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Philippe Pibarot - One of the best experts on this subject based on the ideXlab platform.
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Hemodynamic Performance of the balloon expandable sapien 3 valve as assessed by cardiac magnetic resonance
International Journal of Cardiology, 2020Co-Authors: Alfredo Nunes Ferreiraneto, Eric Larose, Philippe Pibarot, Constanze Merten, Hanswilko Beurich, Dirk Zachow, Gert Richardt, Leonardo Guimaraes, Emilie Pelletierbeaumont, Josep RodescabauAbstract:Abstract Background Scarce data exist on transcatheter heart valve (THV) Performance evaluated by cardiac magnetic resonance (CMR) in newer generation THV patients. Furthermore, it has been suggested that echocardiographic evaluation after TAVR may inaccurately assess residual AR in some patients. This study aimed to determine the incidence and severity of aortic regurgitation (AR) assessed by CMR in patients undergoing TAVR with the SAPIEN 3 valve, and evaluate the agreement between CMR and transthoracic echocardiography (TTE) on the assessment of AR severity in such patients. Methods This multicentric observational study included 146 SAPIEN 3 patients with TTE and CMR within the month following their procedure. According to the CMR regurgitation fraction (RF), AR was considered mild and moderate-severe if the RF was 15– Results By CMR, SAPIEN 3 recipients displayed a mean RF of 5.0 ± 6.1%, and mild and moderate-severe AR rates of 3.4% and 0.7%, respectively. The agreement between CMR-TTE was modest (weighted κ = 0.2640, p Conclusions SAPIEN 3 recipients exhibited very low rates of residual AR by CMR, suggesting a surgical-like Performance regarding AR with this newer generation THV. TTE tended to overestimate the severity of AR, particularly among mild AR patients.
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Mitral valve-in-valve Hemodynamic Performance: An in vitro study
The Journal of thoracic and cardiovascular surgery, 2015Co-Authors: Morgane Evin, Josep Rodés-cabau, Carine Guivier-curien, Régis Rieu, Philippe PibarotAbstract:Abstract Objectives The valve-in-valve (VinV) procedure may be used in high-risk patients with failed mitral surgical bioprostheses. The objective of this in vitro study was to assess the Hemodynamic function of different VinV configurations. Methods A double activation duplicator was used to test 11 valve configurations (surgical bioprostheses alone) and 15 VinV configurations (Sapien [Edwards Lifesciences, Irvine, Calif] implanted within the surgical bioprosthesis) under 8 different Hemodynamic conditions. The internal orifice diameter (IOD) of the surgical bioprosthesis was measured with a Smartscope (OGP Multi Sensor Measuring Instruments, Singapore). Results The VinV procedure was associated with significant deterioration in antegrade Hemodynamic parameters compared with valve configuration (effective orifice area, 1.51 ± 0.21 cm 2 vs 1.65 ± 0.37 cm 2 ; P P 20%, and IOD > 23 mm was associated with higher risk of paravalvular regurgitation when oversizing was Conclusions This in vitro study shows that VinV within mitral surgical bioprostheses provides satisfactory Hemodynamic results in the majority of patients. However, significant mitral stenosis is more likely to occur when the IOD of the surgical bioprosthesis is 20%. Significant paravalvular regurgitation is rare and occurs with larger IODs and lower percentage of oversizing (8%).
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Comparison of Hemodynamic Performance of the Balloon-Expandable SAPIEN 3 Versus SAPIEN XT Transcatheter Valve.
The American journal of cardiology, 2014Co-Authors: Ignacio J. Amat-santos, Abdellaziz Dahou, Eric Larose, John Webb, Danny Dvir, Jonathon Leipsic, Jean G Dumesnil, Ricardo Allende, Philippe Pibarot, Marina Urena, Sylvie Bilodeau, Christopher R. Thompson, Scott Bergeron, Sergio Pasian, Robert Delarochellière, Henrique B. Ribeiro, Jean Michel Paradis, Eric Dumont, Josep Rodés-cabauAbstract:The SAPIEN 3 valve (S3V) is a new-generation transcatheter valve with enhanced anti-paravalvular leak properties, but no data comparing with earlier transcatheter valve systems are available. We aimed to compare the Hemodynamic Performance of the S3V and the SAPIEN XT valve (SXTV) in a case-matched study with echo core laboratory analysis. A total of 27 patients who underwent transcatheter aortic valve replacement (TAVR) with the S3V were matched for prosthesis size (26 mm), aortic annulus area, and mean diameter measured by computed tomography, left ventricular ejection fraction, body surface area, and body mass index with 50 patients treated with the SXTV. The prosthesis size was determined by oversizing of 1% to 15% of annulus area. Doppler echocardiographic images collected at baseline and 1-month follow-up were analyzed in a central echocardiography core laboratory. The need for postdilation was higher in the SXTV group (20% vs 4%, p = 0.047), and mean residual gradient and effective orifice area were similar in both groups (p >0.05). The incidence of paravalvular aortic regurgitation was greater with the SXTV (≥mild: 42%, moderate: 8%) than with the S3V (≥mild: 7%, moderate: 0%; p = 0.002 for ≥mild vs SXTV). The implantation of an S3V was the only factor associated with trace or no paravalvular leak after TAVR (p = 0.007). In conclusion, TAVR with the S3V was associated with a very low rate of paravalvular leaks and need for balloon postdilation, much lower than that observed with the earlier generation of balloon-expandable valve (SXTV). The confirmation of these results in a larger cohort of patients will represent a major step forward in using transcatheter valves for the treatment of aortic stenosis.
