Clinical and hemodynamic implications of supra-annular implant of biological aortic valves.
The use of stented bioprostheses in elderly patients with degenerative aortic stenosis, despite being desirable, raises concerns about the harmful effects of residual obstruction to left ventricular outflow. To overcome this limitation new stented and stentless bioprostheses have been designed for supra-annular implant. However, the actual hemodynamic advantage of supra-annular implant over the intra-annular one remains incompletely understood. This review focuses on the geometry of biological valve prostheses designed for supra-annular implant and its implications for the echocardiographic assessment of valve hemodynamics. Available data about the hemodynamic performance of these valves implanted in the supra-annular position in comparison with the usual intra-annular implant are also reviewed. Other issues related to biological heart valve performance, such as biomaterials, tissue mechanics, durability, and clinical outcome are not addressed in this review.
Badano
Luigi P
LP
Department of Cardiopulmonary Sciences, A.O. S Maria della Misericordia, Udine, Italy. badano.luigi@aoud.sanita.fvg.it
Zamorano
Jose Luis
JL
Pavoni
Daisy
D
Tosoratti
Elena
E
Baldassi
Mara
M
Zakja
Edlira
E
Gianfagna
Pasquale
P
Fioretti
Paolo M
PM
Livi
Ugolino
U
D001011:Aorta / Q000033:anatomy & histology; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D001705:Bioprosthesis; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D015607:Stents; D014463:Ultrasonography