Aortic valve repair: state of the art
Prof. Hermann Reichenspurner
MVT Aortic 2022, vol.2
– This video includes a comprehensive look at aortic valve repair, with topics ranging from repair techniques to remodeling techniques, including challenges, tips and tricks, and outcomes.
– David, Yacoub, Okazi, Ross, reimplantation, remodeling, annuloplasty, and more.
Prof. Martin Andreas
MVT Aortic 2022, vol.2
– There are different centers and different techniques, but do they share the same outcomes?
– Be sure to catch his explanation about what makes decellularized heart valves so unique.
– Proper skills and robust training are key.
Dr. Patrick Klein
MVT Aortic 2022, vol.2
– Listen to what he has to say about total aortic root replacement.
– How can we assess the durability and avoid adverse valve-related events when using mechanical and biological valves?
– Hear about his personal experience using new-generation biological valves in patients 57 ± 7 years old.
Dr. Dashkevich
MVT Aortic 2022, vol.2
– For a patient with endocarditis, should we consider a biological or mechanical prosthesis?
– Briefly see an interesting patient case, accompanied by detailed photos and explanations.
– Don’t forget to pay attention to the anterior mitral leaflet, and strongly consider your coronary reimplantation strategy.
Prof. Ruggero De Paulis
MVT Aortic 2022, vol.1
– Many surgical options, very comprehensive, and very unbiased
– A redo-SAVR is not as simple as just “redoing” the procedure: beware of higher risk and more complex procedures
– Very clear 7-step removal process of the original valve prosthesis
-Pros and cons of different pledgets, suture techniques, valve positioning, valve sizing, and more
Prof. Alessandro Della Corte
MVT Aortic 2022, vol.1
– Patients with an “ascending” phenotype? A separate vale and ascending graft replacement procedure is an option
– Patients with a “root” phenotype? Consider addressing the root earlier (50 mm root diameter)
– Bentall is still the gold standard, but valve-sparing procedures have similarly good results
Prof. Ruggero De Paulis
MVT Aortic 2022, vol.1
– First and foremost, not all bicuspid aortic valves are the same
– Many post-operative measurements and goals are included within to help guide you to optimal patient outcomes
– Check out the insight provided about valve-sparing, valve repair, external annuloplasty, and more
Prof. Michael Borger
MVT Aortic 2022, vol.1
-The “aortic size paradox”: an interesting paradox, indeed
-Length? Diameter? Which should we pay more attention to?
-Be sure to pay attention to genetics, biomarkers, abnormal flow, other risk factors, and more
Ai L et al. Innovations. 2017; 12: 338–45. DOI: 10.1097/imi.0000000000000407
Aim
To develop a clinically relevant aortic root model, and then compare the haemodynamic function of the EDWARDS INTUITY valve (a rapid deployment valve) with the Carpentier- Edwards PERIMOUNT Magna Ease valve (a conventional bioprosthetic valve), in vitro.
Background Information
Many trials have shown the short-term safety and efficacy of sutureless rapid deployment aortic valves, but direct comparisons of the haemodynamic performance of these new valves with conventional bioprosthetic valves are lacking.
Methods
Model development
Multi-slice computed tomography reconstructions in patients with aortic stenosis were used to generate a 3D printed model of an aortic root.
Effective diameter of the aortic annulus was 21 mm, effective area was 3.38 cm2 and LVOT area was 3.01 cm2.
Valve Deployment
For measurement of haemodynamic parameters (EOA, TPG and LVOT geometry), Magna Ease valves were sutured to the model’s annulus, with and without the use of pledgets, and EDWARDS INTUITY valves were secured by balloon inflation. EDWARDS INTUITY
valves were further tested with frames expanded
to 22, 23, 24 and 25 mm.
Figure 1: EDWARDS INTUITY and Magna Ease valves in the aortic root model and cadaver heart
A: EDWARDS INTUITY valve in the model;
B: Magna Ease valve in the model without pledgets;
C: Magna Ease valve in the model, with pledgets;
D: Outflow view of the aortic root model; E: EDWARDS INTUITY valve in the cadaver heart;
F: Magna Ease valve without pledgets in the cadaver heart.