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comparison of the Hemodynamic Performance of percutaneous and surgical bioprostheses for the treatment of severe aortic stenosis
Journal of the American College of Cardiology, 2009Co-Authors: Marie-annick Clavel, Christopher R. Thompson, Philippe Pibarot, Eric Dumont, John G Webb, Jeanbernard Masson, Daniel Doyle, Lukas Altwegg, Robert De Larochelliere, Sebastien BergeronAbstract:Objectives This study was undertaken to compare the Hemodynamic Performance of a percutaneous bioprosthesis to that of surgically implanted (stented and stentless) bioprostheses for the treatment of severe aortic stenosis. Methods Fifty patients who underwent percutaneous aortic valve implantation (PAVI) with the Cribier-Edwards or Edwards SAPIEN bioprosthetic valve (Edwards Lifesciences, Inc., Irvine, California) were matched 1:1 for sex, aortic annulus diameter, left ventricular ejection fraction, body surface area, and body mass index, with 2 groups of 50 patients who underwent surgical aortic valve replacement (SAVR) with a stented valve (Edwards Perimount Magna [SAVR-ST group]), or a stentless valve (Medtronic Freestyle, Medtronic, Minneapolis, Minnesota [SAVR-SL group]). Doppler echocardiographic data were prospectively obtained before the intervention, at discharge, and at 6- to 12-month follow-up. Results Mean transprosthetic gradient at discharge was lower (p Conclusions PAVI provided superior Hemodynamic Performance compared with the surgical bioprostheses in terms of transprosthetic gradient and prevention of severe prosthesis-patient mismatch, but was associated with a higher incidence of AR.
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delayed improvement in valve Hemodynamic Performance after percutaneous pulmonary valve implantation
The Annals of Thoracic Surgery, 2008Co-Authors: Josep Rodescabau, Christine Houde, Jean Perron, Lee N Benson, Philippe PibarotAbstract:We report the case of a 21-year-old woman with a severely stenotic pulmonary homograft who underwent percutaneous pulmonary valve implantation, with no significant change in transvalvular gradient within the 24 hours after the procedure. Major improvement in Hemodynamic valve Performance of more than 60% decrease in transvalvular gradient and more than 30% increase in pulmonary valve area was observed 3 months after the procedure, showing that Hemodynamic improvement can occur late after pulmonary valve implantation. An echocardiogram after 3 months should be done before concluding the procedure failed and that reintervention is necessary.
Hartzell V Schaff - One of the best experts on this subject based on the ideXlab platform.
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midterm multicenter clinical and Hemodynamic results for the trifecta aortic pericardial valve
The Journal of Thoracic and Cardiovascular Surgery, 2017Co-Authors: Scott M Goldman, Joseph E Bavaria, Anson Cheung, Michael R Petracek, Mark A Groh, Hartzell V SchaffAbstract:Abstract Objective To evaluate the midterm Hemodynamic Performance and clinical outcomes of the Trifecta aortic pericardial valve. Methods In a multicenter, prospective, nonrandomized, follow-up study, 710 patients underwent surgical implantation of a pericardial stented aortic prosthesis (Trifecta valve; St Jude Medical, St. Paul, Minn). The valve is constructed from bovine pericardium mounted externally onto a titanium stent. Subjects were followed on an annual basis over 6 years. Results Operations were performed from 2007 to 2009, and mean age was 72.4 ± 9.3 years; 471 of 710 (66.3%) were men. Preoperatively, 361 of 710 (50.8%) of patients were in New York Heart Association class III or IV, and at 6 years postoperatively, 92 of 96 (95.8%) were New York Heart Association class I or II. Six years postoperatively, average mean gradient across all valve sizes was 11.0 mm Hg, and the average effective orifice area index was 0.80 cm 2 /m 2 . The proportion of patients without moderate-to-severe valvular regurgitation at 6 years was 95.2% (80/84). Six years postoperatively, freedom from valve-related mortality, nonstructural dysfunction, and paravalvular leak were 98.3%, 98.6%, and 98.9%, respectively, and freedom from reoperation due to structural valve deterioration was 97.3% (95% confidence limits, 98.6-94.7). Conclusion These midterm results demonstrate that the Trifecta valve is a safe and effective valve substitute with excellent Hemodynamic Performance and durability that is maintained through the 6-year follow-up period.
