1
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Nowak M, Divo E, Adamczyk WP. Multiscale model for blood flow after a bileaflet artificial aortic valve implantation. Comput Biol Med 2023; 158:106805. [PMID: 37019010 DOI: 10.1016/j.compbiomed.2023.106805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/15/2023] [Accepted: 03/20/2023] [Indexed: 04/05/2023]
Abstract
Cardiovascular diseases are the leading cause of mortality in the world, mainly due to atherosclerosis and its consequences. The article presents the numerical model of the blood flow through artificial aortic valve. The overset mesh approach was applied to simulate the valve leaflets motion and to realize the moving mesh, in the aortic arch and the main branches of cardiovascular system. To capture the cardiac system's response and the effect of vessel compliance on the outlet pressure, the lumped parameter model has been also included within the solution procedure. Three different turbulence modeling approaches were used and compared - the laminar, k-ϵ and k-ω model. The simulation results were also compared with the model excluding the moving valve geometry and the importance of the lumped parameter model for the outlet boundary condition was analyzed. Proposed numerical model and protocol was found as suitable for performing the virtual operations on the real patient vasculature geometry. The time-efficient turbulence model and overall solving procedure allows to support the clinicians in making decisions about the patient treatment and to predict the results of the future surgery.
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2
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Lee H, Hwang HY, Sohn SH, Choi JW, Park JB, Kim KH, Kim KB. Hemodynamic Performance of Pericardial Bioprostheses in the Aortic Position. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 53:285-290. [PMID: 33020346 PMCID: PMC7553830 DOI: 10.5090/kjtcs.19.099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/26/2020] [Accepted: 05/16/2020] [Indexed: 11/17/2022]
Abstract
Background This study was conducted to evaluate the hemodynamic performance and the incidence of prosthesis-patient mismatch (PPM) after aortic valve replacement (AVR) using bovine pericardial valves (Carpentier-Edwards Perimount Magana and Magna Ease). Methods In total, 216 patients (mean age, 70.0±10.5 years) who underwent AVR using stented bovine pericardial valves and had follow-up echocardiography between 3 months and 2 years (mean, 12.0±6.6 months) after surgery were enrolled. The implanted valve sizes were 19, 21, 23, and 25 mm in 32, 56, 99, and 29 patients, respectively. Results On follow-up echocardiography, the mean transvalvular pressure gradients for the 19-mm, 21-mm, 23-mm, and 25-mm valves were 13.3±4.4, 12.6±4.2, 10.5±3.9, and 10.2± 3.7 mm Hg, respectively. The effective orifice area (EOA) was 1.25±0.26, 1.54±0.31, 1.81±0.41, and 1.87±0.33 cm2, respectively. These values were smaller than those suggested by the manufacturer for the corresponding sizes. No patients had PPM, when based on the reference EOA. However, moderate (EOA index ≤0.85 cm2/m2) and severe (EOA index ≤0.65 cm2/m2) PPM was present in 56 patients (11.8%) and 9 patients (1.9%), respectively, when using the measured values. Conclusion Carpentier-Edwards Perimount Magna and Magna Ease bovine pericardial valves showed satisfactory hemodynamic performance with low rates of PPM, although the reference EOA could overestimate the true EOA for individual patients.
