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Eur J Cardiothorac Surg 2005;27:450-455
© 2005 Elsevier Science NL
a Department of Cardiovascular Surgery Heart Center Brandenburg, Ladeburger Strasse 17, 16321 Bernau, Germany
b Institute of Medical Physics and Biophysics, Charite, Berlin, Germany
Received 16 September 2004; received in revised form 18 November 2004; accepted 1 December 2004.
* Corresponding author. Address: Herzchirurgie, Herzzentrum Brandenberg, Ladeburger Strasse 17, Bernau 16321, Germany. Tel.: +49 3338 69 4510; fax: +49 3338 69 4544. (E-mail: j.albes{at}immanuel.de).
Objective: Biological valves exhibit characteristic curves (CC) regarding transvalvular gradient, resistance, and effective orifice area when correlated with a physiological cardiac output range (CO). The slope of the curve of transvalvular resistance over a typical CO range characterizes the clinical performance of the valve. These information may support an individualized decision towards the most adequate valve type. Methods: In an extracorporeal mock circuit two types of stented biological aortic valves (constructed pericardial valves, Edwards Perimount: EP; porcine cusp valves, Medtronic Mosaic: MM) of 21, 23, and 25mm were investigated. Mean transvalvular gradient was measured over a range of 1.9 to 7.2l/min CO at a simulated heart rate of 70beats/min. Transvalvular resistance was calculated and presented as characteristic curves in a log–log-plot against cardiac output. Results: EP valves of all sizes demonstrated low slopes (resistance range; slope: 21mm: 53–79dynesscm–5; 0.29; 23mm: 44–56dynesscm–5; 0.12; 25mm: 38–45dynesscm–5; 0.12) while MM valves exhibited steep slopes (resistance range; slope: 21mm: 46–169dynesscm–5; 0.97; 23mm: 36– –146dynesscm–5; 0.95; 25mm: 27–64dynesscm–5; 0.68) Conclusions: While constructed pericardial valves demonstrate sufficient hemodynamic performance especially in the higher CO range porcine cusp valves exhibited minor resistance in the lower CO range. Patients who exercise regularly may therefore profit from a pericardial valve while patients with a small body surface area and little exercise who therefore remain in the lower CO range may be adequately treated with a porcine cusp valve.
Key Words: Aortic valve • Biological valve replacement • Hemodynamics • Cardiovascular pathology • Cardiovascular model
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