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comparison of early Hemodynamic Performance of 3 aortic valve bioprostheses
The Journal of Thoracic and Cardiovascular Surgery, 2014Co-Authors: Murat Ugur, Rakesh M Suri, Richard C Daly, Harold M Burkhart, Kevin L Greason, Joseph A Dearani, Soon J Park, Lyle D Joyce, Hartzell V SchaffAbstract:Objective The study objective was to determine whether the new-generation Trifecta (St Jude Medical Inc, St Paul, Minn) bovine aortic valve bioprosthesis, which is designed for supra-annular positioning, produces early postoperative Hemodynamic results comparable to or better than those of the Mitroflow (Sorin Group, Milan, Italy) or Perimount Magna (Edwards Lifesciences Corp, Irvine, Calif) bovine aortic valve bioprostheses. Methods We retrospectively reviewed the medical records of patients who underwent aortic valve replacement with a Trifecta, Mitroflow, or Perimount Magna bovine pericardial prosthesis at Mayo Clinic between June 2007 and December 2012 and analyzed early postoperative Hemodynamic Performance by Doppler echocardiography. Results A total of 1436 patients underwent aortic valve replacement (Trifecta in 196, Mitroflow in 1135, Perimount Magna in 105). Preoperative characteristics and early clinical outcomes were similar among the 3 valve groups. The average mean gradients were lower and valve areas were greater with the Trifecta valves. For the Trifecta, Mitroflow, and Perimount Magna valves, the average mean gradient was 11.4 mm Hg, 16.9 mm Hg, and 14.1 mm Hg, respectively; the effective orifice area was 2.22 cm 2 , 1.85 cm 2 , and 2.09 cm 2 , respectively; and the indexed effective orifice area was 1.14 cm 2 /m 2 , 0.96 cm 2 /m 2 , and 1.07 cm 2 /m 2 , respectively (all P 2 /m 2 ) was detected in 1.3% of patients (n = 2/150) with the Trifecta, 5.8% of patients (n = 44/758) with the Mitroflow, and 3.2% of patients (n = 3/95) with the Perimount Magna ( P = .048). Conclusions Early Hemodynamic postoperative Performance of the Trifecta bioprosthesis is favorable. Additional follow-up should determine whether these small Hemodynamic differences will persist and influence later clinical outcomes.
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suture technique does not affect Hemodynamic Performance of the small supra annular trifecta bioprosthesis
The Journal of Thoracic and Cardiovascular Surgery, 2014Co-Authors: Murat Ugur, John G Byrne, Joseph E Bavaria, Anson Cheung, Michael R Petracek, Mark A Groh, Rakesh M Suri, Michael A Borger, Hartzell V SchaffAbstract:Objective The study objective was to evaluate whether aortic valve replacement with the Trifecta valve (St Jude Medical Inc, St Paul, Minn) using simple sutures produces better Hemodynamic Performance than valve replacement with noneverting pledget-reinforced sutures. Methods We analyzed prospectively acquired 1-year Hemodynamic data of patients with small aortic annulus sizes who were enrolled in a multicenter trial of the Trifecta aortic valve bioprosthesis and underwent aortic valve replacement with a 19-mm or 21-mm bioprosthesis between August 2007 and November 2009. We compared preoperative clinical information and 1-year postoperative Hemodynamic data for noneverting pledget-reinforced sutures (group 1) versus everting mattress sutures or simple sutures (group 2). Results A total of 346 patients underwent aortic valve replacement: 269 in group 1 and 77 in group 2. Preoperative demographic characteristics for the 2 groups were similar. For groups 1 and 2, the mean gradient was 10.4 ± 4.7 mm Hg and 11.1 ± 4.4 mm Hg for 19-mm valves, respectively, and 8.4 ± 3.5 mm Hg and 8.8 ± 3.6 mm Hg for 21-mm valves, respectively; the effective orifice area was 1.40 cm 2 and 1.25 cm 2 for 19-mm valves, respectively, and 1.57 cm 2 and 1.50 cm 2 for 21-mm valves, respectively. The rate of severe prosthesis–patient mismatch (indexed effective orifice area ≤0.65 cm 2 /m 2 ) was 18.6% (n = 11) and 25% (n = 6) for 19-mm valves, respectively, and 10.9% (n = 20) and 16.3% (n = 8) for 21-mm valves, respectively. Conclusions The suture method did not affect Hemodynamic Performance of supra-annular bioprostheses in patients with small aortic annulus sizes. Choice of suture technique should be determined by surgeon experience and local anatomic features.
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Hemodynamic Performance of small aortic valve bioprostheses is there a difference
The Annals of Thoracic Surgery, 1997Co-Authors: Monica L Mcdonald, Hartzell V Schaff, Richard C Daly, M Charles B J Mullany, Fletcher A Miller, James J Morris, Thomas A OrszulakAbstract:Abstract Background . There is the potential for left ventricular outflow obstruction when small aortic valve bioprostheses are employed in normal-sized or large adults. It has been hoped that bovine pericardial valves would improve Hemodynamic Performance in the smaller tissue valve sizes. Methods . To determine in vivo Hemodynamic Performance of heterograft aortic valve prostheses, we analyzed echocardiographic data from patients receiving 21- or 23-mm Carpentier-Edwards pericardial, Medtronic Intact, and Carpentier-Edwards porcine bioprostheses. In addition, data from 19-mm Carpentier-Edwards pericardial valves were included for comparison of Hemodynamic Performance between valve sizes. Doppler echocardiography was performed in 151 patients within 2 weeks of operation. Left ventricular outflow gradient was derived from continuous Doppler measurements of flow velocity, and effective orifice area was calculated by the continuity equation. Results . There were statistically significant differences in Hemodynamic Performance of different sized prostheses for each valve type (effective orifice area, p p Conclusions . The in vivo Hemodynamic Performance of these three different aortic valve heterograft bioprostheses is similar. Patient–prosthesis mismatch with heterograft prostheses, as demonstrated by the indexed effective orifice area can be avoided by appropriate sizing and use of annular enlarging techniques when necessary. (Ann Thorac Surg 1997;63:362–6)
Akif Undar - One of the best experts on this subject based on the ideXlab platform.
