TY - JOUR
T1 - Preclinical determination of the best functional position for transcatheter heart valves implanted in rapid deployment bioprostheses
AU - Schäfer, Timm
AU - Doose, Christian
AU - Fujita, Buntaro
AU - Utzenrath, Marc
AU - Egron, Sandrine
AU - Schmitz, Christoph
AU - Scholtz, Smita
AU - Kütting, Maximilian
AU - Hakim-Meibodi, Kavous
AU - Börgermann, Jochen
AU - Gummert, Jan
AU - Steinseifer, Ulrich
AU - Ensminger, Stephan
N1 - Publisher Copyright:
© Europa Digital & Publishing 2017. All rights reserved.
Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2017/2
Y1 - 2017/2
N2 - Aims: The aim of this study was to determine the best functional position of a transcatheter heart valve (THV) implanted as a valve-in-valve (ViV) procedure in small rapid deployment valves (RDV) in an in vitro model. Methods and results: A 21 mm Perceval, Enable or INTUITY RDV was mounted into a pulse duplicator and a 23 mm balloon-expandable or a self-expanding THV was deployed (valve-in-valve) in two different positions. Under physiological hydrodynamic conditions, the performance of the THV was characterised by mean transvalvular pressure gradient (MPG), effective orifice area (EOA) and regurgitation volume (RV). Leaflet kinematics were assessed with high-speed video recordings, and X-ray images were acquired. All THV/RDV combinations met ISO requirements regarding hydrodynamic performance. In most cases, the higher position of the THV performed better than the lower one in terms of a lower MPG and increased EOA. Leaflet motion of the implanted THV was impaired in the lower position. In contrast, regurgitation volumes were relatively small and similar, regardless of the THV position. Conclusions: ViV implantation of a THV in a small RDV yielded satisfactory hydrodynamic results. In most cases, a high implantation position achieved lower MPG, higher EOA and a reduced risk of impaired THV leaflet function. Fluoroscopy images of the best functional ViV positions are presented as a blueprint for patient procedures.
AB - Aims: The aim of this study was to determine the best functional position of a transcatheter heart valve (THV) implanted as a valve-in-valve (ViV) procedure in small rapid deployment valves (RDV) in an in vitro model. Methods and results: A 21 mm Perceval, Enable or INTUITY RDV was mounted into a pulse duplicator and a 23 mm balloon-expandable or a self-expanding THV was deployed (valve-in-valve) in two different positions. Under physiological hydrodynamic conditions, the performance of the THV was characterised by mean transvalvular pressure gradient (MPG), effective orifice area (EOA) and regurgitation volume (RV). Leaflet kinematics were assessed with high-speed video recordings, and X-ray images were acquired. All THV/RDV combinations met ISO requirements regarding hydrodynamic performance. In most cases, the higher position of the THV performed better than the lower one in terms of a lower MPG and increased EOA. Leaflet motion of the implanted THV was impaired in the lower position. In contrast, regurgitation volumes were relatively small and similar, regardless of the THV position. Conclusions: ViV implantation of a THV in a small RDV yielded satisfactory hydrodynamic results. In most cases, a high implantation position achieved lower MPG, higher EOA and a reduced risk of impaired THV leaflet function. Fluoroscopy images of the best functional ViV positions are presented as a blueprint for patient procedures.
UR - http://www.scopus.com/inward/record.url?scp=85016071158&partnerID=8YFLogxK
U2 - 10.4244/EIJ-D-16-00237
DO - 10.4244/EIJ-D-16-00237
M3 - Journal articles
C2 - 27746401
AN - SCOPUS:85016071158
SN - 1774-024X
VL - 12
SP - 1706
EP - 1714
JO - EuroIntervention
JF - EuroIntervention
IS - 14
ER -