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Normal aortic valves stay open much longer in systole than porcine substitutes
Maboo Subhani1, Ramarathnam Krishna Kumar, Komarakshi R Balakrishnan
1Department of Mechanical Engineering, Indian Institute of Technology Madras, Chennai, India.
Objective:
To compare the opening mechanics of porcine valve substitutes with those of a normal human aortic valve.
Background:
All commercially available porcine valves are pretreated with glutaraldehyde. This study was undertaken to evaluate the consequences of such treatment on valve mechanics.
Methods:
The opening mechanics of the aortic valve, especially the time taken to open fully from a closed position, and the duration for which the valve is maximally open, were compared in a normal aortic valve, a stent-mounted porcine valve, and a stentless porcine valve, using a finite element model.
Results:
Despite a 4-fold higher gradient, stent-mounted porcine valves were slower in attaining the fully open position, and the time for which the valve was fully open was almost 25% less than a normal valve. In stentless valves, the compliant root made the initial opening mechanics similar to those of a normal valve. Once this effect was over, the effect of porcine leaflet properties took over, and there was a corresponding delay in the valve opening.
Conclusions:
Fixing the root with a stent and stiffening the leaflets with glutaraldehyde result in delayed valve opening and decrease the duration for which the valve is fully open, thus contributing to inferior hemodynamics.