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evaluation of centrifugal blood pumps in term of Hemodynamic Performance using simulated neonatal and pediatric ecmo circuits
Artificial Organs, 2020Co-Authors: Shigang Wang, Allen R Kunselman, John L Myers, Morgan K Moroi, Akif UndarAbstract:The objective of this translational study was to evaluate the FDA-approved PediMag, CentriMag, and RotaFlow centrifugal blood pumps in terms of Hemodynamic Performance using simulated neonatal and pediatric extracorporeal membrane oxygenation (ECMO) circuits with different sizes of arterial and venous cannulae. Cost of disposable pump heads was another important variable for this particular study. The experimental circuit was composed of one of the centrifugal pump heads, a polymethylpentene membrane oxygenator, neonatal and pediatric arterial/venous cannulae, and 1/4-inch ID tubing. Circuits were primed with lactated Ringer's solution and packed human red blood cells (hematocrit 35%). Trials were conducted at 36°C using the three pump heads and different cannulae (arterial/venous cannulae: 8 Fr/18 Fr, 10 Fr/20 Fr, and 12 Fr/22 Fr) at various flow rates (200-2400 mL/min, 200 mL/min increments) and rotational speeds. Pseudo patient pressure was 60 mm Hg. Real-time pressure and flow data were recorded for analysis. The RotaFlow pump had a higher pressure head and flow range compared with the PediMag and CentriMag pumps at the same rotational speed and identical experimental settings (P < 0.001). The PediMag pump had lower flow output than others (P < 0.001). Small-caliber arterial cannulae and higher flow rates predictably created higher circuit pressures and pressure drops. There was no significant difference in Hemodynamic energy delivered to the pseudo patient with each of the three pumps. The arterial cannula had the highest pressure drop and Hemodynamic energy loss in the circuit when compared to the oxygenator and arterial tubing. The RotaFlow centrifugal pump had a significantly better Hemodynamic Performance when compared to the PediMag and CentriMag blood pumps at identical experimental conditions in simulated neonatal and pediatric ECMO settings. In addition, the cost of the RotaFlow pump head ($400) is 20 to 30-fold less than the other centrifugal pumps [CentriMag ($12 000) or PediMag ($8000)] that were evaluated in this translational study.
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evaluation of combined extracorporeal life support and continuous renal replacement therapy on Hemodynamic Performance and gaseous microemboli handling ability in a simulated neonatal ecls system
Artificial Organs, 2018Co-Authors: Kaitlyn Shank, John L Myers, Allen R Kunselman, Shigang Wang, Karl Woitas, Elizabeth Profeta, Christian Oconnor, Akif UndarAbstract:The objective of this study was to evaluate the Hemodynamic Performance and gaseous microemboli (GME) handling ability of a simulated neonatal extracorporeal life support (ECLS) circuit with an in-line continuous renal replacement therapy (CRRT) device. The circuit consisted of a Maquet RotaFlow centrifugal pump or HL20 roller pump, Quadrox-iD Pediatric diffusion membrane oxygenator, 8-Fr arterial cannula, 10-Fr venous cannula, and Better-Bladder (BB) with “Y” connector. A second Quadrox-I Adult oxygenator was added postarterial cannula for GME experiments. The circuit and pseudo-patient were primed with lactated Ringer's solution and packed human red blood cells (hematocrit 40%). All Hemodynamic trials were conducted at ECLS flow rates ranging from 200 to 600 mL/min and CRRT flow rate of 75 mL/min at 36°C. Real-time pressure and flow data were recorded with a data acquisition system and GME were detected and characterized using the Emboli Detection and Classification Quantifier System. CRRT was added at distinct locations such that blood entered CRRT between the pump and oxygenator (A), recirculated through the pump (B), or bypassed the pump (C). With the centrifugal pump, all CRRT positions had similar flow rates, mean arterial pressure (MAP), and total Hemodynamic energy (THE) loss. With the roller pump, C demonstrated increased flow rates (293.2–686.4 mL/min) and increased MAP (59.4–75.5 mm Hg) (P < 0.01); B had decreased flow rates (129.7–529.7 mL/min), and MAP (34.2–45.0 mm Hg) (P < 0.01); A maintained the same when compared to without CRRT. At 600 mL/min C lost more THE (81.4%) (P < 0.01) with a larger pressure drop across the oxygenator (95.6 mm Hg) (P < 0.01) than without CRRT (78.3%; 49.1 mm Hg) (P < 0.01). C also demonstrated a poorer GME handling ability using the roller pump, with 87.1% volume and 17.8% count reduction across the circuit, compared to A and B with 99.9% volume and 65.8–72.3% count reduction. These findings suggest that, in contrast to A and B, adding CRRT at position C is unsafe and not advised for clinical use.
