Influence of Transvalvar Pressure Gradient on Hinge Washing in Closed Mechanical Prosthetic Cardiac Valves Under Pulmonary Pressure Conditions: A Comparative In Vitro Study

Hanna Pragt, Joost P. van Melle, Massimo A. Mariani, Gijsbertus J. Verkerke, Tjark Ebels

    Research output: Contribution to journalArticleAcademicpeer-review

    Abstract

    OBJECTIVE:: Hinge washing is a crucial factor in the prevention of mechanical prosthetic valvar thrombosis, especially in the pulmonary valve position. The aim of this laboratory study was to determine the relationship between pressure difference and the amount of hinge washing in the closed position, using the pressures that are normal for the right ventricle and pulmonary artery.

    METHODS:: In an in vitro setting, four different bileaflet mechanical valves were tested for hinge washing in closed position. Based on similarity in inner diameter (range: 20.5-21.4 mm), the following valves were tested: Abbott SJM Regent size 23, Cryolife On-X size 23, LivaNova Carbomedics-R size 25, Medtronic Open Pivot (M-OP)-A size 25. Tests were carried out in a range between 3 and 100 mm Hg pressure difference, using water as a test fluid. The amount of leakage per minute through the closed valve was measured.

    RESULTS:: All four valves showed an increase in leakage with increasing transvalvar gradient, and the relationship between pressure and leakage behaves in logarithmic fashion. Leakage under normal pulmonary diastolic pressure conditions (10 mm Hg) was between 23.3% and 29.3% of the leakage under aortic diastolic pressure conditions (80 mm Hg). The Cryolife On-X valve showed the highest closed leakage volume under pulmonary conditions (10 mm Hg) 0.254 ± 0.01 (L/min), where the Medtronic M-OP showed the lowest leakage volume with 0.125 ± 0.014 (mL/min).

    CONCLUSION:: Hinge washing is related to transvalvar pressure difference in closed position. Valve brands differed significantly from each other in the amount of hinge washing.

    Original languageEnglish
    Pages (from-to)145-150
    Number of pages6
    JournalWorld journal for pediatric & congenital heart surgery
    Volume10
    Issue number2
    DOIs
    Publication statusPublished - 1 Mar 2019

    Fingerprint

    Heart Valves
    Pressure
    Lung
    Blood Pressure
    Pulmonary Valve
    Pulmonary Artery
    Heart Ventricles
    Arterial Pressure
    Thrombosis
    In Vitro Techniques
    Water

    Keywords

    • UT-Hybrid-D
    • Mechanical heart valve
    • Pulmonary valve replacement
    • Congenital heart disease

    Cite this

    @article{9a5c6d4bdddb481ab5d5a383968d6c61,
    title = "Influence of Transvalvar Pressure Gradient on Hinge Washing in Closed Mechanical Prosthetic Cardiac Valves Under Pulmonary Pressure Conditions: A Comparative In Vitro Study",
    abstract = "OBJECTIVE:: Hinge washing is a crucial factor in the prevention of mechanical prosthetic valvar thrombosis, especially in the pulmonary valve position. The aim of this laboratory study was to determine the relationship between pressure difference and the amount of hinge washing in the closed position, using the pressures that are normal for the right ventricle and pulmonary artery. METHODS:: In an in vitro setting, four different bileaflet mechanical valves were tested for hinge washing in closed position. Based on similarity in inner diameter (range: 20.5-21.4 mm), the following valves were tested: Abbott SJM Regent size 23, Cryolife On-X size 23, LivaNova Carbomedics-R size 25, Medtronic Open Pivot (M-OP)-A size 25. Tests were carried out in a range between 3 and 100 mm Hg pressure difference, using water as a test fluid. The amount of leakage per minute through the closed valve was measured.RESULTS:: All four valves showed an increase in leakage with increasing transvalvar gradient, and the relationship between pressure and leakage behaves in logarithmic fashion. Leakage under normal pulmonary diastolic pressure conditions (10 mm Hg) was between 23.3{\%} and 29.3{\%} of the leakage under aortic diastolic pressure conditions (80 mm Hg). The Cryolife On-X valve showed the highest closed leakage volume under pulmonary conditions (10 mm Hg) 0.254 ± 0.01 (L/min), where the Medtronic M-OP showed the lowest leakage volume with 0.125 ± 0.014 (mL/min).CONCLUSION:: Hinge washing is related to transvalvar pressure difference in closed position. Valve brands differed significantly from each other in the amount of hinge washing.",
    keywords = "UT-Hybrid-D, Mechanical heart valve, Pulmonary valve replacement, Congenital heart disease",
    author = "Hanna Pragt and {van Melle}, {Joost P.} and Mariani, {Massimo A.} and Verkerke, {Gijsbertus J.} and Tjark Ebels",
    year = "2019",
    month = "3",
    day = "1",
    doi = "10.1177/2150135118818760",
    language = "English",
    volume = "10",
    pages = "145--150",
    journal = "World Journal for Pediatric and Congenital Hearth Surgery",
    issn = "2150-1351",
    publisher = "Sage Periodicals Press",
    number = "2",

    }

    Influence of Transvalvar Pressure Gradient on Hinge Washing in Closed Mechanical Prosthetic Cardiac Valves Under Pulmonary Pressure Conditions : A Comparative In Vitro Study. / Pragt, Hanna; van Melle, Joost P.; Mariani, Massimo A.; Verkerke, Gijsbertus J.; Ebels, Tjark.

