Abstract
Surgical aortic valve replacement is the most common procedure of choice for the treatment of severe aortic stenosis. Bioprosthetic valves are traditionally sewed-in the aortic root by means of pledget-armed sutures during open-heart surgery. Recently, novel bioprostheses which include a stent-based anchoring system have been introduced to allow rapid implantation, therefore reducing the duration and invasiveness of the intervention. Different effects on the hemodynamics were clinically reported associated with the two technologies. The aim of this study was therefore to investigate whether the differences in hemodynamic performances are an effect of different anchoring systems. Two commercially available bio-prosthetic aortic valves, one sewed-in with pledget-armed sutures and one rapid-deployment, were thus tested in this study by means of a combined approach of experimental and computational tools. In vitro experiments were performed to evaluate the overall hydrodynamic performance under identical standard conditions; computational fluid dynamics analyses were set-up to explore local flow variations due to different design of the anchoring system. The results showed how the performance of cardiac valve substitutes is negatively affected by the presence of pledget-armed sutures. These are causing flow disturbances, which in turn increase the mean pressure gradient and decrease the effective orifice area. The combined approach of experiments and numerical simulations can be effectively used to quantify the detailed relationship between local fluid-dynamics and overall performances associated with different valve technologies.
Highlights
Aortic stenosis (AS) is the most common valvular heart disease in industrialized countries, and its impact on public health is expected to increase due to the aging population.[8]
The experiments provided a comparative assessment of the hydrodynamics of the three valve configurations tested
The Magna_Pledgets valve showed an average increase of 2.18 mmHg in terms of mean pressure gradient (MPG) compared to the Magna tested without pledgets and an average increase of 2.41 mmHg compared to the Intuity
Summary
Aortic stenosis (AS) is the most common valvular heart disease in industrialized countries, and its impact on public health is expected to increase due to the aging population.[8]. Pledget-armed sutures are commonly used to secure the valve in either an intra- or supra-annular position.[1,3,32] To decrease the surgical trauma of the implantation procedure, and the associated peri-operative risks, less invasive procedures have been explored.[12] rapid-deployment valve systems have been recently introduced to the clinical arena.[15,16] Currently, two systems are commercially available in this group of devices, generally known as ‘‘sutureless valves’’: Sorin Perceval (Sorin Group, Italy), and Edwards Intuity (Edwards Lifesciences, CA) Both are inserted either via full- or mini-sternotomy or via right anterior thoracotomy. Radial pressure of the stent frame should ensure a safe
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