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evaluation and comparison of Hemodynamic Performance of three ecls systems in a simulated adult cardiogenic shock model
Artificial Organs, 2018Co-Authors: Akif Undar, Allen R Kunselman, Shigang Wang, Morgan Moroi, Christoph BrehmAbstract:The objective of this study was to evaluate three commercially available ECLS systems with rotary pumps in terms of circuit pressure, pressure drop, perfusion modes, and Hemodynamic energy transmission in a simulated adult cardiogenic shock model. One circuit consisted of a Cardiohelp system, which included a Cardiohelp console and HLS Module Advanced 7.0 tubing set with integrated centrifugal pump and oxygenator. The alternative circuit was composed of a Quadrox-D Adult oxygenator connected in series with either an i-cor diagonal pump and console or a Rotaflow centrifugal pump and console. The circuit was primed with lactated Ringer's solution and packed red blood cells (hematocrit 40%). The trials were conducted at flow rates of 1-5 L/min with pseudo patient pressures of 60 mm Hg and 80 mm Hg. Pulsatile flow was tested when using the i-cor system. Mean pre-oxygenator pressure and pressure drop across ECLS circuit (including oxygenator and arterial tubing) were lower when using the Cardiohelp system as compared to the Rotaflow and i-cor systems (P < 0.01). The i-cor system was able to deliver more Hemodynamic energy to the pseudo patient because of its ability to produce pulsatile flow (P < 0.01). The Cardiohelp HLS Module Advanced 7.0 integrated oxygenator had a lower resistance than the Quadrox-D oxygenator. Although the compact Cardiohelp system had a better Hemodynamic Performance when compared to Rotaflow and i-cor systems, the pulsatile flow of the i-cor system delivered more Hemodynamic energy to the pseudo patient. This may render more physiological benefits in high-risk patients on ECLS.
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evaluation of Hemodynamic Performance of a combined ecls and crrt circuit in seven positions with a simulated neonatal patient
Artificial Organs, 2018Co-Authors: Elizabeth Profeta, John L Myers, Allen R Kunselman, Shigang Wang, Karl Woitas, Kaitlyn Shank, Christian Oconnor, Akif UndarAbstract:As it is common for patients treated with extracorporeal life support (ECLS) to subsequently require continuous renal replacement therapy (CRRT), and neonatal patients encounter limitations due to lack of access points, inclusion of CRRT in the ECLS circuit could provide advanced treatment for this population. The objective of this study was to evaluate an alternative neonatal ECLS circuit containing either a Maquet RotaFlow centrifugal pump or Maquet HL20 roller pump with one of seven configurations of CRRT using the Prismaflex 2000 System. All ECLS circuit setups included a Quadrox-iD Pediatric diffusion membrane oxygenator, a Better Bladder, an 8-Fr arterial cannula, a 10-Fr venous cannula, and 6 feet of ¼-inch diameter arterial and venous tubing. The circuit was primed with lactated Ringer's solution and packed human red blood cells resulting in a total priming volume of 700 mL for both the circuit and the 3-kg pseudopatient. Hemodynamic data were recorded for ECLS flow rates of 200, 400, and 600 mL/min and a CRRT flow rate of 50 mL/min. When a centrifugal pump is used, the Hemodynamic Performance of any combined ECLS and CRRT circuit was not significantly different than that of the circuit without CRRT, thus any configuration could potentially be used. However, introduction of CRRT to a circuit containing a roller pump does affect Performance properties for some CRRT positions. The circuits with CRRT positions B and G demonstrated decreased total Hemodynamic energy (THE) levels at the post-arterial cannula site, while positions D and E demonstrated increased post-arterial cannula THE levels compared to the circuit without CRRT. CRRT positions A, C, and F did not have significant changes with respect to pre-arterial cannula flow and THE levels, compared to the circuit without CRRT. Considering Hemodynamic Performance, for neonatal combined extracorporeal membrane oxygenation (ECMO) and CRRT circuits with both blood pumps, we recommend the use of CRRT position A due to its Hemodynamic similarities to the ECMO circuit without CRRT.
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building a better neonatal extracorporeal life support circuit comparison of Hemodynamic Performance and gaseous microemboli handling in different pump and oxygenator technologies
Artificial Organs, 2017Co-Authors: Kristen Glass, Allen R Kunselman, Shigang Wang, Karl Woitas, Payal Trivedi, Akif UndarAbstract:Neurologic complications during neonatal extracorporeal life support (ECLS) are associated with significant morbidity and mortality. Gaseous microemboli (GME) in the ECLS circuit may be a possible cause. Advances in neonatal circuitry may improve Hemodynamic Performance and GME handling leading to reduction in patient complications. This study compared Hemodynamic Performance and GME handling using two centrifugal pumps (Maquet RotaFlow and Medos Deltastream DP3) and polymethylpentene oxygenators (Maquet Quadrox-iD and Medos Hilite 800LT) in a neonatal ECLS circuit model. The experimental circuit was primed with Lactated Ringer's solution and packed human red blood cells (hematocrit 40%) and arranged in parallel with the RotaFlow and DP3 pump, Quadrox-iD and Hilite oxygenator, and Better-Bladder. Hemodynamic trials evaluating pressure drops and total Hemodynamic energy (THE) were conducted at 300 and 500 mL/min at 36°C. GME handling was measured after 0.5 mL of air was injected into the venous line using the Emboli Detection and Classification Quantifier System with unique pump, oxygenator, and Better-Bladder combinations. The RotaFlow pump and Quadrox oxygenator arrangement had lower pressure drops and THE loss at both flow rates compared to the DP3 pump and Hilite oxygenator (P < 0.01). Total GME volume and counts decreased with Better-Bladder at both flow rates with all combinations (P < 0.01). Hemodynamic Performance and energy loss were similar in all of the circuit combinations. The Better-Bladder significantly decreased GME. All four combinations of pumps and oxygenators also performed similarly in terms of GME handling.
