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A mechanistic investigation of the EDWARDS INTUITY Elite valve’s hemodynamic performance



Rapid deployment surgical aortic valve replacement has emerged as an alternative to the contemporary sutured valve technique. A difference in transvalvular pressure has been observed clinically between RD-SAVR and contemporary SAVR. A mechanistic inquiry into the impact of the rapid deployment valve inflow frame design on the left ventricular outflow tract and valve hemodynamics is needed.


A 23 mm EDWARDS INTUITY Elite rapid deployment valve and a control contemporary, sutured valve, a 23 mm Magna Ease valve, were implanted in an explanted human heart by an experienced cardiac surgeon. Per convention, the rapid deployment valve was implanted with three non-pledgeted, simple guiding sutures, while fifteen pledgeted, mattress sutures were used to implant the contemporary surgical valve. In vitro flow models were created from micro-computed tomography scans of the implanted valves and surrounding cardiac anatomy. Particle image velocimetry and hydrodynamic characterization experiments were conducted in the vicinity of the valves in a validated pulsatile flow loop system.


The rapid deployment and control valves were found to have mean transvalvular pressure gradients of 7.92 ± 0.37 and 10.13 ± 0.48 mmHg, respectively. The inflow frame of the rapid deployment valve formed a larger, more circular, left ventricular outflow tract compared to the control valve. Furthermore, it was found that the presence of the control valve’s sub-annular pledgets compromised its velocity distribution and consequently its pressure gradient.


The rapid deployment valve’s intra-annular inflow frame provides for a larger, left ventricular outflow tract, thus reducing the transvalvular pressure gradient and improving overall hemodynamic performance.

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  1. Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart disease and stroke statistics—2017 update: a report from the american heart association. Circulation. 2017;135:e146–603.

    Article  Google Scholar 

  2. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary. J Am Coll Cardiol. 2014;63:2438–88.

    Article  Google Scholar 

  3. Di Eusanio M, Phan K. Sutureless aortic valve replacement. Ann Cardiothorac Surg. 2015;4:123–30.

    PubMed  PubMed Central  Google Scholar 

  4. Liakopoulos OJ, Gerfer S, Weider S, et al. Direct comparison of the Edwards Intuity Elite and Sorin Perceval S rapid deployment aortic valves. Ann Thorac Surg. 2018;105:108–14.

    Article  Google Scholar 

  5. Sohn SH, Jang M, Hwang HY, et al. Rapid deployment or sutureless versus conventional bioprosthetic aortic valve replacement: a meta-analysis. J Thorac Cardiovasc Surg. 2018;155(2402–2412):e5.

    Google Scholar 

  6. Phan K, Tsai Y-C, Niranjan N, et al. Sutureless aortic valve replacement: a systematic review and meta-analysis. Ann Cardiothorac Surg. 2015;4:100–11.

    PubMed  PubMed Central  Google Scholar 

  7. Young C, Laufer G, Kocher A, et al. One-year outcomes after rapid-deployment aortic valve replacement. J Thorac Cardiovasc Surg. 2018;155:575–85.

    Article  Google Scholar 

  8. Rahmanian PB. Invited commentary. Ann Thorac Surg. 2018;106(6):1749–50.

    Article  PubMed  Google Scholar 

  9. Ferrari E, Roduit C, Salamin P, et al. Rapid-deployment aortic valve replacement versus standard bioprosthesis implantation. J Card Surg. 2017;32:322–7.

    Article  Google Scholar 

  10. Jahren SE, Heinisch PP, Wirz J, et al. Hemodynamic performance of Edwards Intuity valve in a compliant aortic root model. In: 2015 37th annual international conference of the IEEE Engineering in Medicine and Biology Society, vol. 2015, IEEE; 2015. p. 3315–18.

  11. Capelli C, Corsini C, Biscarini D, et al. Pledget-armed sutures affect the haemodynamic performance of biologic aortic valve substitutes: a preliminary experimental and computational study. Cardiovasc Eng Technol. 2017;8:17–29.

    Article  Google Scholar 

  12. Bloodworth CH, Pierce EL, Easley TF, et al. Ex vivo methods for informing computational models of the mitral valve. Ann Biomed Eng. 2017;45:496–507.

    Article  Google Scholar 

  13. Midha PA, Raghav V, Okafor I, et al. The effect of valve-in-valve implantation height on sinus flow. Ann Biomed Eng. 2017;45:405–12.

