Open Access
Thorac Cardiovasc Surg 2017; 65(S 01): S1-S110
DOI: 10.1055/s-0037-1598969
e-Poster Presentations
Tuesday, February 14th, 2017
DGTHG: e-Poster - Acquired Heart Valve Disease
Georg Thieme Verlag KG Stuttgart · New York

St Jude Trifecta versus Edwards Perimount Magna Ease: No Difference in Coronary Flow after Transcatheter Aortic Valve-in-Valve Implantation. An In Vitro Investigation

S. Stock
1   University of Luebeck, Department of Cardiac and Thoracic Vascular Surgery, Luebeck, Germany
,
M. Scharfschwerdt
1   University of Luebeck, Department of Cardiac and Thoracic Vascular Surgery, Luebeck, Germany
,
R. Meyer-Saraei
1   University of Luebeck, Department of Cardiac and Thoracic Vascular Surgery, Luebeck, Germany
,
D. Richardt
1   University of Luebeck, Department of Cardiac and Thoracic Vascular Surgery, Luebeck, Germany
,
E.I. Charitos
2   Universitiy of Halle (Saale), Department of Cardiac Surgery, Halle (Saale), Germany
,
H.-H. Sievers
1   University of Luebeck, Department of Cardiac and Thoracic Vascular Surgery, Luebeck, Germany
,
T. Hanke
1   University of Luebeck, Department of Cardiac and Thoracic Vascular Surgery, Luebeck, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
03 February 2017 (online)

 
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    Objectives: Nowadays, the transcatheter aortic valve-in-valve implantation (TAVI-ViV) is an established treatment strategy for degenerated surgical aortic valve bioprostheses (SAVB). Despite excellent hemodynamics, there is some concern regarding coronary obstruction, especially after TAVI-ViV in calcified SAVB with externally mounted leaflets. We sought to determine differences in coronary flow after TAVI-ViV in non-calcified and artificially “calcified” SAVB with externally and internally mounted leaflets in an in vitro investigation.

    Methods: Aortic root models including known risk factors for coronary obstruction served for the implantation of SAVB with either externally (Trifecta, St. Jude Medical, St. Paul, MN, United States) or internally (Perimount Magna Ease, Edwards Lifesciences, Irvine, CA, United States) mounted leaflets (both label size 25). Left and right coronary flow at two different coronary heights (8 and 10 mm) as well as hydrodynamics (transvalvular gradient and geometric orifice area) were measured before and after TAVI-ViV with an Edwards Sapien XT, label size 23. After the first experimental run, the SAVB leaflets were artificially “calcified” with glue and the measurements repeated.

    Results:

    In both models, non-calcified and “calcified,” we found no significant reduction in coronary flow following TAVI-ViV, neither when testing Trifecta™ nor Perimount® Magna Ease.

    Transvalvular gradient increased significantly after TAVI-ViV in the non-calcified model (Trifecta p = 0.0001, Perimount Magna Ease p = 0.006), whereas geometric orifice area decreased significantly (both p < 0.001). In the “calcified” model, transvalvular gradient decreased and geometric orifice area increased significantly after TAVI-ViV (all p < 0.001).

    Conclusion: In this specific model, TAVI-ViV is feasible in SAVB with externally (St. Jude Medical Trifecta) and internally (Edwards Perimount Magna Ease) mounted leaflets, noncalcified as well as “calcified,” without risk of coronary obstruction. Nevertheless, because of the variety of aortic root pathology, preoperative thorough assessment remains mandatory for uneventful TAVI-ViV.


     

    No conflict of interest has been declared by the author(s).

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