(1)背景:本研究旨在分析两代自膨胀经导管心脏瓣膜(THV)作为瓣膜中瓣膜(ViV)在不同外科主动脉瓣(SAV)模型下的流体动力学性能。基于镍钛诺的EvolutR阀经常用于ViV程序。目前还不清楚它的继任者,EvolutPRO,在ViV程序中是优越的,特别是考虑到先前植入的SAV模型。(2)方法:EvolutTMR26mm和EvolutTMPRO26mm假体植入9个21mm标记大小的SAV模型(Hancock®II,Mosaic®UltraTM,EpicTM上,TrifectaTMGT,Perimount®,Perimount®MagnaEase,AvalusTM,IntuityTM,Freestyle®)在脉冲复制器中在定义的循环条件下分析其流体动力学性能。(3)结果:两种THV均在Hancock®II内具有最低有效孔口面积(EOA)和最高平均压力梯度(MPG),而Intuity中的THV表现出最高的EOA和最低的MPG。EvolutR和EvolutPRO显示出明显的流体动力学差异,具体取决于SAV。两种THV在猪瓣膜中相似地执行。尽管EvolutR在支架牛SAV中的表现优于EvolutPRO,EvolutPRO在Intuity内部是优越的。Further,SAV模型设计显着影响了TAV的几何孔口面积和针轮指数。(4)结论:这些发现表明,根据先前植入的SAV模型,EvolutR和EvolutPRO的表现有所不同。用于治疗特定SAV模型的THV选择应考虑这些结果。
(1) Background: This study aimed to analyse the hydrodynamic performance of two generations of self-expanding transcatheter heart valves (THV) as a valve-in-valve (ViV) in different surgical aortic valve (SAV) models under standardised conditions. The nitinol-based Evolut R valve is frequently used in ViV procedures. It is unclear whether its successor, the Evolut PRO, is superior in ViV procedures, particularly considering the previously implanted SAV model. (2) Methods: EvolutTM R 26 mm and EvolutTM PRO 26 mm prostheses were implanted in nine 21 mm labelled size SAV models (Hancock® II, Mosaic® UltraTM, EpicTM Supra, TrifectaTM GT, Perimount®, Perimount® Magna Ease, AvalusTM, IntuityTM, Freestyle®) to analyse their hydrodynamic performance under defined circulatory conditions in a pulse duplicator. (3) Results: Both THVs presented with the lowest effective orifice area (EOA) and highest mean pressure gradient (MPG) inside Hancock® II, whereas THVs in Intuity showed the highest EOA and lowest MPG. Evolut R and Evolut PRO showed significant hydrodynamic differences depending on the SAV. Both THVs performed similarly in porcine valves. Although the Evolut R performed better than Evolut PRO in stented bovine SAVs, the Evolut PRO was superior inside the Intuity. Further, the SAV model design markedly influenced the TAV\'s geometric orifice area and pin-wheeling index. (4) Conclusions: These findings show that the Evolut R and Evolut PRO perform differently depending on the previously implanted SAV model. THV selection for treatment of a specific SAV model should consider these results.