericardium Freedom SOLO (FS) stentless valve emerged in 2004 as a modified version of the Pericarbon Freedom stentless valve and as a very attractive alternative to stented bioprostheses. The design, choice of tissue, and anticalcification treatment fulfill most, if not all, requirements for an ideal valve substitute. The FS combines the singlesuture, subcoronary implantation technique with the latest-generation bovine pericardial tissue and novel anticalcification treatment. The design allows imitation of the native healthy valve through unrestricted adaption to the patient's anatomy, reproducing a normal valve/root complex. However, despite hemodynamic performance superior to stented valves, we are approaching a critical observation period as superior durability, freedom from structural valve deterioration, and nonstructural failure has not been proven as expected. However, optimal performance and freedom from structural valve deterioration depend on correct sizing and perfect symmetric implantation, to ensure low leaflet stress. Any malpositioning can lead to tissue fatigue over time. Furthermore, the potential for better outcomes depends on optimal patient selection and observance of the limitations for the use of stentless valves, particularly for the FS. Clearly, stentless valve implantation techniques are less reproducible and standardized, and require surgeondependent experience and skill. Regardless of whether or not stentless valve durability surpasses third-generation stented bioprostheses, they will continue to play a role in the surgical repertoire. This review intends to help practitioners avoid pitfalls, observe limitations, and improve patient selection for optimal long-term outcome with the attractive FS stentless valve.

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“…Stentless bioprosthetic valves were first introduced in the 1990`s and are reported to have superior hemodynamic properties comparing to stented valves due to lower pressure gradients and reduced turbulence in the aortic sinuses. This ensures superior coronary circulation during diastole [18].…”

Section: Treatment Of Valvular Aortic Stenosismentioning

confidence: 99%

“…Mean length of hospital stay was 11 days [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. 30 day-mortality rate was 3.5%.…”

Section: Own Experiencementioning

confidence: 99%

Recent developments for surgical aortic valve replacement: The concept of sutureless valve technology

Carrel¹,

Englberger²,

Stalder³

2013

Open J Cardiol

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Stentless bioprostheses improve postoperative coronary flow more than stented prostheses after valve replacement for aortic stenosis

Cited by 45 publications

References 20 publications

In vitro assessment of flow patterns and turbulence intensity in prosthetic heart valves using generalized phase‐contrast MRI

In vitro assessment of flow patterns and turbulence intensity in prosthetic heart valves using generalized phase‐contrast MRI

The Freedom SOLO bovine pericardial stentless valve

Recent developments for surgical aortic valve replacement: The concept of sutureless valve technology

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