Reproduced from Ai L et al, 2017. © 2017 Wolters Kluwer Health, Inc. Reproduced with permission LVOT in the rubber gasket aortic root model and in the cadaver heart.
Results
Hemodynamic Performance
The EDWARDS INTUITY valve had both a greater EOA and a lower TPG than the Magna Ease valve, irrespective of pledget use (Figure 1). EOA
and TPG were also significantly different between Magna Ease valves with and without pledgets (all p<0.002 or 0.001).
LVOT Performance
Expanding the EDWARDS INTUITY valve frame diameter from 22 to 25 mm increased the average LVOT area index stepwise from 1.07 to 1.34: this minimally affected EOA or TPG (Table 1).
EDWARDS INTUITY valves resulted in more circular LVOTs than Magna Ease valves, although increasing ellipticity did not impact EOA or TPG.
Average maximum flow velocity was lower across the EDWARDS INTUITY valve than the Magna Ease valve without pledgets (p<0.003), as were maximum turbulent shear stress (p<0.02) and turbulent kinetic
energy (p<0.002).
| EDWARDS INTUITY valve (n=4) | Magna Ease valve (n=4) | Magna Ease valve with pledgets (n=4) | |
| EOA, cm2 | 1.85 ± 0.06 | 1.56 ± 0.01 | 1.21 ± 0.08 |
| Mean gradient, mmHg | 16.8 ± 1.3 | 23.4 ± 0.51 | 1.21 ± 0.08 |
EOA: effective orifice area
Table 1: TPG and EOA of models with an EDWARDS INTUITY valve or a Magna Ease valve (with or without pledgets)
Limitations
- Such a model, isolated from the left ventricle, cannot replicate all physiological mechanical properties.
- Pathological changes and normal physiological variations can affect valve performance in vivo: these were not modelled here.
- The use of saline, rather than blood or a substitute, may have affected simulated valve performance.
Conclusions
- Haemodynamic performance was superior for the EDWARDS INTUITY valve than the Magna Ease valve with increased EOA and reduced mean gradient.
- Pledgets worsened Magna Ease valve performance.
- Maximum velocity, turbulent shear stress and kinetic energy were all lower across the EDWARDS INTUITY valve than the Magna Ease valve.
- Haemodynamic advantages may account for the superior clinical performance of rapid deployment valves over conventional surgical valves
Important safety information:
Use of the EDWARDS INTUITY Elite valve system may be associated with new or worsened conduction disturbances,
which may require a permanent cardiac pacemaker implant (PPI). The rate of PPI for the EDWARDS INTUITY Elite
valve is within the range reported in the literature for various rapid deployment valves, but higher than that reported
for surgical aortic valves. Physicians should assess the benefits and risks of the EDWARDS INTUITY Elite valve prior to
implantation. See instructions for use for additional information.
For professional use. For a listing of indications, contraindications, precautions, warnings, and potential adverse events, please refer to the Instructions for Use (consult eifu.edwards.com where applicable).
Edwards devices placed on the European market meeting the essential requirements referred to in Article 3 of the Medical Device Directive 93/42/EEC bear the CE marking of conformity
Edwards, Edwards Lifesciences, the stylized E logo, Carpentier-Edwards, Carpentier-Edwards PERIMOUNT, EDWARDS INTUITY, EDWARDS INTUITY Elite, Magna, Magna Ease, PERI, PERIMOUNT and PERIMOUNT Magna are trademarks are trademarks or service marks of Edwards Lifesciences Corporation or its affiliates. All other trademarks are the property of their respective owners.
© 2021 Edwards Lifesciences Corporation. All rights reserved. PP–EU-2350 v1.0
Edwards Lifesciences • Route de l’Etraz 70, 1260 Nyon, Switzerland • edwards.com
Dr. Gianluigi Perri
MVT Aortic 2021
Prof. Conal Austin
MVT Aortic 2021
Prof. Ruggero De Paulis
MVT Aortic 2021
Prof. Stephan Ensminger
MVT Aortic 2021
Prof. Alfred Kocher
MVT Aortic 2021
Dr. Alain Berrebi
MVT Aortic 2021
Michael Borger, Germany
Can Gollmann-Tepeköylü, Austria
