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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Does valve design impact the maximum implantable bioprosthetic diameter? A prospective, multicenter observational
Irving B David1, Frank Catinella, Kenneth Herskowitz
1Heart Lung Surgical Institute of South Florida, 5601 N. Dixie Highway, Suite 209, Fort Lauderdale, FL 33334, USA. thedavids@aol.com
The Journal of Heart Valve Disease
|December 22, 2007
Summary
Bioprosthetic aortic valve sizing impacts patient outcomes. The Medtronic Hancock II/Mosaic (MM) sizer accommodates larger prostheses than the Edwards Perimount (EP) for a given annulus, potentially affecting effective orifice area index (EOAI) calculations.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Prosthetic Valve Design
Background:
- Effective orifice area index (EOAI) is crucial for bioprosthetic aortic valve function and patient longevity.
- Discrepancies in valve sizing can arise due to differences in prosthesis design and manufacturer sizing guidelines.
- Accurate sizing is essential for optimizing hemodynamic performance and long-term outcomes in aortic valve disease.
Purpose of the Study:
- To investigate the relationship between true aortic annular diameter and the sizers used for Medtronic Hancock II/Mosaic (MM) and Edwards Perimount (EP) bioprosthetic valves.
- To evaluate how different valve designs accommodate various prosthesis sizes within a given annular diameter.
- To understand the implications of sizing variations on the resultant implanted prosthesis and its effective orifice area (EOA).
Main Methods:
- Prospective observational study of 318 patients undergoing aortic valve replacement.
- Determination of true annular diameter using a universal sizer (UNIV).
- Comparison of the largest fitting MM and EP standard aortic sizers against the UNIV sizer and the implanted prosthesis size.
Main Results:
- The EP sizer was smaller than the UNIV in 34% of cases, versus 5.3% for the MM sizer (p < 0.001).
- The MM sizer was at least one size larger than the true annulus in 38.7% of cases, versus 5.3% for the EP sizer (p < 0.001).
- MM implants were equal to or greater than UNIV in 88.5% of cases, compared to 49.6% for EP implants (p < 0.001).
Conclusions:
- A larger MM prosthesis can be accommodated for a given true annular diameter compared to the EP prosthesis.
- These sizing differences may explain variations in the advertised effective orifice area (EOA) between different bioprosthetic aortic valve models.
- Optimizing prosthesis selection based on true annular diameter is critical for accurate EOAI assessment and improved patient outcomes.
