Cardiovascular Institute, University of Padova, Italy.
J Thorac Cardiovasc Surg. 2012 Mar;143(3):558-68. doi: 10.1016/j.jtcvs.2011.05.033. Epub 2011 Sep 3.
The aim of the present study was to compare the hydrodynamics of 4 different mechanical prostheses fitting the atrioventricular annulus in children.
We tested different inverted aortic prostheses with a prosthesis-annulus relationship in the mitral chamber of the Sheffield pulse duplicator (Department of Medical Physics and Clinical Engineering, Royal Hallamshire Hospital, Sheffield, UK), analyzed by comparing the prosthetic housing diameter and the predicted annulus diameter based on body surface area (0.8 and 1 m(2) corresponding to an annulus diameter of 18.8-20.2 mm). The On-X 19 (On-X Life Technologies, Inc, Austin, Tex), SJM Regent 19 (St Jude Medical Inc, St Paul, Minn), Sorin Overline 18 (Sorin Biomedica, Saluggia, Italy), and Medtronic Advantage Supra 19 (Medtronic Inc, Minneapolis, Minn) valves with a housing diameter of 19 to 20 mm were hydrodynamically compared. The tests were carried out at increasing pulse rate of 72, 80, 100, and 120 beats/min for a stroke volume of 20 and 30 mL. Therefore, cardiac output ranged from 1.44 to 3.6 L/min.
Regardless of the pulse rate and stroke volume, the Medtronic Advantage Supra valve showed the highest mean diastolic pressure difference at each cardiac output (P < .05). The mean gradients were significantly lower for the Sorin Overline valve regardless of the cardiac output, stroke volume, and pulse rate (P < .05). The effective orifice areas observed followed exactly the same behavior: the lowest for the Medtronic Advantage Supra valve and the highest for the Sorin Overline valve. The Sorin Overline valve showed the highest closure volumes (P < .05), and the On-X prosthesis showed the highest leakage volumes (P < .05). The Sorin Overline valve had the highest total regurgitant volume (P < .05), and the Medtronic Advantage Supra valve had the lowest total regurgitant volume (P < .05). The On-X valve showed the highest total energy loss regardless of the pulse rate at 20 mL of stroke volume, which was comparable to the SJM Regent and Sorin Overline valves at increased stroke volume. The Medtronic Advantage Supra valve showed the lowest total energy loss regardless of cardiac outputs (P < .05).
This hydrodynamic evaluation model allowed us to compare the efficiency of currently available valve prostheses suitable for atrioventricular replacement in children. Among these prostheses, the Sorin Overline valve showed the best diastolic performance. On the other hand, for total energy loss, the Medtronic Advantage Supra valve demonstrated excellent performance.
本研究旨在比较 4 种不同机械人工心脏瓣膜在儿童房室环中的血流动力学。
我们在谢菲尔德脉搏复制机的二尖瓣腔中测试了不同的倒置主动脉人工心脏瓣膜，通过比较人工心脏瓣膜外壳直径和基于体表面积预测的瓣环直径（0.8 和 1 m²对应于 18.8-20.2 mm 的瓣环直径）来分析。比较了 On-X 19（On-X Life Technologies，Inc.，Austin，Tex）、SJM Regent 19（St Jude Medical Inc.，St Paul，Minn）、Sorin Overline 18（Sorin Biomedica，Saluggia，Italy）和 Medtronic Advantage Supra 19（Medtronic Inc.，Minneapolis，Minn）等人工心脏瓣膜，这些瓣膜的外壳直径为 19 至 20 mm。在每个心输出量为 72、80、100 和 120 次/分钟的情况下，以 20 和 30 mL 的冲程容积进行了血流动力学比较。因此，心输出量范围为 1.44 至 3.6 L/min。
无论脉搏率和心输出量如何，Medtronic Advantage Supra 瓣膜在每个心输出量时均显示出最高的平均舒张压差（P <.05）。无论心输出量、冲程容积和脉搏率如何，Sorin Overline 瓣膜的平均梯度均明显较低（P <.05）。观察到的有效瓣口面积完全相同：Medtronic Advantage Supra 瓣膜最低，Sorin Overline 瓣膜最高。Sorin Overline 瓣膜的闭合容积最高（P <.05），而 On-X 人工心脏瓣膜的漏血量最高（P <.05）。Sorin Overline 瓣膜的总反流量最高（P <.05），而 Medtronic Advantage Supra 瓣膜的总反流量最低（P <.05）。无论在以 20 mL 冲程容积为基础的 20 次/分钟的脉搏率下，On-X 瓣膜的总能量损失最高，与 SJM Regent 和 Sorin Overline 瓣膜相似。无论心输出量如何，Medtronic Advantage Supra 瓣膜的总能量损失最低（P <.05）。
该血流动力学评估模型允许我们比较目前适用于儿童房室置换的人工心脏瓣膜的效率。在这些人工心脏瓣膜中，Sorin Overline 瓣膜显示出最佳的舒张性能。另一方面，对于总能量损失，Medtronic Advantage Supra 瓣膜表现出优异的性能。
