Prosthetic aortic valve fixation study 48 replacement valves analyzed using digital pressure mapping

Candice Y. Lee, Joshua K. Wong, Ronald E. Ross, David C. Liu, Kamal R. Khabbaz, Angelo J. Martellaro, Heather R. Gorea, Jude S. Sauer, Peter A. Knight

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Objective: Prostheses attachment is critical in aortic valve replacement surgery, yet reliable prosthetic security remains a challenge. Accurate techniques to analyze prosthetic fixation pressures may enable the use of fewer sutures while reducing the risk of paravalvular leaks (PVL). Methods: Customized digital thin film pressure transducers were sutured between aortic annulus models and 21-mm bioprosthetic valves with 15 × 4-mm, 12 × 4-mm, or 9 × 6-mm-wide pledgeted mattress sutures. Simulating open and minimally invasive access, 4 surgeons, blinded to data acquisition, each secured 12 valves using manual knottying (hand-tied [HT] or knot-pusher [KP]) or automated titanium fasteners (TFs). Real-time pressure measurements and times were recorded. Two-dimensional (2D) and 3D pressure maps were generated for all valves. Pressures less than 80 mm Hg were considered at risk for PVL. Results: Pressures under each knot (intrasuture) fell less than 80 mm Hg for 12 of 144 manual knots (5/144 HT, 7/144 KP) versus 0 of 288 TF (P < 0.001). Pressures outside adjacent sutures (extrasuture) were less than 80 mm Hg in 10 of 60 HT, zero of 60 KP, and zero of 120 TF sites for 15 × 4-mm valves; 17 of 48 HT, 25 of 48 KP, and 12 of 96 TF for 12 × 4-mm valves; and 15 of 36 HT, 17 of 36 KP, and 9 and 72 TF for 9 × 6-mm valves; P < 0.001 all manual versus TF. Annular areas with pressures less than 80 mm Hg ranged from 0% of the sewing-ring area (all open TF) to 31% (12 × 4 mm, KP). The average time per manual knot, 46 seconds (HT, 31 seconds; KP, 61 seconds), was greater than TF, 14 seconds (P < 0.005). Conclusions: Reduced operative times and PVL risk would fortify the advantages of surgical aortic valve replacement. This research encourages continued exploration of technical factors in optimizing prosthetic valve security.

Original languageEnglish (US)
Pages (from-to)327-336
Number of pages10
JournalInnovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Volume11
Issue number5
DOIs
StatePublished - Jan 1 2016

Keywords

  • Aortic valve replacement
  • Automated titanium fasteners
  • Digital pressure mapping
  • Minimally invasive surgery
  • Pressure transducer

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