Elección de Prótesis Valvular Cardiaca para Pacientes ...€¦ · Vascular y Endovascular IOT -...

Elección

de

Prótesis Valvular Cardiaca

para

Pacientes AdultosDr. Osvaldo Amerio

Jefe Servicio de Cirugia Cardiaca

Vascular y Endovascular

IOT - Sanatorio Integral Centro Integral de Cardiologia

www.sanatorioiot.com.ar

Elección de Prótesis Valvular Cardiaca para Pacientes Adultos


PROTESIS DESEABLE

Biocompatible

Durable

Atrombogenica

Generar un Bajo Gradiente

Transvalvular

Ser imperceptible al portador


http://images.google.com.ar/imgres?imgurl=www.me.utexas.edu/~uer/heartvalves/valves/bsccur.gif&imgrefurl=http://www.me.utexas.edu/~uer/uertoc.html&h=405&w=450&prev=/images?q=Bjork+Shiley&svnum=10&hl=es&lr=&ie=UTF-8&oe=


PRINCIPIO de ROSS


PROTESIS DESEABLE

Biocompatible

Durable

Atrombogenica

Generar un Bajo Gradiente

Transvalvular

Ser imperceptible al portador


DETERIORO ESTRUCTURAL de las

VALVULAS BIOLOGICAS

Calcificación de las Valvas con/sin

Desgarro Secundario.

Fallo Mecánico de la Estructura de la

Valva sin Calcificación. (fatiga)


TROMBOGENICIDAD de las VALVULAS MECANICAS


Journal of the American College of Cardiology Vol. 41, No. 6, 2003

© 2003 by the American College of Cardiology Foundation ISSN 0735-

1097/03/$30.00

Published by Elsevier Science Inc. doi:10.1016/S0735-1097(02)02965-0

STATE-OF-THE-ART PAPER

Choice of Prosthetic Heart Valve for Adult Patients

Shahbudin H. Rahimtoola, MB, FRCP, MACP, MACC,

DSC(HON)

Los Angeles, California


Mortalidad

Complicaciones

Sangrado

Deterioro Estructural

Tamaño de la Prótesis

Homografts

Autograft


Mortalidad

Complicaciones

Sangrado



Homografts

Autograft


http://www.sciencedirect.com/science?_ob=MiamiCaptionURL&_method=retrieve&_udi=B6T18-5056GDN-1&_image=B6T18-5056GDN-1-F&_ba=&_fmt=full&_orig=na&_pii=S0735109710011964&view=full&_isHiQual=Y&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=22cfdacf09b0f40f73f69c25f81a048c


http://www.sciencedirect.com/science?_ob=MiamiCaptionURL&_method=retrieve&_udi=B6T18-5056GDN-1&_image=B6T18-5056GDN-1-N&_ba=&_fmt=full&_orig=na&_pii=S0735109710011964&view=full&_isHiQual=Y&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=6444dfcb43ba2790bdb4d80b99f6e029


60-70 years >70 years >80 years

11.5% 17.3% 32%

Reoperative Mortality


Mechanical Tissue All P value

No. 1340 1193 2533

Age (y) 64.5 ± 12.9 72.0 ± 12.6 68.0 ± 13.3 .0001

Female sex (%) 49.0 39.8 44.7 <.001

NYHA class IV (%) 37.8 (n = 1108) 40.9 (n = 995) 39.3 (n = 2103) .15

Coronary artery disease (%) 50.2 61.6 55.6 .001

Diabetes (%) 14.1 14.6 14.3 .78

Prior MI (%) 19.3 20.0 19.7 .82

Ejection fraction (%) 54.0 ± 14.7 (n = 573) 53.0 ± 15.2 (n = 636) 53.5 ± 15.0 (n = 1209) .21

Operative mortality (%) 7.9 9.8 8.8 .09

CABG (%) 44.1 55.8 49.6 .001

Values are given as means ± SD where shown. NYHA, New York Heart Association; CABG, coronary artery bypass grafting; MI, myocardial

infarction, NS, not significant (P > .2).

Table 1. Preoperative patient characteristics


Mortalidad

Complicaciones

Sangrado



Homografts

Autograft


State-of-the-Art Paper

Choice of Prosthetic Heart Valve in Adults: An Update

Shahbudin H. Rahimtoola MB, FRCP, DSc (Hon)a Griffith Center, Division of Cardiovascular Medicine, Department of

Medicine, LAC+USC Medical Center, Keck School of Medicine at

University of Southern California, Los Angeles, California

Available online 25 May 2010.


