In vitro study of percutaneous aortic valve replacement: selection of a tissue valve.
BACKGROUND
Selection of the best tissue valve is an essential step before percutaneous aortic valve replacement (PAVR) becomes a clinical reality. The aim of this study was to evaluate in vitro three different tissue valves mounted within the same endovascular stent.


METHODS
Thirty stented valves (10 aortic porcine, 10 pulmonary porcine, and 10 pericardial tubular) were sutured within a 32-mm long by 23-mm diameter cobalt-nickel stent. The porcine valves were trimmed down close to the cusps. All valves were delivered with a percutaneous valvuloplasty catheter and placed orthotopically in a latex root that was cast from a sheep's aorta. The roots were tested in a pulse duplicator at a rate of 60 beats per minute and 3.5 liters per minute. The transvalvular gradient, maximum valve orifice area, and presence of central and paravalvular leaks were recorded echocardiographically.


RESULTS
Within the limitations of implantation in a synthetic, noncalcified annulus, the pericardial valve performed best in terms of orifice area, transvalvular gradients, and tissue bulk; but four of the ten valves showed a central leak due to the type of stent used.


CONCLUSIONS
The ideal valve for PAVR should collapse with minimal bulk to avoid coronary obstruction and central and paravalvular leaks. The tubular pericardial valve showed the lowest pressure gradients and was the most compressible, but was more open to manufacturing errors.
Flecher
Erwan M
EM
The International Heart Institute of Montana Foundation at Saint Patrick Hospital and Health Sciences Center, Missoula, Montana 59802, USA.
Curry
John W
JW
Joudinaud
Thomas M
TM
Saber
Hashim
H
MacNett
Jamie
J
Ahlin
Amy
A
Weber
Patricia A
PA
Duran
Carlos M G
CM
D000818:Animals; D001021:Aortic Valve / Q000502:physiology / Q000601:surgery*; D001672:Biocompatible Materials; D001705:Bioprosthesis / Q000145:classification*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods*; D008422:Materials Testing; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D008955:Models, Cardiovascular; D011474:Prosthesis Design; D011673:Pulsatile Flow; D012756:Sheep; D015607:Stents; D013552:Swine
D001672:Biocompatible Materials