HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Rainald Seitelberger Gernot Seebacher Reinhard Moidl Paul Simon Ernst Wolner Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Seitelberger, R. Articles by Wolner, E. Search for Related Content PubMed PubMed Citation Articles by Seitelberger, R. Articles by Wolner, E. Related Collections Valve disease

Eur J Cardiothorac Surg 2004;25:358-363
© 2004 Elsevier Science NL

Relation between size of prosthesis and valve gradient: comparison of two aortic bioprosthesis

Department of Cardio-Thoracic Surgery, Medical University Vienna, Allgemeines Krankenhaus, Waehringer Guertel 18-20, A-1090 Vienna, Austria

Received 13 October 2003; received in revised form 9 December 2003; accepted 15 December 2003.

^* Corresponding author. Tel.: +43-1-404005620; fax: +43-1-4405309
e-mail: seitel{at}magnet.at

Objectives: The outcome of patients undergoing aortic valve replacement (AVR) may be affected by the influence of prosthesis–patient mismatch on left ventricular mass regression. However, due to the discrepancies in labeled valve size, size of sizer and actual valve dimension, it is difficult to compare different valve types. In order to perform an objective comparison, this study was designed to compare the hemodynamics of the Edwards Lifescience pericardial (ELP) and the Medtronic Mosaic porcine (MM) bioprosthesis between patients receiving the same valve size and between patients with the same aortic annulus diameter. Methods: This prospective, randomized study was performed on 81 hospital survivors out of 86 patients undergoing AVR with either the ELP (n=39) or the MM (n=42) bioprosthesis. Intra-operative randomization was performed after the surgeon had excised the aortic valve, measured the size of the aortic annulus with three different sizers (ELP, MM and a set of metric sizers), and decided which size he would implant for either of the valve types. All valves were implanted in supra-annular position with the same implantation technique. Echocardiographic follow-up was performed early postoperatively and 6 months thereafter. Results: In 12 (31%) of the patients receiving the ELP-valve, as compared to 3 (7.1%) of the patients receiving the MM-valve, the labeled valve size was smaller than the aortic annulus diameter (P<0.05). Early postoperatively, mean (17.4±3.1 vs 20.3±3.6 mmHg) and peak gradients (30.1±4.8 vs 37.6±9.6 mmHg) for the 21 mm ELP-valve were lower than for the 21 mm MM-valve (P<0.05). All other hemodynamic parameters did not show significant differences at any time point. When the same aortic annulus diameter was taken as a reference, there were no significant hemodynamic differences between either valve type at any time point, regardless of the valve size implanted. Conclusions: This study demonstrates that the hemodynamic performance of the ELP and the MM bioprosthesis are comparable when the same aortic annulus diameter is taken as a reference. The significant variabilities between different valve types with regard to labeled valve size, valve-sizer size and actual valve size have to be taken into account, when hemodynamic comparisons are performed.

Key Words: Aortic valve replacement • Biological prosthesis • Aortic annulus diameter • Labeled valve size • Hemodynamic performance

This article has been cited by other articles:

				F. Bakhtiary, O. Dzemali, U. Steinseiffer, C. Schmitz, B. Glasmacher, A. Moritz, and P. Kleine Opening and closing kinematics of fresh and calcified aortic valve prostheses: An in vitro study J. Thorac. Cardiovasc. Surg., September 1, 2007; 134(3): 657 - 662. [Abstract] [Full Text] [PDF]

				M. J. Dalmau, J. Maria Gonzalez-Santos, J. Lopez-Rodriguez, M. Bueno, A. Arribas, and F. Nieto One year hemodynamic performance of the Perimount Magna pericardial xenograft and the Medtronic Mosaic bioprosthesis in the aortic position: a prospective randomized study Interactive CardioVascular and Thoracic Surgery, June 1, 2007; 6(3): 345 - 349. [Abstract] [Full Text] [PDF]

				I. M. Wagner, W. B. Eichinger, S. Bleiziffer, F. Botzenhardt, I. Gebauer, R. Guenzinger, R. Bauernschmitt, and R. Lange Influence of completely supra-annular placement of bioprostheses on exercise hemodynamics in patients with a small aortic annulus J. Thorac. Cardiovasc. Surg., May 1, 2007; 133(5): 1234 - 1241. [Abstract] [Full Text] [PDF]

				F. Bakhtiary, M. Schiemann, O. Dzemali, S. Dogan, V. Schachinger, H. Ackermann, A. Moritz, and P. Kleine Impact of Patient-Prosthesis Mismatch and Aortic Valve Design on Coronary Flow Reserve After Aortic Valve Replacement J. Am. Coll. Cardiol., February 20, 2007; 49(7): 790 - 796. [Abstract] [Full Text] [PDF]

				G. Gerosa, V. Tarzia, G. Rizzoli, and T. Bottio Small aortic annulus: The hydrodynamic performances of 5 commercially available tissue valves J. Thorac. Cardiovasc. Surg., May 1, 2006; 131(5): 1058 - 1064. [Abstract] [Full Text] [PDF]

				M. R. Moon, M. K. Pasque, N. A. Munfakh, S. J. Melby, J. S. Lawton, N. Moazami, J. E. Codd, T. D. Crabtree, H. B. Barner, and R. J. Damiano Jr Prosthesis-Patient Mismatch After Aortic Valve Replacement: Impact of Age and Body Size on Late Survival Ann. Thorac. Surg., February 1, 2006; 81(2): 481 - 489. [Abstract] [Full Text] [PDF]

				H.-H. Sievers Prosthetic aortic valve replacement J. Thorac. Cardiovasc. Surg., May 1, 2005; 129(5): 961 - 965. [Full Text] [PDF]

				R.-U. Kuehnel, R. Puchner, A. Pohl, M. O. Wendt, M. Hartrumpf, M. Pohl, and J. M. Albes Characteristic resistance curves of aortic valve substitutes facilitate individualized decision for a particular type Eur. J. Cardiothorac. Surg., March 1, 2005; 27(3): 450 - 455. [Abstract] [Full Text] [PDF]