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Preclinical Determination of the Best Functional Position for Transcatheter Heart Valves Implanted in Rapid Deployment Bioprostheses.

Preclinical Determination of the Best Functional Position for Transcatheter Heart Valves Implanted in Rapid Deployment Bioprostheses.
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Schäfer T, Doose C, Fujita B, Utzenrath M, Egron S, Schmitz C, Scholtz S, Kütting M, Hakim-Meibodi K, Börgermann J, Gummert J, Steinseifer U, Ensminger S,


Schäfer T, Doose C, Fujita B, Utzenrath M, Egron S, Schmitz C, Scholtz S, Kütting M, Hakim-Meibodi K, Börgermann J, Gummert J, Steinseifer U, Ensminger S, (click to view)

Schäfer T, Doose C, Fujita B, Utzenrath M, Egron S, Schmitz C, Scholtz S, Kütting M, Hakim-Meibodi K, Börgermann J, Gummert J, Steinseifer U, Ensminger S,

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EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 2016 Oct 18() pii EIJ-D-16-00237
Abstract
AIMS
The aim was to determine the best functional position of a transcatheter heart valve (THV) implanted as a valve-in-valve (ViV) procedure in small rapid deployment valves (RDV) in an in vitro model.

METHODS AND RESULTS
A 21mm Perceval™, Enable™ or INTUITY™ RDV was mounted into a pulse duplicator and a 23mm balloon-expandable or a self-expanding THV was deployed (valve-in-valve) in two different positions. Under physiological hydrodynamic conditions, performance of the THV was characterized by mean transvalvular pressure gradient (MPG), effective orifice area (EOA) and regurgitation volume (RV). Leaflet kinematics were assessed with high-speed video recordings and X-ray images acquired. All THV-RDV-combinations met ISO requirements regarding hydrodynamic performance. In most cases, the higher position of the THV performed better than the lower one by means of a lower MPG and increased EOA. Leaflet motion of the implanted THV was impaired in the lower position. In contrast, regurgitation volumes were relatively small and similar, regardless of the THV position.

CONCLUSIONS
ViV-implantation of a THV in small RDVs yielded satisfactory hydrodynamic results. In most cases, a high implantation position achieved lower MPG, higher EOA and reduced risk of impaired THV leaflet function. Fluoroscopy images of the best functional ViV positions are presented as a blueprint for patient procedures.

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