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Affiliation(s)
- Haeju Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Suk Ho Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kyung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Ki-Bong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
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3
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Corso P, Giannakopoulos G, Gulan U, Frouzakis CE, Holzner M. A Novel Estimation Approach of Pressure Gradient and Haemodynamic Stresses as Indicators of Pathological Aortic Flow Using Subvoxel Modelling. IEEE Trans Biomed Eng 2020; 68:980-991. [PMID: 32816672 DOI: 10.1109/tbme.2020.3018173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The flow downstream from aortic stenoses is characterised by the onset of shear-induced turbulence that leads to irreversible pressure losses. These extra losses represent an increased resistance that impacts cardiac efficiency. A novel approach is suggested in this study to accurately evaluate the pressure gradient profile along the aorta centreline using modelling of haemodynamic stress at scales that are smaller than the typical resolution achieved in experiments. METHODS We use benchmark data obtained from direct numerical simulation (DNS) along with results from in silico and in vitro three-dimensional particle tracking velocimetry (3D-PTV) at three voxel sizes, namely 750 μm, 1 mm and 1.5 mm. A differential equation is derived for the pressure gradient, and the subvoxel-scale (SVS) stresses are closed using the Smagorinsky and a new refined model. Model constants are optimised using DNS and in silico PTV data and validated based on pulsatile in vitro 3D-PTV data and pressure catheter measurements. RESULTS The Smagorinsky-based model was found to be more accurate for SVS stress estimation but also more sensitive to errors especially at lower resolution, whereas the new model was found to more accurately estimate the projected pressure gradient even for larger voxel size of 1.5 mm albeit at the cost of increased sensitivity at this voxel size. A comparison with other methods in the literature shows that the new approach applied to in vitro PTV measurements estimates the irreversible pressure drop by decreasing the errors by at least 20%. CONCLUSION Our novel approach based on the modelling of subvoxel stress offers a validated and more accurate way to estimate pressure gradient, irreversible pressure loss and SVS stress. SIGNIFICANCE We anticipate that the approach may potentially be applied to image-based in vivo, in vitro 4D flow data or in silico data with limited spatial resolution to assess pressure loss and SVS stresses in disturbed aortic blood flow.
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4
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The hemodynamics of transcatheter aortic valves in transcatheter aortic valves. J Thorac Cardiovasc Surg 2019; 161:565-576.e2. [PMID: 31767355 DOI: 10.1016/j.jtcvs.2019.09.174] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/22/2019] [Accepted: 09/06/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND The durability of transcatheter aortic valves (TAVs) remains their greatest disadvantage, given that fixed tissue leaflets are not immune to structural degeneration from calcification and thrombosis. Therefore, a second intervention is necessary, especially given that TAV in low-risk patients has shown noninferior outcomes compared with surgery. This study aimed to assess the hemodynamic and turbulent properties of the flow downstream with different TAV-in-TAV configurations, to offer basic hemodynamic guidance for future interventions when currently implanted valves structurally degrade. METHODS Six TAV-in-TAV configurations were chosen: 23 mm Evolut-in-26 mm Evolut, 23 mm Evolut-in-23 mm SAPIEN 3, 26 mm Evolut-in-26 mm Evolut, 26 mm Evolut-in-23 mm SAPIEN 3, 23 mm SAPIEN3-in-26 mm Evolut, and 23 mm SAPIEN3-in-23 mm SAPIEN 3. Their hemodynamic performance was assessed in a pulse duplicator for 100 cycles. High-speed imaging and particle image velocimetry were performed to assess turbulence. Effective orifice area (EOA), pinwheeling index (PI), and Reynolds shear stress (RSS) were evaluated. RESULTS The largest mean EOA was obtained with 23 mm SAPIEN-in-26 mm Evolut (2.07 ± 0.06 cm2), and the smallest was obtained with 23 mm Evolut-in-23 mm SAPIEN (1.50 ± 0.04 cm2) (P < .001). The highest mean PI was obtained with SAPIEN-in-SAPIEN (26.5 ± 2.00%), and the lowest was obtained with 26 mm Evolut-in-26 mm Evolut (7.5 ± 1.6%) (P < .01). At peak systole, the least detrimental RSS range was obtained with 23 mm Evolut-in-26 mm Evolut (up to ∼340 Pa), and the most detrimental RSS range was obtained with 23 mm Evolut-in-SAPIEN (∼900 Pa) (P < .01). CONCLUSIONS This study shows that best hemodynamic parameters are TAV-specific (implanted and to be implanted). In addition, it shows that RSS levels, which are indicative of turbulence levels and associated with blood damage, are 2- to 3-fold higher after TAV-in-TAV.
