Biological

Biological prosthetic valves

Normal values for Biological Aortic Valve Prosthesis1

Valve	Type	Size (mm)	Peak gradient (mmHg)	Mean gradient (mmHg)	EOA (cm2)
Baxter Perimount	Stented bovine pericardial	19	32.5 ± 8.5	19.5 ± 5.5	1.3 ± 0.2
		21	24.9 ± 7.7	13.8 ± 4.0	1.3 ± 0.3
		23	19.9 ± 7.4	11.5 ± 3.9	1.6 ± 0.3
		25	16.5 ± 7.8	10.7 ± 3.8	1.6 ± 0.4
		27	12.8 ± 5.4	4.8 ± 2.2	2.0 ± 0.4
Biocor	Stented porcine	23	30.0 ± 10.7	20 ± 6.6	1.3 ± 0.3
		25	23.0 ± 7.9	16 ± 5.1	1.7 ± 0.4
		27	22.0 ± 6.5	15.0 ± 3.7	2.2 ± 0.4
BioFlo	Stented bovine pericardial	19	37.2 ± 8.8	26.4 ± 5.5	0.7 ± 0.1
		21	28.7 ± 6.2	18.7 ± 5.5	1.1 ± 0.1
Carpentier Edwards Pericardial	Stented bovine pericardial	19	32.1 ± 3.4	24.2 ± 8.6	1.2 ± 0.3
		21	25.7 ± 9.9	20.3 ± 9.1	1.5 ± 0.4
		23	21.7 ± 8.6	13.0 ± 5.3	1.8 ± 0.3
		25	16.5 ± 5.4	9.0 ± 2.3
Carpentier Edwards Standard	Stented porcine	19	43.5 ± 12.7	25.6 ± 8.0	0.9 ± 0.2
		21	27.7 ± 7.6	17.3 ± 6.2	1.5 ± 0.3
		23	28.9 ± 7.5	16.1 ± 6.2	1.7 ± 0.5
		25	24.0 ± 7.1	12.9 ± 4.6	1.9 ± 0.5
		27	22.1 ± 8.2	12.1 ± 5.5	2.3 ± 0.6
		29		9.9 ± 2.9	2.8 ± 0.5
Carpentier Supra - Annular	Stented porcine	19	34.1 ± 2.7		1.1 ± 0.1
		21	28.0 ± 10.5	17.5 ± 3.8	1.4 ± 0.9
		23	25.3 ± 10.5	13.4 ± 4.5	1.6 ± 0.6
		25	24.4 ± 7.6	13.2 ± 4.8	1.8 ± 0.4
		27	16.7 ± 4.7	8.8 ± 2.8	1.9 ± 0.7
CryoLife	Stentless	19		9.0 ± 2.0	1.5 ± 0.3
		21		6.6 ± 2.9	1.7 ± 0.4
		23		6.0 ± 2.3	2.3 ± 0.2
		25		6.1 ± 2.6	2.6 ± 0.2
		27		4.0 ± 2.4	2.8 ± 0.3
Extended Biocor	Stentless	19	17.5 ± 6.5	9.6 ± 3.6	1.4 ± 0.4
		21	17.5 ± 6.5	9.6 ± 3.6	1.4 ± 0.4
		23	14.7 ± 7.3	7.7 ± 3.8	1.7 ± 0.4
		25	14.0 ± 4.3	7.4 ± 2.5	1.8 ± 0.4
Hancock	Stented porcine	21	18.0 ± 6.0	12.0 ± 2.0
		23	16.0 ± 2.0	11.0 ± 2.0
		25	15.0 ± 3.0	10.0 ± 3.0
Hancock II	Stented porcine	21		14.8 ± 4.1	1.3 ± 0.4
