[HSF] Valve sizing F/U to infected freestyle

[hgrmd at aol.com]

Tom,
  How have you measured the gradients?  By echo?  By cath?  In humans?  In animals?  Too many unanswered questions.  To be honest, I've always done what the big boys, like Cleveland Clinic, do.  I'm no engineer, and I'm no aortic valve expert, even though I'm on track to insert about 80 this year.  However, I've seen the Magna and the Perimount side by side.  No question, the EOA of a 19 Magna is the same as a 21 Perimount.  As I said before, they accomplish this by thinning out the stent and sewing ring.  I don't know for sure, but the Mosaic's sewing ring looks to be similar in thickness as the Perimount.  I doubt it has the same hemodynamic performance as the Magna.  In addition, it's a pig valve.  Bovine pericardial valves supposedly have superior durability.
Hal 
 
-----Original Message-----
From: tdmartin2000 at aol.com
To: OpenHeart-L at lists.hsforum.com
Sent: Tue, 1 May 2007 10:32 PM
Subject: Re: [HSF] Valve sizing F/U to infected freestyle


Hal
It's all marketing smoke and mirrors. I have used every valve and valve sizer 
possible and have put them all to the test by getting sizers from each company 
and then trying them in the same annulus. I guarantee you that in any annulus 
you size to a 21 Magna you will size it to a 23 Mosaic. The sizers are 
completely different. That is why Edwards always says that "size for size" their 
valve is significantly better in terms of GOA and EOA. That statement is 
technically true if you use the labeled sizes. But again, they are not the same 
and you can fit one labeled size higher Mosaic in than the Magna. When you do 
that the GOA's and EOA's are almost the same. I have directly measured the 
gradients across multiple valves and have measured similarly low gradients 
across comparable valves. I challenge anyone on the forum to do the same as I 
have done and take out all of the sizers and compare them in a real annulus.



In a message dated 05/01/07 10:45:40 Eastern Daylight Time, Hgrmd writes:
Sorry, Tom.  I'm not following your logic.  What makes you think  a 25 Mosaic 
will fit as well as a 23 Magna?  Unless there are sizing  discrepancies 
between the 2 companies valves (which I've seen), the smaller  valve should fit 
more easily than the larger one.  Parenthetically, though  I'm sure you are 
aware, the Magna is designed such that it's 19mm valve has the  same EOA as its 
21mm Perimount.  They do this by thinning out the stent and  sewing ring.  I've 
been using them for about a year, and have been pleased  with their performance 
so far.  In the larger annuli, it probably doesn't  make much difference.   
However, for the smaller roots the hemodynamic data  I've seen (company 
provided, of course) appear favorable. 

Hal 



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