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Kalogerakos PD, Kontopodis N, Ioannou CV, Kladou E, Chalkiadakis G, Athanasiou T, Lazopoulos G. Hemodynamics and reverse remodeling associated with Mosaic, Perimount and Trifecta aortic bioprostheses. Expert Rev Med Devices 2019; 16:743-751. [PMID: 31318302 DOI: 10.1080/17434440.2019.1642105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: The implantation rate of aortic bioprostheses is increasing. Their durability has improved to some extent over the years and they allow for future transcatheter valve-in-valve deployment. In the lack of long term follow up, their hemodynamic profile, i.e. transvalvular mean pressure gradient and effective orifice area indexed, and the associated left ventricular reverse remodeling indexed are useful surrogates for clinical outcomes. Areas covered: A systematic review of the literature was conducted by searching Medline, Cochrane, Scielo, Embase databases, and grey literature until July 2018 for articles that perform comparisons among the three most popular aortic bioprostheses. Six randomized and 12 non-randomized studies were included with 565 patients receiving a Mosaic, 1334 a Perimount and 557 a Trifecta valve. These articles are heterogeneous but they allow the meta-analytic comparison of the abovementioned outcomes. Expert opinion: Compared to the Perimount valve, the Mosaic is hemodynamically inferior, while the Trifecta is superior. Despite these statistically significant differences, the left ventricular mass regression indexed, that is indicative of reverse remodeling, was comparable in all groups. All patients were similarly benefited. The predilection among these valves is fueled by their hemodynamic profile but not supported by the comparable reverse remodeling.
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Affiliation(s)
- Paris D Kalogerakos
- a Cardiothoracic Surgery Division, University Hospital of Heraklion , Crete , Greece
| | - Nikolaos Kontopodis
- b Vascular Surgery Division, University Hospital of Heraklion , Crete , Greece
| | - Christos V Ioannou
- b Vascular Surgery Division, University Hospital of Heraklion , Crete , Greece
| | - Eleni Kladou
- c Internal Medicine Department, University Hospital of Heraklion , Crete , Greece
| | - George Chalkiadakis
- a Cardiothoracic Surgery Division, University Hospital of Heraklion , Crete , Greece
| | - Thanos Athanasiou
- d Faculty of Medicine, Department of Surgery and Cancer, Imperial College London , London , UK
| | - George Lazopoulos
- a Cardiothoracic Surgery Division, University Hospital of Heraklion , Crete , Greece
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6
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Bertrand PB, Pettinari M, De Cannière H, Gutermann H, Smeets CJ, Verhaert D, Dion RA, Verdonck P, Vandervoort PM. Effective Orifice Area during Exercise in Bileaflet Mechanical Valve Prostheses. J Am Soc Echocardiogr 2017; 30:404-413. [DOI: 10.1016/j.echo.2016.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Indexed: 10/20/2022]
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7
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Tavakoli R, Auf der Maur C, Mueller X, Schläpfer R, Jamshidi P, Daubeuf F, Frossard N. Full-root aortic valve replacement with stentless xenograft achieves superior regression of left ventricular hypertrophy compared to pericardial stented aortic valves. J Cardiothorac Surg 2015; 10:15. [PMID: 25643748 PMCID: PMC4322600 DOI: 10.1186/s13019-015-0219-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 01/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Full-root aortic valve replacement with stentless xenografts has potentially superior hemodynamic performance compared to stented valves. However, a number of cardiac surgeons are reluctant to transform a classical stented aortic valve replacement into a technically more demanding full-root stentless aortic valve replacement. Here we describe our technique of full-root stentless aortic xenograft implantation and compare the early clinical and midterm hemodynamic outcomes to those after aortic valve replacement with stented valves. METHODS We retrospectively compared the pre-operative characteristics of 180 consecutive patients who underwent full-root replacement with stentless aortic xenografts with those of 80 patients undergoing aortic valve replacement with stented valves. In subgroups presenting with aortic stenosis, we further analyzed the intra-operative data, early postoperative outcomes and mid-term regression of left ventricular mass index. RESULTS Patients in the stentless group were younger (62.6 ± 13 vs. 70.3 ± 11.8 years, p < 0.0001) but had a higher Euroscore (9.14 ± 3.39 vs.6.83 ± 2.54, p < 0.0001) than those in the stented group. In the subgroups operated for aortic stenosis, the ischemic (84.3 ± 9.8 vs. 62.3 ± 9.4 min, p < 0.0001) and operative times (246.3 ± 53.6 vs. 191.7 ± 53.2 min, p < 0.0001) were longer for stentless versus stented valve implantation. Nevertheless, early mortality (0% vs. 3%, p < 0.25), re-exploration for bleeding (0% vs. 3%, p < 0.25) and stroke (1.8% vs. 3%, p < 0.77) did not differ between stentless and stented groups. One year after the operation, the mean transvalvular gradient was lower in the stentless versus stented group (5.8 ± 2.9 vs. 13.9 ± 5.3 mmHg, p < 0.0001), associated with a significant regression of the left ventricular mass index in the stentless (p < 0.0001) but not in the stented group (p = 0.2). CONCLUSION Our data support that full-root stentless aortic valve replacement can be performed without adversely affecting the early morbidity or mortality in patients operated on for aortic valve stenosis provided that the coronary ostia are not heavily calcified. The additional time necessary for the full-root stentless compared to the classical stented aortic valve replacement is therefore not detrimental to the early clinical outcomes and is largely rewarded in patients with aortic stenosis by lower transvalvular gradients at mid-term and a better regression of their left ventricular mass index.
