title: Comparison of the Performance of a Sutureless Bioprosthesis With Two Pericardial Stented Valves on Small Annuli: An In Vitro Study.
abstract: BACKGROUND
  Aortic valve replacement has evolved recently with the development of the sutureless bioprosthesis. One such valve is the Perceval bioprosthesis, which is built by mounting leaflets of bovine pericardium to a thin stent; this approach has the potential to provide an excellent fluid dynamic performance. We undertook an in vitro study to compare the hydrodynamic performance of the sutureless bioprosthesis with two standard pericardial stented bioprostheses (Crown and Magna).
  
  
  METHODS
  Tests were conducted using a mock loop, testing on two sizes of the three prostheses. The prosthesis sizes were chosen to house the valves in porcine aortic roots with a native annulus diameter of 19 mm (n = 6) or 21 mm (n = 6). The stroke volume ranged from 25 mL to 105 mL at a simulated heart rate of 70 beats per minute.
  
  
  RESULTS
  Mean pressure drop and energy loss rose with increasing stroke volume in all of the valves tested (p < 0.001), with the sutureless valve showing the lowest values for both variables (p < 0.001). Effective orifice area values were stable across the stroke volume intervals and were larger in the sutureless valves (p < 0.001).
  
  
  CONCLUSIONS
  All of the valves tested provided good fluid dynamic performances. The sutureless bioprosthesis provided the best performance with the least hindrance to flow behavior. From the hydrodynamic perspective, the sutureless prosthesis may present an advance in the evolution of bioprostheses, ensuring low gradients and potential for low incidence of patient-prosthesis mismatch even in small annuli.
authors.affiliation: Cardiovascular Department, Cardiac Surgery Unit, Ospedale "A. Manzoni" di Lecco, Lecco; Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan. Electronic address: giordano.tasca67@gmail.com.
authors.forename: Giordano
authors.initials: G
authors.lastname: Tasca
authors.affiliation: Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan; FoRCardioLab, Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Vismara
authors.affiliation: Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan; FoRCardioLab, Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan; Cardiovascular Surgery Department, "L. Sacco" Hospital, Università degli Studi di Milano, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Mangini
authors.affiliation: FoRCardioLab, Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan; Cardiovascular Surgery Department, "L. Sacco" Hospital, Università degli Studi di Milano, Milan, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Romagnoni
authors.affiliation: FoRCardioLab, Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan; Cardiovascular Surgery Department, "L. Sacco" Hospital, Università degli Studi di Milano, Milan, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Contino
authors.affiliation: Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan; FoRCardioLab, Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan.
authors.forename: Alberto
authors.initials: A
authors.lastname: Redaelli
authors.affiliation: Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan; FoRCardioLab, Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan.
authors.forename: Gianfranco Beniamino
authors.initials: GB
authors.lastname: Fiore
authors.affiliation: FoRCardioLab, Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan; Cardiovascular Surgery Department, "L. Sacco" Hospital, Università degli Studi di Milano, Milan, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Antona
mesh_terms: D000818:Animals; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis; D002417:Cattle; D006350:Heart Valve Prosthesis; D006439:Hemodynamics; D008422:Materials Testing / Q000379:methods*; D010496:Pericardium / Q000637:transplantation*; D011474:Prosthesis Design; D015607:Stents; D013552:Swine