Análise Do Comportamento Hidrodinâmico In Vitro Dos Implantes De Próteses Valvares Transcateter Dentro De Biopróteses Aórticas Convencionais: Uma Nova Alternativa À Reoperações

Análise Do Comportamento Hidrodinâmico In Vitro Dos Implantes De Próteses Valvares Transcateter Dentro De Biopróteses Aórticas Convencionais: Uma Nova Alternativa À Reoperações

Author Cardoso, Caio Cesar Autor UNIFESP Google Scholar
Advisor Fonseca, Jose Honorio De Almeida Palma Da Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Graduate program Tecnologias e atenção à saúde
Abstract OBJECTIVE: Hydrodynamic evaluation of the transcatheter valve implantation in aortic bioprosthesis (valve-in-valve) and in sets of bioprosthesis with a transcatheter valve previously implanted (valve-in-valve-in-valve or sequential valve-in-valve), in order to guide therapeutic limits and the optimal transcatheter valve size. METHODS: With the Pulse Duplicator, and accordingly to FDA and ISO 5840 determinations for cardiac output (5L/min), mean arterial blood preesure (100mmHg) and cardiac frequency variation (70-120), the hydrodynamics tests were procedded to measure efective orificial area (EOA-cm²) and transvalvar gradient (ΔP-mmHg) for each set of valve-in-valve and valve-in-valve-in-valve. The valve-in-valve tests: for each bioprosthesis (Braile Biomédica), between 19mm and 25mm, a transcatheter valve (Braile Inovare, with nominal sizes between 20 and 26mm), either 1mm larger or 1mm smaller, was implanted. The valve-in-valve-in-valve tests: for each optimal set of valve-in-valve (determined in the valve-in-valve tests), a transcatheter valve 2mm smaller than the previous was implanted. Each set described of valve-in-valve or valve-in-valve-in-valve was replicated ten times, and the tests in the Pulse Duplicator were performed for each set three times. RESULTS: The set aortic bioprosthesis 19mm and transcatheter valve 20mm, the EOA was 0,5 and the ΔP was 43,7. Moreover, the sets 21-20 and 21-22 resulted in EOA 0,8 and 0,73, and ΔP 19,4 and 23,4. For the sets 23-22 and 23-24, the tests showed EOA 1,06 and 0,8, and ΔP 12,5 and 19,5. And finally, for the sets 25-24 and 25-26, the EOA was 1,085 and 1,0, and the ΔP was 11,76 and 13,56. The valve-in-valve-in-valve tests has shown that the implantation of a transcatheter valve 22mm in a valve-in-valve set of a 25mm bioprosthesis with the 24mm valve transcathter resulted in EOA 0,99 and ΔP 13,59; when for this set was proceeded the implantation of a third transcatheter valve (20mm), was observed an EOA 10 0,84 and a ΔP 15,31. In a valve-in-valve set with a 23mm bioprosthesis and a 22mm transcatheter valve, the EOA was 0,86 and the ΔP was 15,62 when a 20mm transcatheter valve was implanted. CONCLUSION: The aortic valve-in-valve is fasible, with better hydrodynamic results when the transcatheter valve has the nominal size 1mm smaller than the bioprosthesis; this fact can be explained considering the appropriate oversizing between the bioprosthesis true internal diameter and the transcatheter external diameter (between 10 and 20%). The valve-in-valve in 21mm bioprosthesis should be individualized, and in 19mm prohibited. The transcatheter valve-in-valve-in-valve is feasible as well, with great performance with a sequential implantation of a smaller transcatheter valve up to the 22mm, the 20mm should be cautiously implanted; the oversizing between the immediate smaller transcatheter valve was between 4 and 5%.

OBJETIVO: Avaliação hidrodinâmica do implante de valva transcateter no interior de biopróteses aórticas convencionais (“valve-in-valve”) e de conjuntos de bioprótese com valva transcateter previamente implantada (“valve-in-valve-in-valve ou “valve-in-valve sequencial”), delimitando limites terapêuticos e o melhor tamanho de valva transcateter a ser implantada. MATERIAL E MÉTODOS: Com o Duplicador de Pulsos, seguiu-se especificações do FDA e ISO 5840 para débito cardíaco (5L/min), pressão arterial média (100mmHg) e variação de freqüência cardíaca (FC:70-120bpm), calculando-se EOA (cm²) e ΔP (mmHg). Para os testes valve-in-valve, com cada bioprótese aórtica (Braile Biomédica), entre 19 e 25mm, implantou-se uma valva transcateter (Braile Inovare, de tamanhos 20 a 26mm), 1mm maior e 1mm menor, a fim de delimitar o melhor tamanho a se eleger. Para os testes de valve-in-valve-in-valve, para cada conjunto valve-in-valve mais adequado no teste prévio, alocou-se uma valva transcateter imediatamente menor. Para cada teste proposto, replicou-se 10 conjuntos valve-in-valve/valve-in-valve-in-valve, repetindo-se o ciclo no duplicador de pulsos para cada conjunto 3 vezes. RESULTADOS: Para os testes valve-in-valve, com o conjunto de bioprótese aórtica 19mm e válvula transcateter 20mm, observou-se EOA 0,5 e ΔP 43,75. Com conjuntos 21-20 e 21- 22, resultou-se em EOA 0,8 e 0,73 e ΔP 19,46 e 23,41. Nos conjuntos 23-22 e 23-24, houve EOA 1,06 e 0,8 e ΔP 12,5 e 19,5 Para conjuntos 25-24 e 25-26, notou-se EOA 1,085 e 1,0 e ΔP 11,76 e 13,56. No testes valve-in-valve-in-valve, em conjunto valve-in-valve com bioprótese 25 e valva transcateter 24, quando do implante de valva tanscateter 22 observou-se EOA 0,99 e ΔP 13,59 e após, com implante sequencial de valva transcateter 20, houve EOA 0,84 e ΔP 8 15,31; por fim, em conjunto valve-in-valve com bioprótese 23 e valva transcateter 22, quando implantou-se a valva transcateter 20, detectou-se EOA 0,86 e ΔP 15,62. CONCLUSÃO: O implante valve-in-valve aórtico é factível, havendo melhor desempenho hidrodinâmico com a valva transcateter de tamanho nominal 1mm menor em relação à bioprótese; tal fato se deve à adequação do sobredimensionamento (oversizing) entre o diâmetro interno real da bioprótese e o diâmetro externo da valva transcateter (mantendo-se entre 10 e 20%). Esta modalidade deve ser utilizada com restrições em bioprótese 21 e evitada em bioprótese 19. O implante transcateter sequencial (valve-in-valve-in-valve) aórtico é igualmente factível em testes hidrodinâmicos, com bons resultados até a valva transcateter 22, e havendo restrições com o uso da valva 20. O sobredimensionamento observado foi entre 4 e 5% comparativamente ao implante de valva transcateter em outra já implantada.
Keywords Aortic Valve
Valve Replacement
Transcatheter
Cardiopulmonar Bypass
Bioprosthesis
Valva Aórtica
Troca Valvar
Transcateter
Circulação Extracorpórea
Prótese Biológica
Language Portuguese
Date 2017-12-21
Research area Medicina
Knowledge area Ciências da saúde
Publisher Universidade Federal de São Paulo (UNIFESP)
Extent 75p.
Origin https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=6296255
Access rights Closed access
Type Dissertation
URI http://repositorio.unifesp.br/handle/11600/50861

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