Frame-mounted porcine valve bioprostheses: preparation during aortic-root dilation. Biomechanics and design considerations.

The leaflet geometry and function of frame-mounted porcine bioprostheses prepared with dilation of the aortic root during frame mounting was investigated. The diameter of the porcine aortic root increased by 47% when dilated with a pressure of 120 mm Hg. In the absence of pressure dilation, the ratio of circumferential leaflet length to the radius of the aortic root (S/RA) was 2.7 +/- 0.1, and the angle of inclination of the leaflet to the base of the valve was 17 +/- 4.3 degrees. In this condition, the leaflet geometry was similar to that of some second-generation porcine bioprostheses, which demonstrated high open-leaflet bending strains at the commissures. Dilation of the porcine root with 120 mm Hg reduced the value of S/RA to 1.84 and produced a triangular open-leaflet configuration with minimum open-leaflet bending strains. Open-leaflet bending strains were also reduced in two prototype frame-mounted valves prepared with partial dilation of the aortic root, which had an S/RA ratio of less than 2.3 and a leaflet angle greater than 27 degrees. The study indicates that the next generation of porcine bioprostheses should be prepared with at least 17% dilation of the aortic root during frame mounting and with zero pressure difference across the leaflets during fixation. This can be achieved by applying an equal hydrostatic pressure to both sides of the valve leaflets during fixation and frame mounting.