Biological

Biological prosthetic valves

Normal values for Biological Aortic Valve Prosthesis[1]

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 Prosthesis[1]

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

1. Zoghbi WA, Chambers JB, Dumesnil JG, Foster E, Gottdiener JS, Grayburn PA, Khandheria BK, Levine RA, Marx GR, Miller FA Jr, Nakatani S, Quiñones MA, Rakowski H, Rodriguez LL, Swaminathan M, Waggoner AD, Weissman NJ, Zabalgoitia M, American Society of Echocardiography's Guidelines and Standards Committee, Task Force on Prosthetic Valves, American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, European Association of Echocardiography, European Society of Cardiology, Japanese Society of Echocardiography, Canadian Society of Echocardiography, American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, European Society of Cardiology, Japanese Society of Echocardiography, and Canadian Society of Echocardiography. Recommendations for evaluation of prosthetic valves with echocardiography and doppler ultrasound: a report From the American Society of Echocardiography's Guidelines and Standards Committee and the Task Force on Prosthetic Valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography, endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2009 Sep;22(9):975-1014; quiz 1082-4. DOI:10.1016/j.echo.2009.07.013 |