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

Vahid Sadri; Phillip M Trusty; Immanuel David Madukauwa-David; Ajit P Yoganathan

doi:10.1016/j.xjon.2021.10.056

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

JTCVS Open. 2021 Nov 4:9:59-69. doi: 10.1016/j.xjon.2021.10.056. eCollection 2022 Mar.

Authors

Vahid Sadri¹, Phillip M Trusty¹, Immanuel David Madukauwa-David², Ajit P Yoganathan¹

Affiliations

¹ Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga.
² George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Ga.

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.

Keywords: AWT, accelerated wear testing; BHV, bioprosthetic heart valve; EOA, effective orifice area; GOA, geometric orifice area; PIV, particle image velocimetry; RSS, Reynolds shear stress; SAVR, surgical aortic valve replacement; SVD, structural valve degeneration; TVPG, transvalvular pressure gradient; aortic valve; structural valve degeneration; surgical heart valve; valve durability.