Linde et al
Fig. 4 - A) shows the opening angle pro-
(A)
25 ms for the flexible setting. The SJM valve was completely
closed 12 ms later in the flexible setting compared with the
stiff setting. Compared with the Triflo, the SJM demonstrated
a delay of the closing impact of 12 ms for the stiff setting and
25 ms for the flexible setting.
The beginning of the valve opening showed no significant dif-
ference under all tested conditions for both valves. Maximum
opening speed of the leaflet tips showed a significant differen-
ce when comparing the flexible and stiff aortic root setups. In
the SJM valve, the maximum opening speed decreased by
16% using a stiff aortic root. The maximum opening speed of
the Triflo leaflet decreased by 42% under the same conditions.
Comparing the maximum leaflet closing speeds, a decre-
ase can be seen for the flexible aortic root setting. For the
SJM valve a decrease of 10% was measured, whereas a
decrease of 14% was detected for the Triflo valve.
Valve dynamics measured in this study showed significant
changes in both opening and closing speed due to differen-
ces in aortic root stiffness. An increase in the Triflo opening
speed can be seen for the flexible setting. The flexibility
of the aortic root increases the radial flow of the displaced
fluid on the downstream side of the leaflet. This reduces the
local pressure on the downstream side of the leaflets, thus
increasing the opening speed. The SJM did not present a
significant change in opening speed. The leaflets on this
valve open towards one another, towards the center of the
valve. The pressure on the downstream side of the leaflets
is therefore not dependant on the aortic root flexibility. Par-
ticle Image Velocimetry (PIV) studies in an analogue model
are planned to prove this theory.
The analysis of the high speed videos of the valve orifice
area, especially at the end of valve closing where maxi-
mum closing speed occurs, can only give an approxima-
tion of the maximum closing speed. For more defined data
in this area, closing speed measurements according to
2012 Wichtig Editore - ISSN 0391-3988
pagation during valve closing averaged over
5 cycles. B) shows maximum opening and
closing speed of the leaflet tips in the THIA3
pulse duplicator.
(B)
Chandran et al (23) should be performed. These analyze
the valve dynamics with a laser pointed to the leaflet tip
and measure the displacement of the laser reflection. The
closing time measurements give a sufficient impression of
the differences under the tested conditions. Comparing the
acquired closing speed to different studies under similar
conditions (27) good accordance was achieved.
Blood test
Blood test results for all 24 tests carried out showed a line-
ar increase in plasma free hemoglobin over the whole test
duration of three hours (Fig. 5).
A significant difference between the valves as well as the
aortic root stiffness was visible after this time. The SJM
valve showed an increase in hemolysis of 92% (flexible:
22.2 mg/dl; stiff: 42.69 mg/dl; p<0.0001). Hemolysis with
the Triflo valve was increased by 44% (flexible: 13.39 mg/dl;
stiff: 19.31 mg/dl; p = 0.031). Comparing the hemolysis
levels of the valves under each condition, the SJM had a
66% higher level than the Triflo valve with flexible aortic
root; and a 121% higher level with a stiff aortic root.
The results showed a significant relation between the choi-
ce of the valve, the aortic root stiffness, and the related
hemolysis in this in vitro approach (p = 0.012).
Blood tests in this study have shown a significant influen-
ce of aortic root stiffness on the performance of the two
different valve types. Regarding hemolysis levels, Triflo
seems better suited for both flexible and stiff aortic root
environments. The leaflets almost form a circle when open.
According to the assumption that maximum flow veloci-
ties occur in the center of the orifice (21) and during peak
systole, Triflo leaflets avoid regions of high velocities. This
reduces the level of wall shear stress on the leaflet surfa-
ces and introduces less trauma to the blood.
499