Differences in performance of five types of aortic valve prostheses: haemodynamic assessment by dobutamine stress echocardiography
- 1Department of Cardiology, Glenfield Hospital, University Hospitals of Leicester NHS Trust & NIHR Cardiovascular Biomedical Research Unit, University of Leicester, Leicester, UK
- 2Department of Cardiology, Grantham Hospital, United Lincolnshire Hospitals NHS Trust, Grantham, UK
- 3Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester NHS Trust, University of Leicester, Leicester, UK
- 4Department of Cardiac Surgery, Area del Cor (ACOR) & Research Institute, University Hospital Vall d'Hebron, Universitat Autonòma de Barcelona, Barcelona, Spain
- Correspondence to Dr Derek Chin, Department of Cardiology, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Groby Road, Leicester LE3 9QP, UK;
Contributors The study was conceived by DTC and MG. JPK collated and analysed the DSE data, and drafted the manuscript. KLA collated and analysed the surgical and DSE data, and critically appraised the manuscript. JED performed the DSE studies and critically appraised the manuscript. MG and Mr Andrzej W Sosnowski (collaborator) performed the operations. MG also reviewed the data analysis and critically appraised the manuscript. DTC performed and analysed the DSE studies, and critically appraised and gave final approval to the manuscript.
- Accepted 10 July 2012
- Published Online First 15 August 2012
Background In patients being considered for aortic valve replacement, there remains controversy over which design or tissue offers the best performance. We aimed to evaluate in a single study the haemodynamic performances of five different widely used aortic valve prostheses: stentless porcine xenograft (Elan), stentless bovine pericardium (Pericarbon Freedom), stented porcine xenograft (Aspire), stented bovine pericardium (More) and mechanical (Ultracor). We also compared them with normal aortic valves and stenosed valves of variable severity.
Methods and results Preoperative echocardiography and dobutamine stress echocardiography at 1 year postoperatively were undertaken in 106 patients (n=18–24 from each group). Stentless bioprostheses, whether porcine or bovine, displayed superior haemodynamics across nearly all echocardiographic parameters: lower gradients, larger effective orifice area, higher dimensionless severity index (DSI) and lower resistance, when compared with stented or mechanical prostheses. Comparing both stented designs, bovine tissue performed the worst at rest, but with stress, there was no difference. The stress performances of the stentless bioprostheses were similar to the mildly stenosed native aortic valve, whereas the performances of the stented and mechanical prostheses resembled that of native valves with mild-to-moderate stenoses. Haemodynamic differences, however, did not translate into differences in left ventricular mass reduction at 1 year.
Conclusions Stentless bioprostheses displayed haemodynamics superior to stented or mechanical prostheses and had the closest performance to a normal, native aortic valve. Stress DSI data, least reliant on variable annulus/valve sizes and flow rates, provided the best haemodynamic discrimination.
- Aortic valve prostheses
- stress echocardiography
- heart failure
- imaging and diagnostics
- valvular disease
- aortic valve disease
- cardiac function
- diastolic dysfunction
Competing interests None.
Ethics approval Ethics approval provided by the Local Ethics Research Committee.
Provenance and peer review Not commissioned; externally peer reviewed.