THE AVALUS MEDTRONIC BOVINE PERICARDIAL VALVE SHOWS SIGNIFICANT OPENING RESERVE AT EXERCISE SUPPORTING GOOD CLINICAL OUTCOMES
CCC ePoster Library. Dagenais F. 10/26/19; 280544; 309
François Dagenais
François Dagenais
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Abstract
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BACKGROUND: The Avalus Medtronic valve is a novel low profile stented bovine pericardial valve. The FDA investigational PERIGON trial reported good clinical outcomes although a significant proportion of patients presented moderate to severe PPM at rest. To study this 'conundrum', an exercise-based protocol was designed to evaluate the Avalus valve performance

METHODS AND RESULTS: An ergocycle based exercise testing (25W to 200W with 25W increments) was conducted in 22 patients at an average of 23.7±9.5 months post Avalus valve implant. Throughout exercise, mean pressure gradient, indexed effective valve area (IEOA) and valve opening reserve were calculated. At rest, 8 pts had no PPM (IEOA 0.9±0.1cm2/m2), 11 pts moderate PPM (IEOA 0.7±0.1cm2/m2) and 3pts with severe PPM (IEOA 0.6±0.1cm2/m2). At maximal exercise: mean gradients increased (%from baseline) similarly in all PPM status: no PPM:45.3±24.4; mod PPM:40.5±49.9; severe PPM:61.8±47.9; p=0.74. IEOA showed comparable increase (% from baseline) in all PPM groups: no PPM: 19.0±16.6; mod PPM: 32.6±19.4; severe PPM: 44.7±23.8; p=0.12. At maximal exercise 18 patients showed no PPM while only 4 pts remained in moderate PPM (minimal IEOA 0.76cm2/m2 at exercise) and no pt with severe PPM. Aortic prosthesis opening reserve (cm2/100ml) was comparable for all resting PPM levels: No PPM: 0.34±0.38; Moderate PPM: 0.25±0.12; Severe PPM: 0.26±0.07; p=0.67.

CONCLUSION: At exercise, the avalus valve shows a significant increase in IEOA in all resting PPM levels. Furthermore, the Avalus transvalvular flow reserve is comparable for all resting PPM levels. The good clinical outcomes of the Avalus valve seem supported by an opening reserve of the valve at exercise
BACKGROUND: The Avalus Medtronic valve is a novel low profile stented bovine pericardial valve. The FDA investigational PERIGON trial reported good clinical outcomes although a significant proportion of patients presented moderate to severe PPM at rest. To study this 'conundrum', an exercise-based protocol was designed to evaluate the Avalus valve performance

METHODS AND RESULTS: An ergocycle based exercise testing (25W to 200W with 25W increments) was conducted in 22 patients at an average of 23.7±9.5 months post Avalus valve implant. Throughout exercise, mean pressure gradient, indexed effective valve area (IEOA) and valve opening reserve were calculated. At rest, 8 pts had no PPM (IEOA 0.9±0.1cm2/m2), 11 pts moderate PPM (IEOA 0.7±0.1cm2/m2) and 3pts with severe PPM (IEOA 0.6±0.1cm2/m2). At maximal exercise: mean gradients increased (%from baseline) similarly in all PPM status: no PPM:45.3±24.4; mod PPM:40.5±49.9; severe PPM:61.8±47.9; p=0.74. IEOA showed comparable increase (% from baseline) in all PPM groups: no PPM: 19.0±16.6; mod PPM: 32.6±19.4; severe PPM: 44.7±23.8; p=0.12. At maximal exercise 18 patients showed no PPM while only 4 pts remained in moderate PPM (minimal IEOA 0.76cm2/m2 at exercise) and no pt with severe PPM. Aortic prosthesis opening reserve (cm2/100ml) was comparable for all resting PPM levels: No PPM: 0.34±0.38; Moderate PPM: 0.25±0.12; Severe PPM: 0.26±0.07; p=0.67.

CONCLUSION: At exercise, the avalus valve shows a significant increase in IEOA in all resting PPM levels. Furthermore, the Avalus transvalvular flow reserve is comparable for all resting PPM levels. The good clinical outcomes of the Avalus valve seem supported by an opening reserve of the valve at exercise
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