title: Valve-in-valve outcome: design impact of a pre-existing bioprosthesis on the hydrodynamics of an Edwards Sapien XT valve.
abstract: Bioprosthetic aortic heart valves are increasingly implanted in younger patients. Therefore, a strategy for potential valve failure should be developed before implanting the 'first valve'. The goal of this in vitro study was to provide insight into the effects of the design of a bioprosthesis on a valve-in-valve implanted Sapien XT valve.
  
  
  
  The hydrodynamic performance of a 23-mm Sapien XT valve implanted in Vascutek Aspire, Edwards Perimount, Medtronic Mosaic and St. Jude Medical Trifecta heart valves was investigated in a left heart simulator. In addition to the hydrodynamic results, the leaflet dynamics were analysed in high-speed video recordings of the tests.
  
  
  
  All valve-in-valve combinations in this study fulfilled the minimum acceptance criteria defined by relevant approval standards (e.g. ISO 5840) but displayed significant differences in their performances. Small inner diameters of the bioprostheses were associated with increased mean pressure gradients, decreased effective orifice areas and geometric opening areas as well as with pin-wheeling and uneven leaflet motion. In addition, implantation in bioprostheses with internally mounted leaflets was associated with lower paravalvular leakage.
  
  
  
  The results of this study suggest that a surgical bioprosthesis with a large inner diameter and internally mounted leaflets improves the heamodynamics and potentially the durability of a valve-in-valve combination. These results should give the attending physicians critical information to consider when deciding on a bioprosthesis for younger patients.
authors: Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz-Institute Aachen, RWTH Aachen University, Aachen, Germany.
authors: Christian
authors: C
authors: Doose
authors: Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz-Institute Aachen, RWTH Aachen University, Aachen, Germany.
authors: Maximilian
authors: M
authors: Kütting
authors: Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz-Institute Aachen, RWTH Aachen University, Aachen, Germany.
authors: Sandrine
authors: S
authors: Egron
authors: Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz-Institute Aachen, RWTH Aachen University, Aachen, Germany.
authors: Pejman
authors: P
authors: Farhadi Ghalati
authors: Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz-Institute Aachen, RWTH Aachen University, Aachen, Germany.
authors: Christoph
authors: C
authors: Schmitz
authors: Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz-Institute Aachen, RWTH Aachen University, Aachen, Germany.
authors: Marc
authors: M
authors: Utzenrath
authors: Med. Klinik und Poliklinik II - Kardiologie, Universitätsklinikum Bonn, Rheinische Friedrich-Wilhelms-Universität, Bonn, Germany.
authors: Alexander
authors: A
authors: Sedaghat
authors: Department for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.
authors: Buntaro
authors: B
authors: Fujita
authors: Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz-Institute Aachen, RWTH Aachen University, Aachen, Germany.
authors: Thomas
authors: T
authors: Schmitz-Rode
authors: Department for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.
authors: Stephan
authors: S
authors: Ensminger
authors: Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz-Institute Aachen, RWTH Aachen University, Aachen, Germany.
authors: Ulrich
authors: U
authors: Steinseifer
mesh_terms: D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D057446:Hydrodynamics; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome; D014741:Video Recording
keywords: Bioprosthesis design ; Hydrodynamics ; Sapien XT; Valve-in-valve 