title: Significance of spatial orientation of percutaneously placed bioprosthetic venous valves in an ovine model.
abstract: OBJECTIVE
  To investigate two spatial orientations of a percutaneously placed bicuspid second-generation bioprosthetic venous valve (SG-BVV) in the jugular vein (JV).
  
  
  METHODS
  Twelve SG-BVVs, consisting of small intestinal submucosa attached to a nitinol frame were placed across a natural valve (NV) in the distal JV in six sheep. Six SG-BVVs were oriented as NV leaflets (group A) and the other six SG-BVVs were rotated 90 degrees to NV leaflets (group B). SG-BVV function was studied by venography performed immediately after placement and at 5 weeks after placement. Animals were killed at 5 weeks, and gross examinations were performed.
  
  
  RESULTS
  Desired valve orientation after deployment was seen in all SG-BVVs. In group A, all valves exhibited good valve function on immediate and 5-week venography. At gross examination, leaflets were attached mostly at the valve base and free cusp areas were similar in both cusps with a mean of 154.8 mm2 +/- 45.6 for one cusp and 142 mm2 +/- 53.4 for the other cusp (P = .188). In group B, all valves showed good function on immediate venography and in five valves prior to killing. Valve attachment to the vein wall in this group involved a longer segment of leaflets and their free areas were smaller with a wide variety of cusp sizes. Mean free leaflet areas of opposing cusps measured 106.3 mm2 +/- 36.5 and 66.1 mm2 +/- 34.6, respectively (P = .025). Difference in leaflet areas between group A and group B was significant (P = .019).
  
  
  CONCLUSIONS
  Proper spatial orientation of the SG-BVV at deployment is important for valve function and should have the same orientation as the NV.
authors.affiliation: Dotter Interventional Institute, Oregon Health & Science University, Portland, Oregon 97239, USA. pavcnikd@ohsu.edu
authors.forename: Dusan
authors.initials: D
authors.lastname: Pavcnik
authors.forename: John A
authors.initials: JA
authors.lastname: Kaufman
authors.forename: Barry T
authors.initials: BT
authors.lastname: Uchida
authors.forename: Brian
authors.initials: B
authors.lastname: Case
authors.forename: Luiz O
authors.initials: LO
authors.lastname: Correa
authors.forename: Ahmet Yigit
authors.initials: AY
authors.lastname: Goktay
authors.forename: Ayumi
authors.initials: A
authors.lastname: Hamada
authors.forename: Frederick S
authors.initials: FS
authors.lastname: Keller
authors.forename: Josef
authors.initials: J
authors.lastname: Rösch
mesh_terms: D000818:Animals; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D007421:Intestine, Small / Q000098:blood supply; D007601:Jugular Veins / Q000601:surgery*; D008943:Mitral Valve / Q000601:surgery*; D023421:Models, Animal; D011474:Prosthesis Design; D012756:Sheep