Christopher R. Thompson - One of the best experts on this subject based on the ideXlab platform.
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self expanding portico valve versus balloon expandable sapien xt valve in patients with small aortic annuli comparison of Hemodynamic Performance
Revista Espanola De Cardiologia, 2016Co-Authors: Maria Del Trigo, Abdellaziz Dahou, Christopher R. Thompson, Jonathon Leipsic, Danny Dvir, John G Webb, Rishi Puri, Omar Abduljawad Altisent, Francisco Campeloparada, Dion StubAbstract:Abstract Introduction and objectives The self-expanding Portico valve is a new transcatheter aortic valve system yielding promising preliminary results, yet there are no comparative data against earlier generation transcatheter aortic valve systems. The aim of this study was to compare the Hemodynamic Performance of the Portico and balloon-expandable SAPIEN XT valves in a case-matched study with echocardiographic core laboratory analysis. Methods Twenty-two patients underwent transcatheter aortic valve implantation with the Portico 23-mm valve and were matched for aortic annulus area and mean diameter measured by multidetector computed tomography, left ventricular ejection fraction, body surface area, and body mass index with 40 patients treated with the 23-mm SAPIEN XT. Mean aortic annulus diameters were 19.6 ± 1.3 mm by transthoracic echocardiography and 21.4 ± 1.2 mm by computed tomography, with no significant between-group differences. Doppler echocardiographic images were collected at baseline and at 1-month of follow-up and were analyzed in a central echocardiography core laboratory. Results There were no significant between-group differences in residual mean transaortic gradients (SAPIEN XT: 10.4 ± 3.7 mmHg; Portico: 9.8 ± 1.1 mmHg; P = .49) and effective orifice areas (SAPIEN XT: 1.36 ± 0.27 cm 2 ; Portico, 1.37 ± .29 cm 2 ; P = .54). Rates of severe prosthesis-patient mismatch (effective orifice area 2 /m 2 ) were similar (SAPIEN XT: 13.5%; Portico: 10.0%; P = .56). No between-group differences were found in the occurrence of moderate-severe paravalvular leaks (5.0% vs 4.8% of SAPIEN XT and Portico respectively; P = .90). Conclusions Transcatheter aortic valve implantation with the self-expanding Portico system yielded similar short-term Hemodynamic Performance compared with the balloon-expandable SAPIEN XT system for treating patients with severe aortic stenosis and small annuli. Further prospective studies with longer-term follow-up and in patients with larger aortic annuli are required.
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Comparison of Hemodynamic Performance of the Balloon-Expandable SAPIEN 3 Versus SAPIEN XT Transcatheter Valve.
The American journal of cardiology, 2014Co-Authors: Ignacio J. Amat-santos, Abdellaziz Dahou, Eric Larose, John Webb, Danny Dvir, Jonathon Leipsic, Jean G Dumesnil, Ricardo Allende, Philippe Pibarot, Marina Urena, Sylvie Bilodeau, Christopher R. Thompson, Scott Bergeron, Sergio Pasian, Robert Delarochellière, Henrique B. Ribeiro, Jean Michel Paradis, Eric Dumont, Josep Rodés-cabauAbstract:The SAPIEN 3 valve (S3V) is a new-generation transcatheter valve with enhanced anti-paravalvular leak properties, but no data comparing with earlier transcatheter valve systems are available. We aimed to compare the Hemodynamic Performance of the S3V and the SAPIEN XT valve (SXTV) in a case-matched study with echo core laboratory analysis. A total of 27 patients who underwent transcatheter aortic valve replacement (TAVR) with the S3V were matched for prosthesis size (26 mm), aortic annulus area, and mean diameter measured by computed tomography, left ventricular ejection fraction, body surface area, and body mass index with 50 patients treated with the SXTV. The prosthesis size was determined by oversizing of 1% to 15% of annulus area. Doppler echocardiographic images collected at baseline and 1-month follow-up were analyzed in a central echocardiography core laboratory. The need for postdilation was higher in the SXTV group (20% vs 4%, p = 0.047), and mean residual gradient and effective orifice area were similar in both groups (p >0.05). The incidence of paravalvular aortic regurgitation was greater with the SXTV (≥mild: 42%, moderate: 8%) than with the S3V (≥mild: 7%, moderate: 0%; p = 0.002 for ≥mild vs SXTV). The implantation of an S3V was the only factor associated with trace or no paravalvular leak after TAVR (p = 0.007). In conclusion, TAVR with the S3V was associated with a very low rate of paravalvular leaks and need for balloon postdilation, much lower than that observed with the earlier generation of balloon-expandable valve (SXTV). The confirmation of these results in a larger cohort of patients will represent a major step forward in using transcatheter valves for the treatment of aortic stenosis.
