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J Thorac Cardiovasc Surg 2003;125:1405-1411
© 2003 The American Association for Thoracic Surgery
Surgery for Acquired Cardiovascular Disease |
From the Department of Cardio-vascular Surgery, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada,a and the Department of Cardio-vascular Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.b
Received for publication May 30, 2002. Revisions requested Aug 26, 2002; revisions received Sept 9, 2002. Accepted for publication Oct 25, 2002. Address for reprints: Xavier Mueller, MD, Department of Cardio-vascular Surgery, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec, Canada J1H 5N4 (E-mail: xavier.mueller{at}usherbrooke.ca).
Objective: Small aortic valve replacement remains a challenging hemodynamic problem. A new bioprosthesis (3F Therapeutics, Lake Forest, Calif) was designed to further improve the hemodynamic performance currently achieved with stentless bioprostheses. This valve consists of a tubular structure assembled from 3 equal sections of equine pericardial material, with virtually no foreign material except for a thin polyester ring. Its hemodynamic performance was compared with that of a commercially available stentless prosthesis in a bovine model.
Patients and Methods: Twelve calves (55 ± 2.8 kg) received a 19-mm 3F valve (3F group, n = 6) or a 19-mm stentless control valve (control group, n = 6). The animals were fully equipped for hemodynamic monitoring and transvalvular gradient measurements. After implantation, dopamine was infused in increasing doses, and the hemodynamic values were recorded at each step of 100-µg/min increase. Linear regression analysis was applied for group comparison of each variable.
Results: The mean transvalvular gradient at 4.5 L/min was 3.48 ± 0.14 mm Hg (95% confidence interval) in the 3F group and 5.72 ± 0.28 mm Hg in the control group (P < .0001) and at 6.5 L/min, 7.4 ± 1.55 mm Hg, and 11.13 ± 0.18 mm Hg, respectively (P < .0001). The effective orifice area at 4.5 L/min was 2.4 ± 0.03 cm2 in the 3F group and 1.86 ± 0.02 cm2 in the control group (P < .0001) and at 6.5 L/min, 2.41 ± 0.04 cm2, and 1.96 ± 0.02 cm2, respectively (P < .0001).
Conclusions: This new bioprosthesis without a stent and without a supporting wall that has its commissures fixed directly to the aorta outperforms in vivo standard stentless prostheses in the immediate postimplant period.
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