1
|
Sengupta A, Pastuszko P, Zaidi AN, Murthy RA. Early Outcomes of Pulmonary Valve Replacement With the Edwards Inspiris Resilia Pericardial Bioprosthesis. World J Pediatr Congenit Heart Surg 2024; 15:52-59. [PMID: 37722839 DOI: 10.1177/21501351231178750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
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.
Collapse
Affiliation(s)
- Aditya Sengupta
- Department of Cardiovascular Surgery, The Mount Sinai Hospital, New York, NY, USA
| | - Peter Pastuszko
- Department of Cardiovascular Surgery, The Mount Sinai Hospital, New York, NY, USA
- Mount Sinai Kravis Children's Heart Center, New York, NY, USA
| | - Ali N Zaidi
- Mount Sinai Kravis Children's Heart Center, New York, NY, USA
| | - Raghav A Murthy
- Department of Cardiovascular Surgery, The Mount Sinai Hospital, New York, NY, USA
- Mount Sinai Kravis Children's Heart Center, New York, NY, USA
| |
Collapse
|
2
|
Lee A, Liu X, Giaretta JE, Hoang TP, Crago M, Farajikhah S, Mosse L, Fletcher DF, Dehghani F, Winlaw DS, Naficy S. Bioinspired polymeric heart valves: A combined in vitro and in silico approach. JTCVS OPEN 2023; 15:113-124. [PMID: 37808055 PMCID: PMC10556942 DOI: 10.1016/j.xjon.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/07/2023] [Accepted: 06/27/2023] [Indexed: 10/10/2023]
Abstract
Background Polymeric heart valves (PHVs) may address the limitations of mechanical and tissue valves in the treatment of valvular heart disease. In this study, a bioinspired valve was designed, assessed in silico, and validated by an in vitro model to develop a valve with optimum function for pediatric applications. Methods A bioinspired heart valve was created computationally with leaflet curvature derived from native valve anatomies. A valve diameter of 18 mm was chosen to approach sizes suitable for younger patients. Valves of different thicknesses were fabricated via dip-coating with siloxane-based polyurethane and tested in a pulse duplicator for their hydrodynamic function. The same valves were tested computationally using an arbitrary Lagrangian-Eulerian plus immersed solid approach, in which the fluid-structure interaction between the valves and fluid passing through them was studied and compared with experimental data. Results Computational analysis showed that valves of 110 to 200 μm thickness had effective orifice areas (EOAs) of 1.20 to 1.30 cm2, with thinner valves exhibiting larger openings. In vitro tests demonstrated that PHVs of similar thickness had EOAs of 1.05 to 1.35 cm2 and regurgitant fractions (RFs) <7%. Valves with thinner leaflets exhibited optimal systolic performance, whereas thicker valves had lower RFs. Conclusions Bioinspired PHVs demonstrated good hydrodynamic performance that exceeded ISO 5840-2 standards. Both methods of analysis showed similar correlations between leaflet thickness and valve systolic function. Further development of this PHV may lead to enhanced durability and thus a more reliable heart valve replacement than contemporary options.
