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Four-Dimensional Computed Tomography-Guided Valve Sizing for Transcatheter Pulmonary Valve Replacement
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Aortic annulus diameter and valve design each determine the valve size implanted.
Ulrich O von Oppell1, Leidulf Segadal, Rolf Busund
1University Hospital of Wales, Cardiff, UK. Ulrich.VonOppell@wales.nhs.uk
The Journal of Heart Valve Disease
|November 22, 2012
Summary
The Carpentier-Edwards PERIMOUNT Magna bioprosthetic valve showed better hemodynamics than the Medtronic Mosaic Ultra, with lower gradients and larger effective orifice area. However, the Ultra valve allowed for larger implanted sizes relative to the true aortic annulus.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Medical Devices
Background:
- Aortic stenosis is a common valvular heart disease.
- Bioprosthetic aortic valves are frequently used for aortic valve replacement.
- Accurate valve sizing is crucial for optimal patient outcomes.
Purpose of the Study:
- To compare the sizing characteristics and hemodynamics of Medtronic Mosaic Ultra and Carpentier-Edwards PERIMOUNT Magna bioprosthetic aortic valves.
- To evaluate valve performance in relation to the patient's true aortic annulus size.
Main Methods:
- Prospective, multicenter, randomized study of 141 patients undergoing aortic valve replacement.
- Perioperative and six-month postoperative data collection.
- Measurement of the true aortic annulus size using blinded sizers prior to randomization.
Main Results:
- The Magna valve group exhibited lower mean echo gradients (11 vs. 17 mmHg) and larger effective orifice area (EOA) (1.6 vs. 1.4 cm²) compared to the Ultra valve group (p < 0.01).
- A higher proportion of Magna valves were implanted smaller than the true aortic diameter (44% vs. 33%).
- Trivial to moderate regurgitation was more frequent with Magna valves (48% vs. 24%).
Conclusions:
- The Medtronic Mosaic Ultra valve facilitated the implantation of larger labeled sizes.
- The Carpentier-Edwards PERIMOUNT Magna valve demonstrated superior hemodynamic performance with lower gradients and larger EOAs relative to the true aortic annulus.
- Further long-term studies are needed to determine the clinical significance for bioprosthesis selection.
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