Bioprosthetic Valves




Key Points





  • Most bioprostheses can be identified on and localized by chest radiography. The lateral chest radiograph often assists with obviating the projection of a bioprosthesis onto the spine, particularly in large hearts, which otherwise diminishes the depiction of a bioprosthesis on the frontal radiograph.



  • The appearance of bioprostheses varies depending on the amount and design of radiopaque elements (stent wires and rings) within them. Not all bioprostheses contain radiopaque material, and therefore some bioprostheses are not apparent on the chest radiograph.





Bioprostheses


Bioprostheses may be inserted into any cardiac valve position (aortic, mitral, tricuspid, and pulmonic), and may also be included within extracardiac conduits (usually from the right ventricle to the pulmonary artery) ( Table 10-1 ). Most, but not all, bioprostheses contain a network of wires, the stents, that provide support to the commissures of the porcine aortic valve or of the constructed aortic valve made of pericardial tissue. Wire stents are radiographically evident ( Fig. 10-1 ). However, some bioprostheses contain plastic stents that are not radiopaque, and other models of bioprosthetic valves (the Toronto Stentless Porcine valve and the Medtronic Freestyle valve) are essentially preserved porcine aortic valves and roots, and they contain absolutely no radiopaque material. The Medtronic Solo valve is also radiographically inapparent.



TABLE 10-1

Bioprosthetic Heart Valves







































































































































































































































ValVe Leaflet Material Stents Ring/Sewing Ring
Sorin
MORE Pericardial tissue Polymer stents; low profile; radiopaque wire marker Nonradiopaque polyester sewing ring/supra-annular
Pericarbon Freedom (stentless) Pericardial tissue Stentless No sewing ring or mesh
Freedom Solo (stentless) Pericardial tissue Stentless NA
Soprano Pericardial tissue Nonradiopaque polymer stents Sewing cloth; no ring
Mitroflow Pericardial tissue Radiopaque polymer stents Radiopaque (tungsten-impregnated silicone ring)
Medtronic
Mosaic Porcine aortic valve Nonradiopaque polymer stent; low profile Nonradiopaque sewing ring/supra-annular
Mosaic Ultra Porcine aortic valve Nonradiopaque polymer stent; low profile Nonradiopaque sewing ring/supra-annular
Freestyle Stentless Porcine aortic valve and root Stentless Nonradiopaque/sewing cuff, not sewing ring
Hancock II Porcine aortic valve Nonradiopaque polymer stent; low profile Nonradiopaque sewing ring/supra-annular
Advantage
Melody Bovine jugular stented, percutaneous pulmonic valve replacement, “Bonnhoeffer” Stented NA
Supported and non-supported NA NA
VenPro Contegra (unsupported) Bovine jugular vein valve conduit Stentless NA
VenPro Contegra (supported) Bovine jugular vein valve conduit Stentless With two plastic rings— sometimes seen on fluoroscopy; seldom seen on chest radiography
Carpentier-Edwards
Perimount (aortic and mitral bioprostheses) Bovine pericardial tissue Radiopaque wire (Elgiloy) stent frame Sewing ring is not radiopaque; partially supra-annular position slightly increases available orifice
Perimount Magna (aortic bioprosthesis) Bovine pericardial tissue; different fixation/ preservation technique Radiopaque wire (Elgiloy) stent frame Redesigned Perimount valve, fully supra-annular/sewing ring is not radiopaque
Perimount Magna (mitral bioprosthesis) Bovine pericardial tissue; different fixation/ preservation technique Radiopaque wire (Elgiloy) stent frame Redesigned Perimount valve; saddle-shaped ring/sewing ring is not radiopaque
Perimount Plus (mitral bioprosthesis) Different fixation/ preservation technique Radiopaque wire (Elgiloy) stent frame Redesigned Perimount valve/sewing ring is not radiopaque
Perimount Theon (mitral replacement) Different fixation/ preservation technique Radiopaque wire (Elgiloy) stent frame Redesigned Perimount valve/sewing ring is not radiopaque
S.A.V. Porcine aortic valve Radiopaque wire (Elgiloy) stent frame; low profile Sewing ring is not radiopaque; supra-annular position increases available orifice
Duraflex Low-Pressure Porcine aortic valve; asymmetric orifice (includes muscle shelf); low-pressure fixation to lessen stiffening of leaflets Radiopaque wire (Elgiloy) stent frame Larger sewing ring to fit the mitral orifice
Prima Plus (stentless porcine prosthesis) Porcine aortic valve and root No stent frame No separate sewing ring
BioPhysio (pericardial aortic bioprosthesis) Bovine pericardial tissue Radiopaque wire (Nitinol) stent frame Supra-annular position; nonradiopaque silicone sewing ring
St. Jude Medical Biocor
Porcine (bioprosthesis) Porcine aortic valve Nonradiopaque plastic stents Nonradiopaque (polyester) sewing ring
Supra Porcine (bioprosthesis) Porcine aortic valve Nonradiopaque plastic stents Nonradiopaque (polyester) sewing ring; supra-annular position
Epic Porcine (bioprosthesis) Porcine aortic valve Nonradiopaque plastic stents; low profile Nonradiopaque (polyester) sewing ring
Epic Supra Porcine (bioprosthesis) Porcine aortic valve Nonradiopaque plastic stents; low profile Nonradiopaque (polyester) sewing ring; supra-annular position
Toronto (stentless porcine bioprosthesis) Porcine aortic valve and root NA Nonradiopaque sewing mesh, not sewing ring; subcoronary
Toronto (stentless root porcine bioprosthesis) Porcine aortic valve and root NA Nonradiopaque sewing mesh, not sewing ring
Biocor Bovine pericardial tissue Nonradiopaque plastic stents Nonradiopaque (polyester) sewing ring; supra-annular position
Biocor Stentless Composite porcine aortic valve/pericardial conduit mount Stentless NA
Trifecta Pericardial tissue Stents Sewing ring; supra-annular position
Others
CryoValve aortic valve/conduit Human cadaveric Stentless No sewing ring or mesh
CryoValve pulmonary valve/conduit Human cadaveric Stentless No sewing ring or mesh
CryoValve mitral valve Human cadaveric Stentless No sewing ring or mesh
Cryolife-O’Brien (stentless) Porcine aortic valve Stentless No sewing ring or mesh
Shelhigh Skeletonized Super-Stentless Porcine aortic valve Stentless NA
Shelhigh Skeletonized Super-Stentless Porcine aortic valve Stentless NA
Shelhigh BioMitral Porcine mitral valve NA NA
Shelhigh porcine pulmonic valve conduit Porcine pulmonic valve and conduit NA NA
Koehler Aspire porcine bioprosthesis Porcine aortic valve NA NA
Koehler Elan stentless porcine aortic valve Porcine aortic valve Stentless No sewing ring or mesh
Koehler Elan stentless porcine root prosthesis Porcine aortic valve and root Stentless Sewing mesh

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Apr 10, 2019 | Posted by in CARDIOVASCULAR IMAGING | Comments Off on Bioprosthetic Valves
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