title: Turbulence downstream of subcoronary stentless and stented aortic valves.
abstract: Regions of turbulence downstream of bioprosthetic heart valves may cause damage to blood components, vessel wall as well as to aortic valve leaflets. Stentless aortic heart valves are known to posses several hemodynamic benefits such as larger effective orifice areas, lower aortic transvalvular pressure difference and faster left ventricular mass regression compared with their stented counterpart. Whether this is reflected by diminished turbulence formation, remains to be shown. We implanted either stented pericardial valve prostheses (Mitroflow), stentless valve prostheses (Solo or Toronto SPV) in pigs or they preserved their native valves. Following surgery, blood velocity was measured in the cross sectional area downstream of the valves using 10MHz ultrasonic probes connected to a dedicated pulsed Doppler equipment. As a measure of turbulence, Reynolds normal stress (RNS) was calculated at two different blood pressures (baseline and 50% increase). We found no difference in maximum RNS measurements between any of the investigated valve groups. The native valve had significantly lower mean RNS values than the Mitroflow (p=0.004), Toronto SPV (p=0.008) and Solo valve (p=0.02). There were no statistically significant differences between the artificial valve groups (p=0.3). The mean RNS was significantly larger when increasing blood pressure (p=0.0006). We, thus, found no advantages for the stentless aortic valves compared with stented prosthesis in terms of lower maximum or mean RNS values. Native valves have a significantly lower mean RNS value than all investigated bioprostheses.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Institute of Clinical Medicine, Aarhus University Hospital, Skejby, Brendstrupgaards vej, DK-8200 Aarhus N, Denmark. funder@ki.au.dk
authors.forename: Jonas Amstrup
authors.initials: JA
authors.lastname: Funder
authors.forename: Markus Winther
authors.initials: MW
authors.lastname: Frost
authors.forename: Per
authors.initials: P
authors.lastname: Wierup
authors.forename: Kaj-Erik
authors.initials: KE
authors.lastname: Klaaborg
authors.forename: Vibeke
authors.initials: V
authors.lastname: Hjortdal
authors.forename: Hans
authors.initials: H
authors.lastname: Nygaard
authors.forename: J Michael
authors.initials: JM
authors.lastname: Hasenkam
mesh_terms: D000818:Animals; D001021:Aortic Valve / Q000033:anatomy & histology / Q000502:physiology*; D001705:Bioprosthesis; D001783:Blood Flow Velocity; D001794:Blood Pressure; D002315:Cardiopulmonary Bypass; D004867:Equipment Design; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation*; D006351:Heart Valves; D008953:Models, Anatomic; D011312:Pressure; D012044:Regression Analysis; D015607:Stents; D013552:Swine; D018608:Ultrasonography, Doppler / Q000379:methods