Long-term durability of a new surgical aortic valve: A 1 billion cycle in vitro study

• Type of Material: Article
• Authors: Vahid Sadri, Georgia Institute of Technology; Philip M Trusty, Georgia Institute of Technology; Immanuel D Madukauwa-David, The George W. Woodruff School of Mechanical Engineering; Ajit Yoganathan, Emory University
• Language: English
• Date: 2022-03-01
• Publisher: Elsevier
• Publication Version: Final Published Version
• Copyright Statement: © 2021 The Author(s)
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.xjon.2021.10.056
• Title of Journal or Parent Work: JTCVS Open
• Volume: 9
• Start Page: 59
• End Page: 69
• Grant/Funding Information: This study was funded by a research grant from Edwards Lifesciences.
• Keywords: AWT, accelerated wear testing; RSS, Reynolds shear stress; GOA, geometric orifice area; surgical heart valve; SVD, structural valve degeneration; PIV, particle image velocimetry; structural valve degeneration; TVPG, transvalvular pressure gradient; valve durability; SAVR, surgical aortic valve replacement; BHV, bioprosthetic heart valve; aortic valve; EOA, effective orifice area
• Research Categories: Engineering, Biomedical

Abstract

Background: This study assessed the long-term hemodynamic functional performance of the new Inspiris Resilia aortic valve after accelerated wear testing (AWT). Methods: Three 21-mm and 23-mm Inspiris valves were used for the AWT procedure. After 1 billion cycles (equivalent to 25 years), the valves' hemodynamic performance was compared with that of the corresponding zero-cycled condition. Next, 1 AWT cycled valve of each valve size was selected at random for particle image velocimetry (PIV) and leaflet kinematic tests, and the data were compared with data for an uncycled Inspiris Resilia aortic valve of the same size. PIV was used to quantitatively evaluate flow fields downstream of the valve. Valves were tested according to International Standards Organization 5840-2:2015 protocols. Results: The 21-mm and 23-mm valves met the International Organization for Standardization (ISO) durability performance requirements to 1 billion cycles. The mean effective orifice areas for the 21-mm and 23-mm zero-cycled and 1 billion–cycled valves were 1.89 ± 0.02 cm2 and 1.94 ± 0.01 cm2, respectively (P < .05) and 2.3 ± 0.13 cm2 and 2.40 ± 0.11 cm2, respectively (P < .05). Flow characterization of the control valves and the study valves demonstrated similar flow characteristics. The velocity and shear stress fields were also similar in the control and study valves. Conclusions: The Inspiris Resilia aortic valve demonstrated very good durability and hemodynamic performance after an equivalent of 25 years of simulated in vitro accelerated wear. The study valves exceeded 1 billion cycles of simulated wear, 5 times longer than the standard requirement for a tissue valve as stipulated in ISO 5840-2:2015.