Normal aortic valves stay open much longer in systole than porcine substitutes

Abstract

Objective:

To compare the opening mechanics of porcine valve substitutes with those of a normal human aortic valve.

Background:

All commercially available porcine valves are pretreated with glutaraldehyde. This study was undertaken to evaluate the consequences of such treatment on valve mechanics.

Methods:

The opening mechanics of the aortic valve, especially the time taken to open fully from a closed position, and the duration for which the valve is maximally open, were compared in a normal aortic valve, a stent-mounted porcine valve, and a stentless porcine valve, using a finite element model.

Results:

Despite a 4-fold higher gradient, stent-mounted porcine valves were slower in attaining the fully open position, and the time for which the valve was fully open was almost 25% less than a normal valve. In stentless valves, the compliant root made the initial opening mechanics similar to those of a normal valve. Once this effect was over, the effect of porcine leaflet properties took over, and there was a corresponding delay in the valve opening.

Conclusions:

Fixing the root with a stent and stiffening the leaflets with glutaraldehyde result in delayed valve opening and decrease the duration for which the valve is fully open, thus contributing to inferior hemodynamics.