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comparison of Hemodynamic Performance of self expandable corevalve versus balloon expandable edwards sapien aortic valves inserted by catheter for aortic stenosis
American Journal of Cardiology, 2013Co-Authors: Luis Nombelafranco, Christopher R. Thompson, Eric Dumont, John G Webb, Sam Radhakrishnan, Stephen E Fremes, Marc Ruel, Marc Hansen, Marino Labinaz, Robert DelarochellièreAbstract:Transcatheter aortic valve implantation with the self-expandable CoreValve (CV) and the balloon-expandable Edwards SAPIEN (ES) bioprostheses has been widely used for the treatment of severe aortic stenosis. However, a direct comparison of the Hemodynamic results associated with these 2 prostheses is lacking. The aim of the present study was to compare the Hemodynamic Performance of both bioprostheses. A total of 41 patients who underwent transcatheter aortic valve implantation with the CV prosthesis were matched 1:1 for prosthesis size (26 mm), aortic annulus size, left ventricular ejection fraction, body surface area, and body mass index with patients who underwent transcatheter aortic valve implantation with the ES prosthesis. Doppler-echocardiographic data were prospectively collected before the intervention and at hospital discharge, and all examinations were sent to, and analyzed in, a central echocardiography core laboratory. The mean transprosthetic residual gradient was lower (p = 0.024) in the CV group (7.9 ± 3.1 mm Hg) than in the ES group (9.7 ± 3.8 mm Hg). The effective orifice area tended to be greater in the CV group (1.58 ± 0.31 cm 2 vs 1.49 ± 0.24 cm 2 , p = 0.10). The incidence of severe prosthesis–patient mismatch was, however, similar between the 2 groups (effective orifice area indexed to the body surface area ≤0.65 cm 2 /m 2 ; CV 9.8%, ES 9.8%, p = 1.0). The incidence of paravalvular aortic regurgitation was greater with the CV (grade 1 or more in 85.4%, grade 2 or more in 39%) than with the ES (grade 1 or more in 58.5%, grade 2 or more in 22%; p = 0.001). The number and extent of paravalvular leaks were greater in the CV group (p
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comparison of the Hemodynamic Performance of percutaneous and surgical bioprostheses for the treatment of severe aortic stenosis
Journal of the American College of Cardiology, 2009Co-Authors: Marie-annick Clavel, Christopher R. Thompson, Philippe Pibarot, Eric Dumont, John G Webb, Jeanbernard Masson, Daniel Doyle, Lukas Altwegg, Robert De Larochelliere, Sebastien BergeronAbstract:Objectives This study was undertaken to compare the Hemodynamic Performance of a percutaneous bioprosthesis to that of surgically implanted (stented and stentless) bioprostheses for the treatment of severe aortic stenosis. Methods Fifty patients who underwent percutaneous aortic valve implantation (PAVI) with the Cribier-Edwards or Edwards SAPIEN bioprosthetic valve (Edwards Lifesciences, Inc., Irvine, California) were matched 1:1 for sex, aortic annulus diameter, left ventricular ejection fraction, body surface area, and body mass index, with 2 groups of 50 patients who underwent surgical aortic valve replacement (SAVR) with a stented valve (Edwards Perimount Magna [SAVR-ST group]), or a stentless valve (Medtronic Freestyle, Medtronic, Minneapolis, Minnesota [SAVR-SL group]). Doppler echocardiographic data were prospectively obtained before the intervention, at discharge, and at 6- to 12-month follow-up. Results Mean transprosthetic gradient at discharge was lower (p Conclusions PAVI provided superior Hemodynamic Performance compared with the surgical bioprostheses in terms of transprosthetic gradient and prevention of severe prosthesis-patient mismatch, but was associated with a higher incidence of AR.
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self expanding portico valve versus balloon expandable sapien xt valve in patients with small aortic annuli comparison of Hemodynamic Performance
Revista Espanola De Cardiologia, 2016Co-Authors: Maria Del Trigo, Abdellaziz Dahou, Christopher R. Thompson, Jonathon Leipsic, Danny Dvir, John G Webb, Rishi Puri, Omar Abduljawad Altisent, Francisco Campeloparada, Dion StubAbstract:Abstract Introduction and objectives The self-expanding Portico valve is a new transcatheter aortic valve system yielding promising preliminary results, yet there are no comparative data against earlier generation transcatheter aortic valve systems. The aim of this study was to compare the Hemodynamic Performance of the Portico and balloon-expandable SAPIEN XT valves in a case-matched study with echocardiographic core laboratory analysis. Methods Twenty-two patients underwent transcatheter aortic valve implantation with the Portico 23-mm valve and were matched for aortic annulus area and mean diameter measured by multidetector computed tomography, left ventricular ejection fraction, body surface area, and body mass index with 40 patients treated with the 23-mm SAPIEN XT. Mean aortic annulus diameters were 19.6 ± 1.3 mm by transthoracic echocardiography and 21.4 ± 1.2 mm by computed tomography, with no significant between-group differences. Doppler echocardiographic images were collected at baseline and at 1-month of follow-up and were analyzed in a central echocardiography core laboratory. Results There were no significant between-group differences in residual mean transaortic gradients (SAPIEN XT: 10.4 ± 3.7 mmHg; Portico: 9.8 ± 1.1 mmHg; P = .49) and effective orifice areas (SAPIEN XT: 1.36 ± 0.27 cm 2 ; Portico, 1.37 ± .29 cm 2 ; P = .54). Rates of severe prosthesis-patient mismatch (effective orifice area 2 /m 2 ) were similar (SAPIEN XT: 13.5%; Portico: 10.0%; P = .56). No between-group differences were found in the occurrence of moderate-severe paravalvular leaks (5.0% vs 4.8% of SAPIEN XT and Portico respectively; P = .90). Conclusions Transcatheter aortic valve implantation with the self-expanding Portico system yielded similar short-term Hemodynamic Performance compared with the balloon-expandable SAPIEN XT system for treating patients with severe aortic stenosis and small annuli. Further prospective studies with longer-term follow-up and in patients with larger aortic annuli are required.
