The Complete Supraannular Concept: In Vivo Hemodynamics of Bovine and Porcine Aortic Bioprostheses

• Published in: Circulation (New York, N.Y.) N.Y.), 2009-09, Vol.120 (11), p.S139-S145
• Main Authors: RUZICKA, Daniel J, HETTICH, Ina, HUTTER, Andrea, BLEIZIFFER, Sabine, BADIU, Catalin C, BAUERNSCHMITT, Robert, LANGE, Ruediger, EICHINGER, Walter B
• Format: Article
• Language: English
• Subjects: Aged; Animals; Aortic Valve - physiopathology; Aortic Valve - surgery; Biological and medical sciences; Bioprosthesis; Blood and lymphatic vessels; Blood Pressure; Cardiology. Vascular system; Cattle; Diseases of the aorta; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Heart Valve Prosthesis Implantation - methods; Hemodynamics; Humans; Male; Medical sciences; Swine
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.109.844332

Complete supraannular placement of an aortic bioprosthesis is one approach to optimize the hemodynamic result of an aortic valve replacement. It is achieved with the combination of a special valve design and the supraannular sewing technique with noneverted mattress sutures. We evaluated 5 bioprostheses designed for complete supraannular placement to assess potential hemodynamic differences caused by factors (eg, valve material) other than implantation position. In 336 patients (mean age, 72.0+/-7.1 years; 143 women), hemodynamics including mean pressure gradients, effective orifice areas, and indices and incidence of patient-prosthesis mismatch were evaluated 6 months after surgery. Annulus diameter was measured during surgery. Patients received the Carpentier Edwards Perimount Magna (Magna, n=169), the Medtronic Mosaic (Mosaic, n=46), the Mosaic Ultra (Ultra, n=17), the SJM Epic Supra (Epic, n=46), and the Sorin Soprano (Soprano, n=58). For small annulus sizes (24 mm) annulus sizes, the mean pressure gradients of the Magna were lower than the Epic (10.0+/-3.5 mm Hg versus 14.9+/-6.4 mm Hg; 9.9+/-4.0 mm Hg versus 18.6+/-12.7 mm Hg). Furthermore, in patients with large annulus size, the mean pressure gradients of the Soprano (11.4+/-3.8 mm Hg) were lower compared with the Epic (18.5+/-12.7 mm Hg). Severe patient-prosthesis mismatch was observed more frequently in patients with the Mosaic (12/46; 26.1%) and the Ultra (3/17; 17.6%) prostheses. Complete supraannular placement cannot prevent high pressure gradients or patient-prosthesis mismatch thoroughly, but the choice of a bovine prosthesis can optimize hemodynamic performance.