Abstract 2311: The Complete Supraannular Concept - In-vivo Hemodynamics of Bovine and Porcine Aortic Bioprostheses
Complete supraannular placement of an aortic bioprosthesis is one approach to optimize the hemodynamic result of an aortic valve replacement. It is achieved with the combination of a special valve design and the supraannular sewing technique with non-everted mattress sutures. We evaluated five bioprostheses designed for complete supraannular placement to assess potential hemodynamic differences due to other factors (e.g. valve material) than implantation position. In 336 patients (mean age 72.0 ± 7.1 years; 143 females) hemodynamics including mean pressure gradients (MPG), effective orifice areas (EOA), and indices (EOAi) and incidence of patient-prosthesis-mismatch (PPM) were evaluated 6 months postoperatively. Annulus diameter was measured intraoperatively. Patients received the CE Perimount Magna (Magna n = 169), Medtronic Mosaic (Mosaic n = 46), Mosaic Ultra (Ultra n = 17), SJM Epic Supra (n = 46) and the Sorin Soprano (Soprano n = 58). MPG, EOA and EOAi for all patients divided by annulus size groups are presented in table 1⇓. Severe PPM was observed more frequently in patients with the Mosaic (12/46; 26.1%) and Ultra (3/17; 17.6%) prostheses. Complete supraannular placement cannot prevent high pressure gradients or patient-prosthesis-mismatch thoroughly, but the choice of a bovine prosthesis can optimize hemodynamic performance.