Collapse
Affiliation(s)
- Aeryne Lee
- School of Chemical and Biomolecular Engineering, The University of Sydney, Darlington, Australia
- School of Medicine, The University of Sydney, Camperdown, Australia
| | - Xinying Liu
- School of Chemical and Biomolecular Engineering, The University of Sydney, Darlington, Australia
| | - Jacopo Emilio Giaretta
- School of Chemical and Biomolecular Engineering, The University of Sydney, Darlington, Australia
| | - Thanh Phuong Hoang
- School of Chemical and Biomolecular Engineering, The University of Sydney, Darlington, Australia
| | - Matthew Crago
- School of Chemical and Biomolecular Engineering, The University of Sydney, Darlington, Australia
| | - Syamak Farajikhah
- School of Chemical and Biomolecular Engineering, The University of Sydney, Darlington, Australia
- Sydney Nano Institute, The University of Sydney, Camperdown, Australia
| | - Luke Mosse
- Leap Australia, Clayton North, Australia
| | - David Frederick Fletcher
- School of Chemical and Biomolecular Engineering, The University of Sydney, Darlington, Australia
| | - Fariba Dehghani
- School of Chemical and Biomolecular Engineering, The University of Sydney, Darlington, Australia
- Sydney Nano Institute, The University of Sydney, Camperdown, Australia
| | - David Scott Winlaw
- School of Medicine, The University of Sydney, Camperdown, Australia
- Department of Cardiothoracic Surgery, Heart Institute, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Sina Naficy
- School of Chemical and Biomolecular Engineering, The University of Sydney, Darlington, Australia
- School of Medicine, The University of Sydney, Camperdown, Australia
- Sydney Nano Institute, The University of Sydney, Camperdown, Australia
| |
Collapse
|
3
|
Kostava VT, Telyshev DV, Zelivyanskaya MV, Efimov IA, Lyutova IG, Pugovkin AA. First Experience of Hydrodynamic Testing of Pediatric Heart Valve Bioprostheses in the Aortic Position. BIOMEDICAL ENGINEERING 2023. [DOI: 10.1007/s10527-023-10241-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
|
4
|
Lee CH. Beyond the Valve: Lifelong Management of Right Ventricular Outflow Tract Lesion in Adult Congenital Heart Disease. Korean Circ J 2022; 52:632-634. [PMID: 35929055 PMCID: PMC9353253 DOI: 10.4070/kcj.2022.0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 06/30/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Chang-Ha Lee
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon 14754, Korea
| |
Collapse
|
5
|
Ramchandani B, Sánchez R, Rey J, Polo L, Gonzalez Á, Lamas MJ, Centella T, Díez J, Aroca Á. A Bicentric Propensity Matched Analysis of 158 Patients Comparing Porcine Versus Bovine Stented Bioprosthetic Valves in Pulmonary Position. Korean Circ J 2022; 52:623-631. [PMID: 35790501 PMCID: PMC9353256 DOI: 10.4070/kcj.2021.0335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/09/2022] [Accepted: 03/30/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Bunty Ramchandani
- Congenital Cardiovascular Surgery, Hospital Universitario La Paz, Madrid, Spain
- Congenital Cardiovascular Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Raúl Sánchez
- Congenital Cardiovascular Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - Juvenal Rey
- Congenital Cardiovascular Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - Luz Polo
- Congenital Cardiovascular Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - Álvaro Gonzalez
- Congenital Cardiovascular Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - Maria-Jesús Lamas
- Congenital Cardiovascular Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Tomasa Centella
- Congenital Cardiovascular Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Jesús Díez
- Instituto de Investigación, Hospital Universitario La Paz, Madrid, Spain
| | - Ángel Aroca
- Congenital Cardiovascular Surgery, Hospital Universitario La Paz, Madrid, Spain
| |
Collapse
|
6
|
Lee A, Ebrahimi P, Winlaw DS. Commentary: The right heart—a neglected sibling missing optimal closure. J Thorac Cardiovasc Surg 2020; 159:1061-1062. [DOI: 10.1016/j.jtcvs.2019.06.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 06/24/2019] [Indexed: 10/26/2022]
|
7
|
Zhu G, Wei Y, Yuan Q, Cai L, Nakao M, Yeo JH. In vitro Assessment of the Impacts of Leaflet Design on the Hemodynamic Characteristics of ePTFE Pulmonary Prosthetic Valves. Front Bioeng Biotechnol 2020; 7:477. [PMID: 32076599 PMCID: PMC7006451 DOI: 10.3389/fbioe.2019.00477] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/23/2019] [Indexed: 12/04/2022] Open
Abstract
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 cm2 in the bileaflet valve and 1.72 cm2 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.
Collapse
Affiliation(s)
- Guangyu Zhu
- School of Energy and Power Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Yuan Wei
- School of Energy and Power Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Qi Yuan
- School of Energy and Power Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Li Cai
- NPU-UoG International Cooperative Lab for Computation and Application in Cardiology, Northwestern Polytechnical University, Xi'an, China
| | - Masakazu Nakao
- Cardiothoracic Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - Joon Hock Yeo
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| |
Collapse
|
8
|
Bryant R. Commentary: Is prosthesis oversizing warranted for pulmonary valve replacement in patients with congenital heart disease? J Thorac Cardiovasc Surg 2019; 159:1060. [PMID: 31350022 DOI: 10.1016/j.jtcvs.2019.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Roosevelt Bryant
- Division of Cardiovascular Surgery, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| |
Collapse
|