		23	34.0 ± 13.0	16.6 ± 8.5	1.3 ± 0.4
		25	22.0 ± 5.3	10.8 ± 2.8	1.6 ± 0.4
		29	16.2 ± 1.5	8.2 ± 1.7	1.6 ± 0.2
Homograft	Homograft valves	?	?	?	?
Intact	Stented porcine	19	40.4 ± 15.4	24.5 ± 9.3
		21	40.9 ± 15.6	19.6 ± 8.1	1.6 ± 0.4
		23	32.7 ± 9.6	19.0 ± 6.1	1.6 ± 0.4
		25	29.7 ± 15.0	17.7 ± 7.9	1.7 ± 0.3
		27	25.0 ± 7.6	15.0 ± 4.5
Ionescu - Shiley	Stented bovine pericardial	17	23.8 ± 3.4		0.9 ± 0.1
		19	19.7 ± 5.9	13.3 ± 3.9	1.1 ± 0.1
		21	26.6 ± 9.0
		23		15.6 ± 4.4
Labcor Santiago	Stented bovine pericardial	19	18.6 ± 5.0	11.8 ± 3.3	1.2 ± 0.1
		21	17.5 ± 6.6	8.2 ± 4.5	1.3 ± 0.1
		23	14.8 ± 5.2	7.8 ± 2.9	1.8 ± 0.2
		25	12.3 ± 3.4	6.8 ± 2.0	2.1 ± 0.3
Labcor Synergy	Stented porcine	21	24.3 ± 8.1	13.3 ± 4.2	1.1 ± 0.3
		23	27.3 ± 13.7	15.3 ± 6.9	1.4 ± 0.4
		25	22.5 ± 11.9	13.2 ± 6.4	1.5 ± 0.4
		27	17.8 ± 7.0	10.6 ± 4.6	1.8 ± 0.5
Medtronic Freestyle	Stentless	19		13.0 ± 3.9
		21		9.1 ± 5.1	1.4 ± 0.3
		23	11.0 ± 4.0	8.1 ± 4.6	1.7 ± 0.5
		25		5.3 ± 3.1	2.1 ± 0.5
		27		4.6 ± 3.1	2.5 ± 0.1
Medtronic Mosaic	Stented porcine	21		14.2 ± 5.0	1.4 ± 0.4
		23	23.8 ± 11.0	13.7 ± 4.8	1.5 ± 0.4
		25	22.5 ± 10.0	11.7 ± 5.1	1.8 ± 0.5
		27		10.4 ± 4.3	1.9 ± 0.1
		29		11.1 ± 4.3	2.1 ± 0.2
Mitroflow	Stented bovine pericardial	19	18.6 ± 5.3	13.1 ± 3.3	1.1 ± 0.2
Prima	Stentless	21	28.8 ± 6.0	13.7 ± 1.9	1.4 ± 0.7
		23	21.5 ± 7.5	11.5 ± 4.9	1.5 ± 0.3
		25	22.1 ± 12.5	11.6 ± 7.2	1.8 ± 0.5
Sorin Pericarbon	Stentless	19	36.5 ± 9.0	28.9 ± 7.3	1.2 ± 0.5
		21	28.0 ± 13.3	23.8 ± 11.1	1.3 ± 0.6
		23	27.5 ± 11.5	23.2 ± 7.6	1.5 ± 0.5
St. Jude Medical	Stentless	21	22.6 ± 14.5	10.7 ± 7.2	1.3 ± 0.6
		23	16.2 ± 9.0	8.2 ± 4.7	1.6 ± 0.6
		25	12.7 ± 8.2	6.3 ± 4.1	1.8 ± 0.5
		27	10.1 ± 5.8	5.0 ± 2.9	2.0 ± 0.3
		29	7.7 ± 4.4	4.1 ± 2.4	2.4 ± 0.6