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Affiliation(s)
- Reza Tavakoli
- Department of Cardiac Surgery, Canton Hospital Lucerne, Lucerne, Switzerland. .,Institute of Veterinary Pysiology Vetsuisse Faculty and Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.
| | | | - Xavier Mueller
- Department of Cardiac Surgery, Canton Hospital Lucerne, Lucerne, Switzerland.
| | - Reinhard Schläpfer
- Department of Cardiac Surgery, Canton Hospital Lucerne, Lucerne, Switzerland.
| | - Peiman Jamshidi
- Department of Cardiology, Canton Hospital Lucerne, Lucerne, Switzerland.
| | - François Daubeuf
- Laboratoire d'Innovation Thérapeutique, Unité Mixte de Recherche 7200, Centre National de la Recherche Scientifique-Université de Strasbourg, Faculté de Pharmacie, Illkirch, Strasbourg, F-67400, France.
| | - Nelly Frossard
- Laboratoire d'Innovation Thérapeutique, Unité Mixte de Recherche 7200, Centre National de la Recherche Scientifique-Université de Strasbourg, Faculté de Pharmacie, Illkirch, Strasbourg, F-67400, France.
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8
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Annerel S, Claessens T, Degroote J, Segers P, Vierendeels J. Validation of a numerical FSI simulation of an aortic BMHV by in vitro PIV experiments. Med Eng Phys 2014; 36:1014-23. [PMID: 24924383 DOI: 10.1016/j.medengphy.2014.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 04/01/2014] [Accepted: 05/05/2014] [Indexed: 10/25/2022]
Abstract
In this paper, a validation of a recently developed fluid-structure interaction (FSI) coupling algorithm to simulate numerically the dynamics of an aortic bileaflet mechanical heart valve (BMHV) is performed. This validation is done by comparing the numerical simulation results with in vitro experiments. For the in vitro experiments, the leaflet kinematics and flow fields are obtained via the particle image velocimetry (PIV) technique. Subsequently, the same case is numerically simulated by the coupling algorithm and the resulting leaflet kinematics and flow fields are obtained. Finally, the results are compared, revealing great similarity in leaflet motion and flow fields between the numerical simulation and the experimental test. Therefore, it is concluded that the developed algorithm is able to capture very accurately all the major leaflet kinematics and dynamics and can be used to study and optimize the design of BMHVs.
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Affiliation(s)
- S Annerel
- Ghent University, Department of Flow, Heat and Combustion Mechanics, Sint-Pietersnieuwstraat 41, B-9000 Ghent, Belgium.
| | - T Claessens
- Ghent University, Department of Industrial Technology and Construction, Valentin Vaerwyckweg 1, B-9000 Ghent, Belgium.
| | - J Degroote
- Ghent University, Department of Flow, Heat and Combustion Mechanics, Sint-Pietersnieuwstraat 41, B-9000 Ghent, Belgium.
| | - P Segers
- Ghent University, iMinds Medical IT, IBiTech-bioMMeda, De Pintelaan 185, B-9000 Ghent, Belgium.
| | - J Vierendeels
- Ghent University, Department of Flow, Heat and Combustion Mechanics, Sint-Pietersnieuwstraat 41, B-9000 Ghent, Belgium.
