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Hemodynamic assessment of the Ionescu-Shiley pericardial xenograft in the mitral position
Insights
The Ionescu-Shiley bioprosthesis shows excellent function for mitral valve repair. Hemodynamic assessment revealed significant improvements in cardiac function and reduced pulmonary pressures post-surgery.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Cardiac Physiology
Background:
- The Ionescu-Shiley bioprosthesis is known for low thrombogenicity and good durability.
- Further hemodynamic assessment is needed to fully understand its performance.
Purpose of the Study:
- To assess cardiac function and hemodynamic performance of the Ionescu-Shiley bioprosthesis.
- Evaluate heterograft performance in patients with severe mitral stenosis/regurgitation.
Main Methods:
- Right and left heart catheterization at rest and during exercise.
- Hemodynamic parameters measured 3-6 months postoperation in 8 patients.
- Comparison of pre- and postoperative cardiac function and clinical status (NYHA).
Main Results:
- Significant decrease in mean pulmonary artery pressure (32 to 22 mm Hg) and pulmonary wedge pressure (21 to 13 mm Hg).
- Significant increase in cardiac index (2.1 to 2.5 L/min/m2).
- Marked improvement in clinical status (NYHA), low gradient across the xenograft, and no detected regurgitation in 7/8 patients.
Conclusions:
- The Ionescu-Shiley mitral bioprosthesis demonstrates excellent hemodynamic function.
- The pericardial xenograft provides effective relief from mitral stenosis/regurgitation.
- Positive clinical outcomes and improved cardiac function support its use.
Abstract:
While the very low thrombogenicity without anticoagulant therapy and generally good durability of the lonescu-Shiley bioprosthesis has been demonstrated, further hemodynamic assessment is necessary. The present study assessed cardiac function and heterograft performance during right and left heart catheterization at rest and exercise (three to six months postoperation) of eight patients with severe mitral stenosis and/or regurgitation prior to surgery. We found, comparing pre- and postoperative resting values, that mean pulmonary artery pressure decreased (32 +/- 2.7 to 22 +/- 3.5 mm Hg; P < 0.02), cardiac index increased (2.1 +/- 0.09 to 2.5 +/- 0.13 liters/min/m2; P < 0.01), pulmonary wedge pressure decreased (21 +/- 2.3 to 13 +/- 1.8 mm Hg; P < 0.01), and the clinical status (NYHA) improved markedly. Mean diastolic gradient across the pericardial xenograft was 6.1 +/- 1.1 mm Hg at rest and 14.6 +/- 2.3 mm Hg on exercise. The calculated xenograft surface area was 1.7 cm2 at rest and 2.0 cm2 during exercise. No regurgitation was detected in seven of eight patients. Thus, mitral lonescu-Shiley bioprosthesis provide excellent heterograft function.