Aortic Valves

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Aortic Valves
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Bileaflet Prosthesis

• Lowest gradient due to wide opening angle
• Minimal turbulence due to
• Wide opening angle
• Thin leaflets
• Large cross-sectional area

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Tilting Disc Prosthesis

• Less obstruction to blood flow
• Gradients of 6-7 mmHg
• Opening angle
• High low gradients, increased regurgitation
• Small High gradients less regurgitation

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Ball Valve

• Minimal leakage
• Annular area for flow creates turbulence
• High profile may occlude VOT
• Cage may contact ventricular
• wall during contraction
• Partial obstruction by the
• ball in aortic position

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Medtronic Hall Prosthesis

• Monoleaflet
• Central guide for leaflet travel
• Housing and central guide made of titanium
• Opening angle of 70-75o
• Leaflet motion is by translation and rotation

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Sorin Allcarbon Monoleaflet

• Chromium alloy housing coated with a thin film of
  carbon
• Pyrolytic carbon monoleaflet
• Strut mechanism integral with housing
• Sewing ring carbon coated

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Bjork-Shiley Monostrut

• Monoleaflet prosthesis
• Orifice ring and integral struts are constructed
  from a single piece of cobalt-chromium alloy
• Opening angle of 70o
• Relatively low velocity retrograde washing
  between leaflet and orifice
• Leaflet motion is by rotation and translation

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ATS Medical

• Pyrolyte housing and pyrolite carbon leaflets
  with graphite substrate
• Convex housing with protrusions on the inner
  aspect that support the leaflets therefore no
  protruding struts
• Convex hinge mechanism facilitate retrograde
  washing
• Opening angle of 85o

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Biocarbon Prosthesis

• Sorin Biomedica
• Titanium housing covered by pyrolite carbon
  strengthens prosthesis
• Curved leaflets
• Two effluent passages provide continuous washing
  even in the closed position
• Orifice divided into three sections
• Sewing ring dacron and carbon coated teflon
• Hinge mechanism supports a rolling motion

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Edwards MIRA Prosthesis

• Bileaflet prosthesis
• Pyrolite coated leaflets over tungsten
  impregnated carbon
• Curved leaflets enhance central flow and leaflet
  closure
• Retrograde washing by relative high frequency
  jets
• Closes by rotation and translation

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Carbomedics Prosthesis

• Solid pyrolite housing
• Pyrolite coated leaflets over tungsten
  impregnated carbon
• Radiopaque titanium stiffened ring
• Opening angle of 78o
• Leaflets can be rotated in the orifice

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St Jude Medical

• Pyrolytic carbon over graphite substrate for
  housing and leaflets
• Leaflets impregnated with tungsten for
  radiopacity
• Leaflets open to 85o resulting in near central
  laminar flow
• 10 regurgitant flow
• Leaflet motion by rotation

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Comparison between orifice area in stented and
stentless valves

• Stentless Stented

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Medtronic Freestyle Stentless Valve
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St. Jude Toronto SPV
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• Ross flexible homograft support

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Common sites of origin of extravalvular spread