Thorac Cardiovasc Surg 2014; 62 - SC200
DOI: 10.1055/s-0034-1367461

Eccentricity of the aortic annulus is not associated with functional impairment of the transapical Jenavalve in an in vitro hydrodynamic test model

S. Ensminger 1, M. Utzenrath 2, M. Kütting 2, S. Achenbach 3, A. Schuhbäck 3, S. Jategaonkar 4, J. Börgermann 1, J. Gummert 1, U. Steinseifer 2
  • 1Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Department of Thoracic- and Cardiovascular Surgery, Bad Oeynhausen, Germany
  • 2Institute of Applied Medical Engineering, Helmholtz Institute, Department of Cardiovascular Engineering, Aachen, Germany
  • 3University of Erlangen-Nürnberg, Department of Medicine 2, Erlangen, Germany
  • 4Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Department of Cardiology, Bad Oeynhausen, Germany

Background: CT analyses of patients with aortic stenosis reveal that in many patients the aortic annulus is eccentric. Therefore, the aim of this study was to assess the performance of the transapical Jenavalve® in an in vitro hydrodynamic test method comparing circular and eccentric aortic annulus geometry.

Methods: Based on CT-data from 123 consecutive TAVI-patients, a mean annulus eccentricity (eccentricity = short diameter/long diameter) of 0.84 was determined. Two models of aortic roots with valve leaflets, one circular in shape and one displaying an eccentricity of 0.84 were created with orifice areas corresponding to a circular 27 mm annulus. Valve hydrodynamics were evaluated at different flow rates and frequencies simulating various physiological conditions. Experiments were repeated after transferring prostheses that had been implanted in circular annuli to eccentric annuli.

Results: Analysis was performed with transapical Jenavalve prostheses (27 mm) implanted in circular annuli (n = 3) or annuli with 0.84 eccentricity (n = 3). Hydrodynamic testing under both conditions showed no significant difference in valve performance under both conditions. In the circular annulus the Jenavalve showed an average regurgitation volume of 3.49ccm ± 0.12ccm [4.69% ± 0.20% of total stroke volume]. An increase of regurgitation volume to 3.57ccm ± 1.61ccm [4.81% ± 2.05% of total stroke volume] was seen in the oval annulus, indicating only a small increase by 0.08ccm or 0.12% of the total stroke volume. After switching the valve groups, no difference was seen in valve performance.

Conclusion: This is the first experimental in vitro study demonstrating no significant difference in valve performance with regard to regurgitation volume for a commercially available percutaneous valve implanted in an eccentric annulus.