    In: World journal for pediatric & congenital heart surgery, Vol. 10, No. 2, 01.03.2019, p. 145-150.

    Research output: Contribution to journalArticleAcademicpeer-review

    TY - JOUR

    T1 - Influence of Transvalvar Pressure Gradient on Hinge Washing in Closed Mechanical Prosthetic Cardiac Valves Under Pulmonary Pressure Conditions

    T2 - A Comparative In Vitro Study

    AU - Pragt, Hanna

    AU - van Melle, Joost P.

    AU - Mariani, Massimo A.

    AU - Verkerke, Gijsbertus J.

    AU - Ebels, Tjark

    PY - 2019/3/1

    Y1 - 2019/3/1

    N2 - OBJECTIVE:: Hinge washing is a crucial factor in the prevention of mechanical prosthetic valvar thrombosis, especially in the pulmonary valve position. The aim of this laboratory study was to determine the relationship between pressure difference and the amount of hinge washing in the closed position, using the pressures that are normal for the right ventricle and pulmonary artery. METHODS:: In an in vitro setting, four different bileaflet mechanical valves were tested for hinge washing in closed position. Based on similarity in inner diameter (range: 20.5-21.4 mm), the following valves were tested: Abbott SJM Regent size 23, Cryolife On-X size 23, LivaNova Carbomedics-R size 25, Medtronic Open Pivot (M-OP)-A size 25. Tests were carried out in a range between 3 and 100 mm Hg pressure difference, using water as a test fluid. The amount of leakage per minute through the closed valve was measured.RESULTS:: All four valves showed an increase in leakage with increasing transvalvar gradient, and the relationship between pressure and leakage behaves in logarithmic fashion. Leakage under normal pulmonary diastolic pressure conditions (10 mm Hg) was between 23.3% and 29.3% of the leakage under aortic diastolic pressure conditions (80 mm Hg). The Cryolife On-X valve showed the highest closed leakage volume under pulmonary conditions (10 mm Hg) 0.254 ± 0.01 (L/min), where the Medtronic M-OP showed the lowest leakage volume with 0.125 ± 0.014 (mL/min).CONCLUSION:: Hinge washing is related to transvalvar pressure difference in closed position. Valve brands differed significantly from each other in the amount of hinge washing.

    AB - OBJECTIVE:: Hinge washing is a crucial factor in the prevention of mechanical prosthetic valvar thrombosis, especially in the pulmonary valve position. The aim of this laboratory study was to determine the relationship between pressure difference and the amount of hinge washing in the closed position, using the pressures that are normal for the right ventricle and pulmonary artery. METHODS:: In an in vitro setting, four different bileaflet mechanical valves were tested for hinge washing in closed position. Based on similarity in inner diameter (range: 20.5-21.4 mm), the following valves were tested: Abbott SJM Regent size 23, Cryolife On-X size 23, LivaNova Carbomedics-R size 25, Medtronic Open Pivot (M-OP)-A size 25. Tests were carried out in a range between 3 and 100 mm Hg pressure difference, using water as a test fluid. The amount of leakage per minute through the closed valve was measured.RESULTS:: All four valves showed an increase in leakage with increasing transvalvar gradient, and the relationship between pressure and leakage behaves in logarithmic fashion. Leakage under normal pulmonary diastolic pressure conditions (10 mm Hg) was between 23.3% and 29.3% of the leakage under aortic diastolic pressure conditions (80 mm Hg). The Cryolife On-X valve showed the highest closed leakage volume under pulmonary conditions (10 mm Hg) 0.254 ± 0.01 (L/min), where the Medtronic M-OP showed the lowest leakage volume with 0.125 ± 0.014 (mL/min).CONCLUSION:: Hinge washing is related to transvalvar pressure difference in closed position. Valve brands differed significantly from each other in the amount of hinge washing.

    KW - UT-Hybrid-D

    KW - Mechanical heart valve

    KW - Pulmonary valve replacement

    KW - Congenital heart disease

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    U2 - 10.1177/2150135118818760

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    EP - 150

    JO - World Journal for Pediatric and Congenital Hearth Surgery

    JF - World Journal for Pediatric and Congenital Hearth Surgery

    SN - 2150-1351

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