Comparison of the Hemodynamic Performance of the Rapid Deployment Intuity aortic Valve (RDAV) with the conventional valve design addressing smaller sizes and Patient Prosthesis Mismatch
Thorsten CW Wahlers1, Francis Duhay2, GŁnther Laufer3, Axel Haverich4.
1Heartcent University Hospital Cologne, Cologne, Germany, 2Edwards Lifesciences, Irvine, CA, USA, 3University Hospital Vienna, Vienna, Austria, 4Hannover Medical School, Hannover, Germany.
OBJECTIVE: Prosthesis-Patient mismatch (PPM) especially in the small aortic root after Aortic Valve replacement leads to adverse outcomes.
The newer generation of RDAV is designed to provide improved hemodynamics and may lessen PPM in small dimensions.
Hemodynamic performance of RDAV’s were compared to the standard pericardial valves in smaller sizes (19mm, 21mm, 23mm) to evaluate incidence of severe PPM.
METHODS: Patient echocardiographic data from TRITON clinical report who received RDVAV in smaller sizes: 19mm, 21mm, 23mm (Group I) were compared to patients who received similar size pericardial valves (Group II). Gr II data was collected from post market approval database of the manufacturer of the pericardial valves. PPM is defined as severe when EOAI <0.65cm², and moderate PPM: <0.85cm²/ mt².
RESULTS: One hundred and fifty five patients with RDAVR (Gr I) are compared to 123 patients who received AVR with pericardial bioprosthesis (Gr II). At one year, the echocardiographic data including mean transvalvular gradients, EOA, EOAI, LV Mass, and LV Mass Index were compared between both groups.
(Table)Moderate PPM was noted in 42% of size 19 and 21mm standard valve and none in RDAV.
CONCLUSIONS: Conclusions: In small size annulus RDAV demonstrated superior hemodynamic performance and no incidence of moderate or severe PPM at one year on comparison to conventional pericardial bioprosthesis. This improvement may facilitate improved mid and long-term survival. Replacement with RDAV should be considered in the presence of small Aortic root.
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