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9
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Evin M, Pibarot P, Guivier-Curien C, Tanné D, Kadem L, Rieu R. Localized transvalvular pressure gradients in mitral bileaflet mechanical heart valves and impact on gradient overestimation by Doppler. J Am Soc Echocardiogr 2013; 26:791-800. [PMID: 23611059 DOI: 10.1016/j.echo.2013.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND It has been reported that localized high velocity may be recorded by continuous-wave Doppler interrogation through the smaller central orifices of bileaflet mechanical heart valves (BMHV) and that this may result in overestimation of the transvalvular pressure gradient (TPG). However, the prevalence and clinical relevance of this phenomenon remain unclear, particularly for BMHVs in the mitral position. The objective of this in vitro study was to assess the presence and magnitude of localized high velocity in mitral BMHVs as well as its impact on TPG overestimation by Doppler. METHODS Nine BMHVs were tested under nine different flow conditions (volumes and flow waveforms) in a simulator specifically designed to assess mitral valve hemodynamics. Flow velocity was measured at three different locations (leading edge, midleaflets, and trailing edge) within the central and lateral orifices of the BMHVs using pulsed-wave Doppler. TPG was measured by pulsed-wave and continuous-wave Doppler and by catheterization. RESULTS The maximum flow velocity occurred within the central orifice of the BMHV in 61% of the 81 tested conditions. This locally higher velocity within the central orifice predominantly occurred at the leading edge of the prosthesis. Doppler overestimated mean TPG by an average of 5% to 10% compared with catheterization. The magnitude of the localized high velocity and ensuing overestimation of TPG by Doppler was more important at higher mitral flow volumes (P < .0001) as well as in BMHVs with smaller internal ring diameters (P < .0001). CONCLUSIONS This study shows that the flow velocity distribution within the three orifices of mitral BMHVs is not uniform and that higher velocity occurs more frequently, but not always, within the inflow aspect of the central orifice. In most mitral BMHVs and flow conditions, this localized high-velocity phenomenon causes small overestimation of TPGs (<2 mm Hg and <10%) by Doppler and is thus not clinically relevant. However, in small mitral BMHVs exposed to high flow rates, the overestimation of TPG due to localized high velocity could become more important and overlap with the range of gradients found in patients with prosthesis dysfunction or prosthesis-patient mismatch.
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Affiliation(s)
- Morgane Evin
- Aix-Marseille Université, CNRS, ISM UMR 7287, Marseille, France
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10
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Bach DS, Schmitz C, Dohmen G, Aaronson KD, Steinseifer U, Kleine P. In vitro assessment of prosthesis type and pressure recovery characteristics: Doppler echocardiography overestimation of bileaflet mechanical and bioprosthetic aortic valve gradients. J Thorac Cardiovasc Surg 2012; 144:453-8. [DOI: 10.1016/j.jtcvs.2011.12.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 11/18/2011] [Accepted: 12/14/2011] [Indexed: 10/14/2022]
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11
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Bech-Hanssen O, Aljassim O, Houltz E, Svensson G. The relative contribution of prosthetic gradients, systemic arterial pressure, and pulse pressure to the left ventricular pressure in patients with aortic prosthetic valves. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 12:37-45. [DOI: 10.1093/ejechocard/jeq101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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12