    Article  Google Scholar 

  14. International Organization for Standardization (ISO 5840-3). Cardiovascular implants—cardiac valve prostheses—Part 3: heart valve substitutes implanted by transcatheter techniques. Switzerland, Geneva; 2013.

  15. Gunning PS, Saikrishnan N, McNamara LM, et al. An in vitro evaluation of the impact of eccentric deployment on transcatheter aortic valve hemodynamics. Ann Biomed Eng. 2014;42:1195–206.

    Article  Google Scholar 

  16. Gibson PH, Becher H, Choy JB. Classification of left ventricular size: diameter or volume with contrast echocardiography? Open Hear. 2014;1:e000147.

    Article  Google Scholar 

  17. Borger MA, Moustafine V, Conradi L, et al. A randomized multicenter trial of minimally invasive rapid deployment versus conventional full sternotomy aortic valve replacement. Ann Thorac Surg. 2015;99:17–24.

    Article  Google Scholar 

  18. Bobiarski J, Newcomb AE, Elhenawy AM, et al. One-year hemodynamic comparison of perimount magna with st jude epic aortic bioprostheses. Arch Med Sci. 2013;3:445–51.

    Article  Google Scholar 

  19. Barnhart GR, Accola KD, Grossi EA, et al. TRANSFORM (Multicenter experience with rapid deployment Edwards INTUITY valve system for aortic valve replacement) US clinical trial: performance of a rapid deployment aortic valve. J Thorac Cardiovasc Surg. 2017;153(241–251):e2.

    Google Scholar 

  20. Kocher AA, Laufer G, Haverich A, et al. One-year outcomes of the surgical treatment of aortic stenosis with a next generation surgical aortic valve (TRITON) trial: a prospective multicenter study of rapid-deployment aortic valve replacement with the EDWARDS INTUITY valve system. J Thorac Cardiovasc Surg. 2013;145:110–6.

    Article  Google Scholar 

  21. Andreas M, Wallner S, Habertheuer A, et al. Conventional versus rapid-deployment aortic valve replacement: a single-centre comparison between the Edwards Magna valve and its rapid-deployment successor. Interact Cardiovasc Thorac Surg. 2016;22:799–805.

    Article  Google Scholar 

  22. Wahlers TCW, Andreas M, Rahmanian P, et al. Outcomes of a rapid deployment aortic valve versus its conventional counterpart: a propensity-matched analysis. Innovations. 2018;13(3):177–83.

    Article  PubMed  Google Scholar 

  23. Dayan V, Vignolo G, Soca G, et al. Predictors and outcomes of prosthesis-patient mismatch after aortic valve replacement. JACC Cardiovasc Imaging. 2016;9:924–33.

    Article  Google Scholar 

  24. Mannacio V, Mannacio L, Mango E, et al. Severe prosthesis-patient mismatch after aortic valve replacement for aortic stenosis: analysis of risk factors for early and long-term mortality. J Cardiol. 2017;69:333–9.

    Article  Google Scholar 

  25. Theron A, Gariboldi V, Grisoli D, et al. Rapid deployment of aortic bioprosthesis in elderly patients with small aortic annulus. Ann Thorac Surg. 2016;101:1434–41.

    Article  Google Scholar 

  26. Botzenhardt F, Eichinger WB, Guenzinger R, et al. Hemodynamic performance and incidence of patient-prosthesis mismatch of the complete supraannular perimount magna bioprosthesis in the aortic position. Thorac Cardiovasc Surg. 2005;53:226–30.

    Article  CAS  Google Scholar 

  27. Rahmanian PB, Kaya S, Eghbalzadeh K, et al. Rapid deployment aortic valve replacement: excellent results and increased effective orifice areas. Ann Thorac Surg. 2018;105:24–30.

    Article  Google Scholar 

  28. Laufer G, Haverich A, Andreas M, et al. Long-term outcomes of a rapid deployment aortic valve: data up to 5 years. Eur J Cardio-Thorac Surg. 2017;52:281–7.

    Article  Google Scholar 

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This study was funded by a research grant from Edwards Lifesciences.

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Correspondence to Ajit P. Yoganathan.

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Georgia Tech Research Corporation received a grant from Edwards Lifesciences to carry out this research.

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Sadri, V., Bloodworth, C.H., Madukauwa-David, I.D. et al. A mechanistic investigation of the EDWARDS INTUITY Elite valve’s hemodynamic performance. Gen Thorac Cardiovasc Surg 68, 9–17 (2020).

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  • Aortic valve replacement
  • Cardiac surgery
  • Minimal invasive
  • Rapid deployment valves
  • Sutureless valves