Totally Supra-Annular Mechanical Valve: to provide good hemodynamic performance and good clinical outcomes

When replacing an aortic valve with a mechanical prosthesis it is essential to make the right decision, mine was on the Bicarbon Overline valve (SORIN Group). Bicarbon Overline is a bileaflet mechanical valve designed for a Totally Supra-Annular implant. The innovative design of the valve is highlighted by curved leaflets with an 80° opening angle and an aerofoil titanium housing profile leading to less turbulence, low gradients and limited thromboembolic events. The improved hemodynamic performances are reached also by the Totally SupraAnnular positioning meaning that no components of the valve are placed inside the annulus resulting in a maximization of the blood flow. The low profile of the Bicarbon Overline makes the valve suitable for small aortic roots not occluding the coronary ostia, thus it does not require annulus enlargement. Thanks to the Totally Supra-Annular seating, Bicarbon Overline is ideal for Double Valve Replacement (DVR) because it does not interfere with the mitral valve anterior part. My experience with Bicarbon Overline is dated between September 2004 and June 2010 on 168 patients undergoing AVR. All patients were selected from a specific cardiac database (SICCS) and the general database from La Princesa Hospital in Madrid (Spain). In all patients, at 12 months after the procedure, hemodynamic performances were favorable: satisfactory average effective orifice areas were associated with zero incidence of aortic prosthesis mismatch, and Peak and Mean transprosthetic gradients were 23.6 ± 8.1 and 12.9 ± 4.9mmHg, respectively. The clinical outcomes showed the Bicarbon Overline to be a reliable valve with a low early mortality rate (2.4%), high cumulative survival (91.7%) and freedom from any valve related events (93.3%) at 24 months. With data collected from these experiences I can conclude that the Bicarbon Overline prosthesis showed a good hemodynamic performance, no incidence of patient-prosthesis mismatch, and favorable early clinical results. It is a valuable choice for all patients undergoing AVR with a mechanical prosthesis and is to be considered extremely indicated in those patients having a small annulus because, thanks to the Totally Supra-Annular positioning, the orifice area is not reduced by intra-annular valve components thus resulting in a maximization of the blood flow. Totally Supra-Annular Mechanical Valve: to provide good hemodynamic performance and good clinical outcomes Vinayak Bapat Consultant Cardiothoracic Surgeon, Department of Cardiothroacic Surgery & Cardiology, Guy’s and St. Thomas’ Hospital, London, UK.