Fracturing mechanics before valve-in-valve therapy of small aortic bioprosthetic heart valves

Publikation: Forskning - peer reviewTidsskriftartikel

DOI

AIMS: Patients with degraded bioprosthetic heart valves (BHV) who are not candidates for valve replacement may benefit from transcatheter valve-in-valve (VIV) therapy. However, at smaller sized surgical BHV the resultant orifice may become too narrow. To overcome this, the valve frame can be fractured by a high-pressure balloon prior to VIV. However, knowledge on fracture pressures and mechanics are prerequisites. The aim of this study is to identify the fracture pressures needed in BHV, and to describe the fracture mechanics.

METHODS AND RESULTS: Commonly used BHV of small sizes were mounted on a high-pressure balloon situated in a biplane fluoroscopic system with a high-speed camera. The instant of fracture was captured along with the balloon pressure. The valves were inspected for material protrusion and later dissected for fracture zone investigation and description. The valves with a polymer frame fractured at a lower pressure (8 - 10 atm) than those with a metal stent (19 - 26 atm). None of the fractured valves had elements protruding.

CONCLUSIONS: VIV procedures in small sized BHV may be performed after prior fracture of the valve frame by high-pressure balloon dilatation. This study provides tentative guidelines of expected balloon sizes and pressures for valve fracturing.

OriginalsprogEngelsk
TidsskriftEuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
Vol/bind13
Tidsskriftsnummer9
Sider (fra-til)e1026-e1031
Antal sider6
ISSN1774-024X
DOI
StatusUdgivet - 2017

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