title: Hydrodynamic comparison of biological prostheses during progressive valve calcification in a simulated exercise situation. An in vitro study.
abstract: OBJECTIVE
  Despite continuous development of anticalcification treatment for biological valve prostheses, calcification remains one major cause of structural failure. The following study investigates hemodynamics and changes in opening and closing kinematics in progressively calcified porcine and pericardial valves in a simulated exercise situation.
  
  
  METHODS
  Five pericardial (Edwards Perimount Magna) and five porcine (Medtronic Mosaic Ultra) aortic valve bioprostheses (23 mm) were investigated in an artificial circulation system (150 beats/min, cardiac output 8l/min). Leaflet kinematics were visualized with a high-speed camera (3000 frames/s). Valves were exposed to a calcifying solution for 6 weeks. Repeated testing was performed every week. All prostheses underwent X-ray and photographic examination including measurement of calcium content for evaluation of progressive calcification.
  
  
  RESULTS
  In the exercise situation pericardial valves demonstrated lower pressure gradients initially compared to the porcine valves (8.5+/-1.4 vs 11+/-1.6 mmHg), but significantly higher closing volume (5.3+/-1.2 ml vs 1.2+/-0.2 ml of stroke volume) leading to an equal total energy. Neither valve type demonstrated a significant increase in gradient or closing volume compared to the normal output situation. Opening and closing times were longer for pericardial valves after 6 weeks (opening time 42+/-10 ms vs 28+/-10 ms, closing time 84+/-12 vs 52+/-10 ms after 6 weeks). Pericardial valves calcified faster and more severely leading to an increase in gradients and closure volume.
  
  
  CONCLUSIONS
  In the exercise situation pericardial valves demonstrated superior systolic function compared to porcine valves. Therefore pericardial valves have some advantage in active patients due to the lower gradients. Total energy loss remained constant during progressive calcification for both valves. Leaflet opening and closing is faster in porcine valves; clinical impact of these findings is not known. Diastolic performance is also important and should always be tested also in vivo.
authors.affiliation: Department of Thoracic & Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany. farhad@bakhtiary.de
authors.forename: Farhad
authors.initials: F
authors.lastname: Bakhtiary
authors.forename: Omer
authors.initials: O
authors.lastname: Dzemali
authors.forename: Ulrich
authors.initials: U
authors.lastname: Steinseiffer
authors.forename: Christof
authors.initials: C
authors.lastname: Schmitz
authors.forename: Birgit
authors.initials: B
authors.lastname: Glasmacher
authors.forename: Anton
authors.initials: A
authors.lastname: Moritz
authors.forename: Peter
authors.initials: P
authors.lastname: Kleine
mesh_terms: D000818:Animals; D001021:Aortic Valve; D001696:Biomechanical Phenomena; D001705:Bioprosthesis; D002114:Calcinosis / Q000209:etiology / Q000503:physiopathology*; D009202:Cardiomyopathies / Q000503:physiopathology*; D018450:Disease Progression; D015444:Exercise / Q000502:physiology*; D006350:Heart Valve Prosthesis; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008422:Materials Testing / Q000379:methods*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D013552:Swine