Mid-term results of freestyle aortic stentless bioprosthetic valve: clinical impact of quantitative analysis of in-vivo three-dimensional flow velocity profile by magnetic resonance imaging.
OBJECTIVE
The study aim was to investigate the in-vivo flow profiles of a stentless aortic bioprosthetic valve by MRI flow quantification, and to identify the clinical implication of prosthesis size and implantation method.


METHODS
Twenty-six patients with a Freestyle stentless aortic bioprosthetic valve were studied using three-dimensional flow velocity profile by MRI, and compared with four patients with a stented aortic bioprosthetic valve and four healthy volunteers. Flow velocity profiles were analyzed quantitatively by the hydromechanics parameter, mean to peak velocity ratio at peak systole and compared with parameters monitored echocardiographically.


RESULTS
In larger-sized valves or full root implantation, flow profiles showed an optimal pattern with low gradients, a high mean to peak velocity ratio, and minimum disturbance which approximated that of a normal valve. By contrast, a subset of patients, notably with 21 mm valves and subcoronary implantation, showed suboptimal flow pattern with high gradient and low mean to peak velocity ratio which approximated that of stented valves. The mean to peak velocity ratio was more strongly related to peak velocity than to the indexed effective orifice area.


CONCLUSIONS
Although stentless aortic bioprostheses have excellent hemodynamic performance, some patients show suboptimal results. This seems to occur more often when the subcoronary technique is used, and especially with 21-mm valves. Care must be taken when using the subcoronary technique with a 21-mm valve in patients with a small body surface area.
Matsue
Hajime
H
Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Suita, Japan.
Sawa
Yoshiki
Y
Matsumiya
Goro
G
Matsuda
Hikaru
H
Hamada
Seiki
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis; D001783:Blood Flow Velocity / Q000502:physiology; D019917:Blood Vessel Prosthesis Implantation; D004452:Echocardiography; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D015607:Stents