title: The complete supraannular concept: in vivo hemodynamics of bovine and porcine aortic bioprostheses.
abstract: BACKGROUND
  Complete supraannular placement of an aortic bioprosthesis is one approach to optimize the hemodynamic result of an aortic valve replacement. It is achieved with the combination of a special valve design and the supraannular sewing technique with noneverted mattress sutures. We evaluated 5 bioprostheses designed for complete supraannular placement to assess potential hemodynamic differences caused by factors (eg, valve material) other than implantation position.
  
  
  RESULTS
  In 336 patients (mean age, 72.0+/-7.1 years; 143 women), hemodynamics including mean pressure gradients, effective orifice areas, and indices and incidence of patient-prosthesis mismatch were evaluated 6 months after surgery. Annulus diameter was measured during surgery. Patients received the Carpentier Edwards Perimount Magna (Magna, n=169), the Medtronic Mosaic (Mosaic, n=46), the Mosaic Ultra (Ultra, n=17), the SJM Epic Supra (Epic, n=46), and the Sorin Soprano (Soprano, n=58). For small annulus sizes (<23 mm), the mean pressure gradients of the Magna (11.82+/-4.8 mm Hg) were significantly lower than the Mosaic (16.04+/-6.1 mm Hg) and the Ultra (22.0+/-4.1 mm Hg), and the Soprano (13.3+/-5.2 mm Hg) was hemodynamically superior to the Ultra. For medium (23 to 24 mm) and large (>24 mm) annulus sizes, the mean pressure gradients of the Magna were lower than the Epic (10.0+/-3.5 mm Hg versus 14.9+/-6.4 mm Hg; 9.9+/-4.0 mm Hg versus 18.6+/-12.7 mm Hg). Furthermore, in patients with large annulus size, the mean pressure gradients of the Soprano (11.4+/-3.8 mm Hg) were lower compared with the Epic (18.5+/-12.7 mm Hg). Severe patient-prosthesis mismatch was observed more frequently in patients with the Mosaic (12/46; 26.1%) and the Ultra (3/17; 17.6%) prostheses.
  
  
  CONCLUSIONS
  Complete supraannular placement cannot prevent high pressure gradients or patient-prosthesis mismatch thoroughly, but the choice of a bovine prosthesis can optimize hemodynamic performance.
authors.affiliation: Department for Cardiovascular Surgery, German Heart Center, Munich, Germany. daniel@ruzickas.de
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Ruzicka
authors.forename: Ina
authors.initials: I
authors.lastname: Hettich
authors.forename: Andrea
authors.initials: A
authors.lastname: Hutter
authors.forename: Sabine
authors.initials: S
authors.lastname: Bleiziffer
authors.forename: Catalin C
authors.initials: CC
authors.lastname: Badiu
authors.forename: Robert
authors.initials: R
authors.lastname: Bauernschmitt
authors.forename: Ruediger
authors.initials: R
authors.lastname: Lange
authors.forename: Walter B
authors.initials: WB
authors.lastname: Eichinger
mesh_terms: D000368:Aged; D000818:Animals; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis; D001794:Blood Pressure; D002417:Cattle; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D013552:Swine