Najla Sadat, Michael Scharfschwerdt, Stefan Reichert, Buntaro Fujita, Stephan Ensminger
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Mean pressure gradient (MPG), effective orifice area (EOA), geometric orifice area (GOA<sub>max</sub>), and pinwheeling index (PWI<sub>mean</sub>) were analyzed.</p><p><strong>Results: </strong> EOA and MPG of the THV did not differ significantly regarding the position inside the Magna Ease and the Hancock II (<i>p</i> > 0.05). However, EOA differed significantly, depending on the position of the THV inside Trifecta (2 vs. 5 mm; <i>p</i> = 0.021 and 2 vs. 6 mm; <i>p</i> < 0.001). The THV presented the highest EOA (2.047 cm<sup>2</sup>) and the lowest MPG (5.387 mm Hg) inside the Magna Ease, whereas the lowest EOA (1.335 cm<sup>2</sup>) and the highest MPG (11.876 mm Hg) were shown inside the Hancock II. Additionally, the highest GOA<sub>max</sub> and the lowest PWI<sub>mean</sub> of the THV were noticed inside the Magna Ease. The THV showed lower GOA<sub>max</sub> and higher PWI<sub>mean</sub> inside the Trifecta when placed in a deeper position.</p><p><strong>Conclusion: </strong> Deep implantation of the SAPIEN 3 Ultra inside the Trifecta correlates with impaired functional results. In contrast, the implantation position of the SAPIEN 3 Ultra inside the Magna Ease and the Hancock II did not have a significant effect on functional results.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.3000,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of Different Valve-in-Valve Positions on Functional Results of the New Generation of Balloon-Expandable Transcatheter Heart Valve.\",\"authors\":\"Najla Sadat, Michael Scharfschwerdt, Stefan Reichert, Buntaro Fujita, Stephan Ensminger\",\"doi\":\"10.1055/s-0044-1787701\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong> Very precise positioning of the transcatheter heart valve (THV) inside the degenerated SAV is a crucial factor for valve-in-valve (ViV) procedure to achieve optimal hemodynamic results. Therefore, our study aimed to investigate the impact of implantation depth on functional results after ViV procedures in a standardized in vitro setting.</p><p><strong>Methods: </strong> THV (SAPIEN 3 Ultra 23-mm size) and three SAV models (Magna Ease, Trifecta, and Hancock II-all 21-mm size) were tested at different circulatory conditions in five different positions of the THV (2-6 mm) inside the SAV. Mean pressure gradient (MPG), effective orifice area (EOA), geometric orifice area (GOA<sub>max</sub>), and pinwheeling index (PWI<sub>mean</sub>) were analyzed.</p><p><strong>Results: </strong> EOA and MPG of the THV did not differ significantly regarding the position inside the Magna Ease and the Hancock II (<i>p</i> > 0.05). However, EOA differed significantly, depending on the position of the THV inside Trifecta (2 vs. 5 mm; <i>p</i> = 0.021 and 2 vs. 6 mm; <i>p</i> < 0.001). The THV presented the highest EOA (2.047 cm<sup>2</sup>) and the lowest MPG (5.387 mm Hg) inside the Magna Ease, whereas the lowest EOA (1.335 cm<sup>2</sup>) and the highest MPG (11.876 mm Hg) were shown inside the Hancock II. Additionally, the highest GOA<sub>max</sub> and the lowest PWI<sub>mean</sub> of the THV were noticed inside the Magna Ease. The THV showed lower GOA<sub>max</sub> and higher PWI<sub>mean</sub> inside the Trifecta when placed in a deeper position.</p><p><strong>Conclusion: </strong> Deep implantation of the SAPIEN 3 Ultra inside the Trifecta correlates with impaired functional results. 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引用次数: 0
摘要
目的：经导管心脏瓣膜（THV）在退化的SAV内的精确定位是瓣中瓣（ViV）手术达到最佳血流动力学效果的关键因素。因此，我们的研究旨在体外标准化设置中调查植入深度对 ViV 手术后功能结果的影响：方法：在不同的循环条件下，在 SAV 内 THV 的五个不同位置（2-6 毫米）测试了 THV（SAPIEN 3 Ultra 23 毫米尺寸）和三种 SAV 型号（Magna Ease、Trifecta 和 Hancock II，均为 21 毫米尺寸）。对平均压力梯度（MPG）、有效管口面积（EOA）、几何管口面积（GOAmax）和平滑指数（PWImean）进行了分析：在 Magna Ease 和 Hancock II 中，THV 的 EOA 和 MPG 没有明显差异（P > 0.05）。然而，在 Trifecta 中，EOA 因 THV 的位置不同而有显著差异（2 mm 与 5 mm；p = 0.021 和 2 mm 与 6 mm；p 2），在 Magna Ease 中，MPG 最低（5.387 mm Hg），而在 Hancock II 中，EOA 最低（1.335 cm2），MPG 最高（11.876 mm Hg）。此外，在 Magna Ease 中，THV 的 GOAmax 最高，PWImean 最低。在Trifecta中，THV的GOAmax较低，PWI均值较高：结论：将 SAPIEN 3 Ultra 深植入 Trifecta 内部会导致功能受损。相比之下，SAPIEN 3 Ultra 在 Magna Ease 和 Hancock II 内的植入位置对功能结果没有显著影响。
Impact of Different Valve-in-Valve Positions on Functional Results of the New Generation of Balloon-Expandable Transcatheter Heart Valve.
Objectives: Very precise positioning of the transcatheter heart valve (THV) inside the degenerated SAV is a crucial factor for valve-in-valve (ViV) procedure to achieve optimal hemodynamic results. Therefore, our study aimed to investigate the impact of implantation depth on functional results after ViV procedures in a standardized in vitro setting.
Methods: THV (SAPIEN 3 Ultra 23-mm size) and three SAV models (Magna Ease, Trifecta, and Hancock II-all 21-mm size) were tested at different circulatory conditions in five different positions of the THV (2-6 mm) inside the SAV. Mean pressure gradient (MPG), effective orifice area (EOA), geometric orifice area (GOAmax), and pinwheeling index (PWImean) were analyzed.
Results: EOA and MPG of the THV did not differ significantly regarding the position inside the Magna Ease and the Hancock II (p > 0.05). However, EOA differed significantly, depending on the position of the THV inside Trifecta (2 vs. 5 mm; p = 0.021 and 2 vs. 6 mm; p < 0.001). The THV presented the highest EOA (2.047 cm2) and the lowest MPG (5.387 mm Hg) inside the Magna Ease, whereas the lowest EOA (1.335 cm2) and the highest MPG (11.876 mm Hg) were shown inside the Hancock II. Additionally, the highest GOAmax and the lowest PWImean of the THV were noticed inside the Magna Ease. The THV showed lower GOAmax and higher PWImean inside the Trifecta when placed in a deeper position.
Conclusion: Deep implantation of the SAPIEN 3 Ultra inside the Trifecta correlates with impaired functional results. In contrast, the implantation position of the SAPIEN 3 Ultra inside the Magna Ease and the Hancock II did not have a significant effect on functional results.
期刊介绍：
The Thoracic and Cardiovascular Surgeon publishes articles of the highest standard from internationally recognized thoracic and cardiovascular surgeons, cardiologists, anesthesiologists, physiologists, and pathologists. This journal is an essential resource for anyone working in this field.
Original articles, short communications, reviews and important meeting announcements keep you abreast of key clinical advances, as well as providing the theoretical background of cardiovascular and thoracic surgery. Case reports are published in our Open Access companion journal The Thoracic and Cardiovascular Surgeon Reports.
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