Hemodynamic outcome after aortic valve replacement (AVR) seems dependent on the type of replacement. The impact of the surgical pathway (aortotomy) itself on hemodynamics is still unclear. We proposed an ex-vivo swine model for comprehensive evaluation of aortic hemodynamics after different types of AVR with 4D flow MRI. Postoperative flow changes could be attributed not only to the implanted valve but also to the aortotomy. The new neocuspidization Ozaki procedure compared favorably to a biological valve as it induced fewer secondary flow patterns. Among the three different AVR methods, the mechanical valve allowed for hemodynamics that most closely approached physiology.
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