Open versus closed position fixation of bioprosthesis. Comparative in vitro studies from the viewpoint of durability

In an effort to normalize the dynamic leaflet behavior of a porcine bioprosthesis, an experimental attempt was made to treat a tissue heart valve with 0.625% glutaraldehyde in the open position ("open-type valve"). Eighteen open-type valves, having fixed openings of various sizes, were examined with our pulse simulators. Eight closed-type valves, which were treated in the closed position, were studied for comparison. The results showed that closed-type valve tended to offer an immobile cusp at a low flow state; at a pump pressure of 90 mm Hg in a pulsatile flow or under steady flows of no more than 10 L/min. By contrast, the open-type valve showed the symmetric cusps opening with circular orifices at any given flow rates. Analysis of the pressure loss coefficient revealed that the leaflets prepared in the open position produced only a minimal impediment to the forward flow. One half of the anatomic orifice of a valve was considered to be the optimal size for the fixed opening. It is concluded that open position fixation is expected to provide the bioprosthesis with improved fatigue durability in patients with low cardiac output syndrome and in small children.