title: Performance of the Labcor Dokimos Plus pericardial aortic prosthesis: a single-centre experience.
abstract: In patients with a small aortic annulus, aortic valve replacement (AVR) is frequently associated with high residual pressure gradients. Supra-annular pericardial aortic prostheses are gaining popularity due to the increased effective orifice areas (EOA) and resulting lower gradients. This study reports the clinical and echocardiographic results following implantation of the new supra-annular pericardial aortic prosthesis Dokimos Plus (Labcor, Belo Horizonte, Brazil).
  
  
  
  Between October 2013 and July 2015, 137 patients (41% women, mean age: 74 years) underwent supra-annular AVR with or without concomitant procedures using the Dokimos Plus prosthesis in our department. Transthoracic echocardiography was performed pre- and postoperatively on all patients to assess haemodynamic parameters (gradients, acceleration time [AT], Doppler velocity indices [DVIs] and indexed EOA [EOAI]) and to detect paravalvular leakage (PVL). Data were collected retrospectively from our hospital databases.
  
  
  
  Patients were grouped by prosthesis size: Most patients received 23-mm (57.6%), followed by 21-mm (19%), 25-mm (15.4%) and 27-mm (8%) prostheses. The mean EOAI in all groups was 1.1 ± 0.26 cm 2 /m 2 . Pressure gradients were low in all groups (mean: 8.9 ± 4.4 mmHg; peak: 18.8 ± 6.8 mmHg); AT and DVI were in the normal range according to American Society of Echocardiography/European Association of Cardiovascular Imaging recommendations (mean AT 73.3 ± 29 ms; mean DVI 0.5 ± 0.2). One patient had severe PVL and one presented with central regurgitation, both requiring re-intervention. The mortality rate was 5.1% ( n  = 7); none of the cases was associated with valve insufficiency.
  
  
  
  The Dokimos prosthesis showed a satisfactory overall performance, presenting low gradients and DVIs as well as high EOAI. Further investigations are needed to analyse the cases of regurgitation and monitor long-term performance.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital, Aachen, Germany.
authors.forename: Rashad
authors.initials: R
authors.lastname: Zayat
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital, Aachen, Germany.
authors.forename: Jessica
authors.initials: J
authors.lastname: Arias-Pinilla
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital, Aachen, Germany.
authors.forename: Ali
authors.initials: A
authors.lastname: Aljalloud
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital, Aachen, Germany.
authors.forename: Giulia
authors.initials: G
authors.lastname: Musetti
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital, Aachen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Goetzenich
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital, Aachen, Germany.
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Autschbach
authors.affiliation: Department of Cardiology, St Antonius Hospital, Eschweiler, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: van Gemmeren
authors.affiliation: Department of Cardiology, St Antonius Hospital, Eschweiler, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Niedeggen
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital, Aachen, Germany.
authors.forename: Nima
authors.initials: N
authors.lastname: Hatam
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001705:Bioprosthesis; D015150:Echocardiography, Doppler; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000601:surgery*; D011474:Prosthesis Design
keywords: Aortic valve replacement; Labcor Dokimos Plus prosthesis; Supra-annular aortic valve bioprosthesis