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Kume T, Okura H, Kawamoto T, Watanabe N, Neishi Y, Hayashida A, Tanemoto K, Yoshida K. Impact of Energy Loss Coefficient on Left Ventricular Mass Regression in Patients Undergoing Aortic Valve Replacement: Preliminary Observation. J Am Soc Echocardiogr 2009; 22:454-7. [DOI: 10.1016/j.echo.2009.02.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Indexed: 11/26/2022]
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13
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Youdelman BA, Hirose H, Jain H, Kresh JY, Entwistle JW, Wechsler AS. Comparison of eight prosthetic aortic valves in a cadaver model. J Thorac Cardiovasc Surg 2007; 134:1526-32. [DOI: 10.1016/j.jtcvs.2007.07.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2006] [Revised: 07/04/2007] [Accepted: 07/10/2007] [Indexed: 11/27/2022]
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14
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Ragosta M. Determination of the source and severity of a transvalvular left ventricular outflow tract gradient in patients with a prosthetic aortic valve. Catheter Cardiovasc Interv 2007; 70:809-14. [PMID: 18022904 DOI: 10.1002/ccd.21340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Michael Ragosta
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
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15
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Tao K, Sakata R, Iguro Y, Ueno M, Tanaka Y, Otsuji Y, Tei C. Impact of Valve Prosthesis-Patient Mismatch on Intermediate-term Outcome and Regression of Left Ventricular Mass Following Aortic Valve Replacement with Mechanical Prosthesis. J Card Surg 2007; 22:486-92. [DOI: 10.1111/j.1540-8191.2007.00465.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Mohty D, Mohty-Echahidi D, Malouf JF, Girard SE, Schaff HV, Grill DE, Enriquez-Sarano ME, Miller FA. Impact of Prosthesis-Patient Mismatch on Long-Term Survival in Patients With Small St Jude Medical Mechanical Prostheses in the Aortic Position. Circulation 2006; 113:420-6. [PMID: 16415379 DOI: 10.1161/circulationaha.105.546754] [Citation(s) in RCA: 153] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
The impact of aortic prosthesis-patient mismatch (P-PtM) on long-term survival is unclear.
Methods and Results—
Between 1985 and 2000, 388 patients at Mayo Clinic in Rochester, Minn, underwent aortic valve replacement (AVR) with 19- or 21-mm St Jude Medical prostheses and had transthoracic echocardiography within 1 year after AVR. Mean age of patients was 62±13 years; 69% were female. Prosthesis effective orifice area (EOA) was derived from the continuity equation. P-PtM was classified as severe (indexed EOA ≤0.60 cm
2
/m
2
), moderate (0.60 cm
2
/m
2
<indexed EOA≤0.85 cm
2
/m
2
), or not hemodynamically significant (indexed EOA >0.85 cm
2
/m
2
). P-PtM was severe in 66 patients (17%), moderate in 168 (43%), and not hemodynamically significant in 154 (40%). Patients with severe P-PtM had a significantly larger body surface area (
P
<0.0001), higher mean gradient (
P
<0.0001), lower preoperative (
P
<0.0001) and postoperative (
P
<0.0001) ejection fractions, and lower stroke volume (
P
<0.0001) and more often received a 19-mm prosthesis (
P
=0.0008) than patients with moderate or no hemodynamically significant mismatch. For patients with severe mismatch, 5-year survival rates (72±6%) and 8-year survival rates (41±8%) were significantly less than for patients with moderate mismatch (80±3% and 65±5%;
P
=0.026) or no hemodynamically significant mismatch (85±3% and 74±5%;
P
=0.002). On multivariate analysis after adjustment for other predictors of outcome, severe mismatch was associated with higher mortality (hazard ratio 2.18; 95% confidence interval 1.24 to 3.85;
P
=0.007) and higher incidence of congestive heart failure (hazard ratio 3.1; 95% confidence interval 1.3 to 7.4;
P
=0.009) than no hemodynamically significant mismatch.
Conclusions—
Severe P-PtM is an independent predictor of higher long-term mortality and congestive heart failure in patients with small St Jude Medical aortic valve prostheses. For patients undergoing AVR who are at risk of severe mismatch, every effort should be made to use a larger prosthesis or to consider a prosthesis with a larger EOA.