Normal values for Biological Mitral Valve Prosthesis1

Valve	Type	Size (mm)	Peak gradient (mmHg)	Mean gradient (mmHg)	Peak Velocity (m/s)	Pressure half-time (ms)	EOA (cm2)
Biocor	Stentless bioprosthesis	27	13 ± 1
		29	14 ± 2.5
		31	11.5 ± 0.5
		33	12 ± 0.5
Bioflo pericardial	Stented bioprosthesis	25	10 ± 2	6.3 ± 1.5			2 ± 0.1
		27	9.5 ± 2.6	5.4 ± 1.2			2 ± 0.3
		29	5 ± 2.8	3.6 ± 1			2.4 ± 0.2
		31	4.0	2.0			2.3
Carpentier - Edwards	Stented bioprosthesis	27		6 ± 2	1.7 ± 0.3	98 ± 28
		29		4.7 ± 2	1.76 ± 0.27	92 ± 14
		31		4.4 ± 2	1.54 ± 0.15	92 ± 19
		33		6 ± 3		93 ± 12
Carpentier - Edwards pericardial	Stented Bioprosthesis	27		3.6	1.6	100
		29		5.25 ± 2.36	1.67 ± 0.3	110 ± 15
		31		4.05 ± 0.83	1.53 ± 0.1	90 ± 11
		23		1.0	0.8	80
Hancock I (or NOS)	Stented bioprosthesis	27	10 ± 4	5 ± 2			1.3 ± 0.8
		29	7 ± 3	2:46 ± 0.79		115 ± 20	1.5 ± 0.2
		31	4 ± 0.86	4.86 ± 1.69		95 ± 17	1.6 ± 0.2
		33	3 ± 2	3.87 ± 2		90 ± 12	1.9 ± 0.2
Hancock II	Stented bioprosthesis	27					2.21 ± 0.14
		29					2.77 ± 0.11
		31					2.84 ± 0.1
		33					3.15 ± 0.22
Hancock pericardial	Stented bioprosthesis	29		2.61 ± 1:39	1:42 ± 0:14	105 ± 36
		31		3.57 ± 1.02	1.51 ± 0.27	81 ± 23
Ionescu - Shiley	Stented bioprosthesis	25		4.87 ± 1.08	1.43 ± 0.15	93 ± 11
		27		3.21 ± 0.82	1.31 ± 0.24	100 ± 28
		29		3.22 ± 0.57	1.38 ± 0.2	85 ± 8
		31		3.63 ± 0.9	1.45 ± 0.06	100 ± 36
Ionescu - Shiley low profile	Stented bioprosthesis	29		3.31 ± 0.96	1.36 ± 0.25	80 ± 30
		31		2.74 ± 0.37	1.33 ± 0.14	79 ± 15
Labcor-Santiago pericardial	Stented bioprosthesis	25	8.7	4.5		97	2.2
		27	5.6 ± 2.3	2.8 ± 1.5		85 ± 18	2.12 ± 0.48
		29	6.2 ± 2.1	3 ± 1.3		80 ± 34	2.11 ± 0.73
Medtronic Intact Porcine	Stented bioprosthesis	29		3.5 ± 0.51	1.6 ± 0.22
		31		4.2 ± 1.44	1.6 ± 0.26
		33		4 ± 1.3	1.4 ± 0.24
		35		3.2 ± 1.77	1.3 ± 0.5
Mitroflow	Stented bioprosthesis	25		6.9	2.0	90
		27		3.07 ± 0.91	1.5	90 ± 20
		29		3.5 ± 1.65	1.43 ± 0.29	102 ± 21
		31		3.85 ± 0.81	1.32 ± 0.26	91 ± 22
Stentless quadrileaflet bovine pericardial	Stentless bioprosthesis	26		2.2 ± 1.7	1.6	103 ± 31	1.7
		28			1:58 ± 0.25		1.7 ± 0.6
		30			1.42 ± 0.32		2.3 ± 0.4
Wessex	Stented bioprosthesis	29		3.69 ± 0.61	1.66 ± 0.17	83 ± 19
		31		3.31 ± 0.83	1.41 ± 0.25	80 ± 21

Related valve dysfunction in bioprostheses

In Stentless bioprosthesis proximal joint of the prosthesis may loosen , causing blood between aortic wall and valve can come . When valve thrombosis there arises an increase in the gradient and an increase in the back flow (leakage) due to the larger mass, to enable the valve closes slowly.

References

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1. 1 pmid=19733789

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