Mortalidad

Complicaciones

Sangrado



Homografts

Autograft


PRINCIPIO de ROSS


http://www.sciencedirect.com/science?_ob=MiamiCaptionURL&_method=retrieve&_udi=B6T18-5056GDN-1&_image=B6T18-5056GDN-1-W&_ba=&_fmt=full&_orig=na&_pii=S0735109710011964&view=full&_isHiQual=Y&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=65d74b12390e68c0040fadb69fc7564f


Transcatheter Aortic Valve Implantation


No Toda Innovación

Representa Progreso.

La Viabilidad de una Operación

No es su Mejor Indicación.


1.- Stent Flexible

2.- Apertura Central

3.- Simetria 120 °

A New Concept On

Mechanical Heart Valve

New Design And Materials

Dr. Osvaldo Amerio; Ing. Mario Rosenberger; Prof. Dr. Carlos Schvezov

Fac. de Cs. Ex., Qcas y Nat., Universidad Nacional de Misiones, Argentina.

Sanatorio Integral–IOT – Posadas, Misiones, Argentina.

Centro Integral de Cardiologia


A New Concept on Mechanical Heart Valve - New Design and Materials


15° Congreso Nacional de Cirugia Cardiaca 21

“OVERDUE RESULTS OF PORCINE BIOPROSTHESIS

(CARPENTIER-EDWARDS and BIOCOR) IN ISOLATED

REPLACES OF THE AORTIC AND MITRAL VALVES”

“RESULTADOS TARDIOS DAS BIOPRŐTESES PORCINAS

(CARPENTIER-EDWARDS E BIOCOR) NAS SUBSTITUIÇŐES ISOLADAS

DAS VALVAS AŐRTICA E MITRAL”

OSVALDO N. AMERIO, MARCOS F. BERLINK,

PAULO A. F. OLIVEIRA, JOSE RENATO M. MARTINS,

JANUARIO M. SOUZA e SERGIO ALMEIDA DE OLIVEIRA

Hospital Beneficéncia Portuguêsa

São Paulo, SP

Rio de Janeiro - 1987


(b)

1

2

Inlet flow

(a)



Central Flow

0%

20%

40%

60%

80%

100%

100 600 1100 1600 2100Reynolds

Per

cen

t of

tot

al f

low

Bi-leaflet - Aperture 85º

Tri-Cylindric - Aperture 90º



1 10 100 1000 10000 100000

0,0

0,2

0,4

0,6

0,8

1,0

Shear Stress on the Ring and the Leaves

(Tri-leaflet Cylindrical, Aperture 90º)

Ring - Re 100

Ring - Re 1000

Ring - Re 1600

Ring - Re 2000

Leaves - Re 100

Leaves - Re 1000

Leaves - Re 1600

Leaves - Re 2000

Su

rfa

ce a

rea f

racti

on

Dimensionless shear stress [ D2 /

2]

Reynolds

number

Bileaflet Cylindrical Trileaflet

Leaflet Ring Leaflet Ring

2000 232,000 186,000

2000 139,000 88,000



Pressure

0

500

1000

1500

2000

2500

-0,054 -0,004 0,046 0,096 0,146 0,196

Coordenate z [m]

Re

lati

ve

Pre

ss

ure

, [n

on

dim

.]

Tri-leaflet Cylindrical

Bi-leaflet Flat



Mechanical resistance.

Haemcompatibility.

Technological availability.

Materials Selection



Materials Selection

TITANIUM ALLOY COATED

WITH TITANIUM OXIDE

Mechanical resistance.

Haemocompatibility.

Technological avaliability.



Biomaterials 24 (2003) 2177–2187,

Hemocompatibility of Titanium Oxide FilmsN. Huang, P. Yang, Y.X. Leng, J.Y. Chen, H. Sun, J. Wang,

G.J. Wang, P.D. Ding, T.F. Xi, Y. Leng

Pyrolytic CarbonTitanium Oxide



CONCLUSIONS

The design presented here:

Has a minimum effect on the flow.

The central flow is 98% of the total flow.

The pressure drop is much lower than the observed in other valves.

Produce a shear stress lower than other prosthesis.

Has a surface free 5% larger than the bileaflet valve.

And the material selected :

Titanium alloy coated with titanium oxide has excellent

haemocompatibility and mechanical properties.



Transcatheter Aortic Valve Implantation

Elección de Prótesis Valvular Cardiaca para Pacientes ...€¦ · Vascular y Endovascular IOT -...

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