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Affiliation(s)
- Dania Mohty
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
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Pai RK, Lad V, Agarwal N, Khandeparkar J, Patwardhan A. Implications of valve prosthesis-patient mismatch in patients undergoing aortic valve replacement; who tolerates and who does not? Indian J Thorac Cardiovasc Surg 2005. [DOI: 10.1007/s12055-005-0002-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Tasca G, Brunelli F, Cirillo M, DallaTomba M, Mhagna Z, Troise G, Quaini E. Impact of Valve Prosthesis-Patient Mismatch on Left Ventricular Mass Regression Following Aortic Valve Replacement. Ann Thorac Surg 2005; 79:505-10. [PMID: 15680824 DOI: 10.1016/j.athoracsur.2004.04.042] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND Valve prosthesis-patient mismatch is a frequent problem in patients undergoing aortic valve replacement and its main hemodynamic consequence is to generate high transvalvular gradients through normally functioning prosthetic valves. The persistence of high gradients may hinder or delay the regression of left ventricular hypertrophy after aortic valve replacement. METHODS The aim of the study was to determine the impact of prosthesis-patient mismatch on the postoperative regression of left ventricular mass. Left ventricular mass was measured by Doppler echocardiography in 109 patients undergoing aortic valve replacement with a single type of bioprosthesis (Carpentier-Edwards Perimount) for pure aortic stenosis. Prosthesis-patient mismatch was defined as a projected indexed effective orifice area less than 0.90 cm2/m2. On this basis, 58/109 (53.2%) patients had prosthesis-patient mismatch. RESULTS There was a good correlation (r = 0.61, p < 0.001) between the postoperative mean transprosthetic gradient and the projected indexed effective orifice area. The absolute and relative left ventricular mass regression was significantly (p = 0.002 and p = 0.01, respectively) lower in patients with prosthesis-patient mismatch (-48 +/- 47 g, -17% +/- 16%) compared to those with no prosthesis-patient mismatch (-77 +/- 49 g, -24% +/- 14%). In multivariate analysis, a larger projected indexed effective orifice area, female gender and a higher preoperative left ventricular mass are independent predictors of greater left ventricular mass regression. CONCLUSIONS This study shows that in patients with pure aortic stenosis prosthesis-patient mismatch is associated with lesser regression of left ventricular hypertrophy after aortic valve replacement. These findings may have important clinical implications given that prosthesis-patient mismatch is frequent in these patients.
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Affiliation(s)
- Giordano Tasca
- Department of Cardiac Surgery, Poliambulanza Hospital, Brescia, Italy.
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Bech-Hanssen O, Gjertsson P, Houltz E, Wranne B, Ask P, Loyd D, Caidahl K. Net pressure gradients in aortic prosthetic valves can be estimated by Doppler. J Am Soc Echocardiogr 2003; 16:858-66. [PMID: 12878995 DOI: 10.1067/s0894-7317(03)00422-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND In aortic prosthetic valves, both the Doppler-estimated gradients and orifice areas are misleading in the assessment of hemodynamic performance. The parameter of major interest is the net pressure gradient after pressure recovery (PR). We, therefore, investigated, in vitro, our ability to predict the net pressure gradient and applied the formulas in a representative patient population with 2 different valve designs. METHODS We studied the St Jude Medical (SJM) standard valve (size 19-27) and SJM Biocor (size 21-27) in an in vitro steady-flow model with simultaneous Doppler-estimated pressure and catheter pressure measurements. Using echocardiography, we also studied patients who received the SJM (n = 66) and SJM Biocor (n = 45). RESULTS In the SJM, we observed PR both within the prosthesis and aorta, whereas in the SJM Biocor, PR was only present in the aorta. We estimated the PR within the valve and within the aorta separately from echocardiographic in vitro data, combining a regression equation (valve) with an equation on the basis of fluid mechanics theory (aorta). The difference between estimated and catheter-obtained net gradients (mean +/- SD) was 0.6 +/- 1.6 mm Hg in the SJM and -0.2 +/- 1.9 mm Hg in the SJM Biocor. When these equations were applied in vivo, we found that PR had an overall value of 57 +/- 7% of the peak Doppler gradient in the SJM and 33 +/- 9% in the SJM Biocor. CONCLUSIONS The in vitro results indicate that it is possible to predict the net pressure gradient by Doppler in bileaflet and stented biologic valves. Our data indicate that important PR is also present in stented biologic valves.
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Affiliation(s)
- Odd Bech-Hanssen
- Department of Clinical Physiology, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden.
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