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impact of post implant sapien xt geometry and position on conduction disturbances Hemodynamic Performance and paravalvular regurgitation
Jacc-cardiovascular Interventions, 2013Co-Authors: Ronald K Binder, John G Webb, Stefan Toggweiler, Melanie Freeman, Marco Barbanti, Alexander B Willson, Donya Alhassan, Cameron J Hague, David A Wood, Jonathon LeipsicAbstract:Objectives This report sought to study the impact of the balloon-expandable SAPIEN XT (Edwards Lifesciences, Irvine, California) transcatheter heart valve (THV) stent frame geometry and position on outcomes of transcatheter aortic valve replacement (TAVR). Background Post-implant THV geometry and position might impact atrioventricular conduction, Hemodynamic Performance, and annular sealing. Methods Eighty-nine consecutive patients who underwent TAVR with a Sapien XT THV had pre- and post-implant multidetector computed tomography, transthoracic echocardiography, and electrocardiograms performed to assess THV stent geometry, atrioventricular conduction, and Hemodynamic Performance. Results The THV Circularity (THV eccentricity Conclusions Low implantation depth of balloon-expandable THVs is associated with clinically significant new conduction disturbances and permanent pacemaker implantation. Importantly, annular area oversizing was not associated with these complications.
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comparison of Hemodynamic Performance of self expandable corevalve versus balloon expandable edwards sapien aortic valves inserted by catheter for aortic stenosis
American Journal of Cardiology, 2013Co-Authors: Luis Nombelafranco, Christopher R. Thompson, Eric Dumont, John G Webb, Sam Radhakrishnan, Stephen E Fremes, Marc Ruel, Marc Hansen, Marino Labinaz, Robert DelarochellièreAbstract:Transcatheter aortic valve implantation with the self-expandable CoreValve (CV) and the balloon-expandable Edwards SAPIEN (ES) bioprostheses has been widely used for the treatment of severe aortic stenosis. However, a direct comparison of the Hemodynamic results associated with these 2 prostheses is lacking. The aim of the present study was to compare the Hemodynamic Performance of both bioprostheses. A total of 41 patients who underwent transcatheter aortic valve implantation with the CV prosthesis were matched 1:1 for prosthesis size (26 mm), aortic annulus size, left ventricular ejection fraction, body surface area, and body mass index with patients who underwent transcatheter aortic valve implantation with the ES prosthesis. Doppler-echocardiographic data were prospectively collected before the intervention and at hospital discharge, and all examinations were sent to, and analyzed in, a central echocardiography core laboratory. The mean transprosthetic residual gradient was lower (p = 0.024) in the CV group (7.9 ± 3.1 mm Hg) than in the ES group (9.7 ± 3.8 mm Hg). The effective orifice area tended to be greater in the CV group (1.58 ± 0.31 cm 2 vs 1.49 ± 0.24 cm 2 , p = 0.10). The incidence of severe prosthesis–patient mismatch was, however, similar between the 2 groups (effective orifice area indexed to the body surface area ≤0.65 cm 2 /m 2 ; CV 9.8%, ES 9.8%, p = 1.0). The incidence of paravalvular aortic regurgitation was greater with the CV (grade 1 or more in 85.4%, grade 2 or more in 39%) than with the ES (grade 1 or more in 58.5%, grade 2 or more in 22%; p = 0.001). The number and extent of paravalvular leaks were greater in the CV group (p
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comparison of the Hemodynamic Performance of percutaneous and surgical bioprostheses for the treatment of severe aortic stenosis
Journal of the American College of Cardiology, 2009Co-Authors: Marie-annick Clavel, Christopher R. Thompson, Philippe Pibarot, Eric Dumont, John G Webb, Jeanbernard Masson, Daniel Doyle, Lukas Altwegg, Robert De Larochelliere, Sebastien BergeronAbstract:Objectives This study was undertaken to compare the Hemodynamic Performance of a percutaneous bioprosthesis to that of surgically implanted (stented and stentless) bioprostheses for the treatment of severe aortic stenosis. Methods Fifty patients who underwent percutaneous aortic valve implantation (PAVI) with the Cribier-Edwards or Edwards SAPIEN bioprosthetic valve (Edwards Lifesciences, Inc., Irvine, California) were matched 1:1 for sex, aortic annulus diameter, left ventricular ejection fraction, body surface area, and body mass index, with 2 groups of 50 patients who underwent surgical aortic valve replacement (SAVR) with a stented valve (Edwards Perimount Magna [SAVR-ST group]), or a stentless valve (Medtronic Freestyle, Medtronic, Minneapolis, Minnesota [SAVR-SL group]). Doppler echocardiographic data were prospectively obtained before the intervention, at discharge, and at 6- to 12-month follow-up. Results Mean transprosthetic gradient at discharge was lower (p Conclusions PAVI provided superior Hemodynamic Performance compared with the surgical bioprostheses in terms of transprosthetic gradient and prevention of severe prosthesis-patient mismatch, but was associated with a higher incidence of AR.