In an investigation of the influence of glutaraldehyde fixation pressure and subsequent valve constraint on the coaptive characteristics of porcine aortic valves, 14 valves were examined, eight having been fixed at low pressure (congruent to 1 mm Hg) and six at high pressure (80 mm Hg). The coaptive ratios of the left and right coronary leaflets in the low-pressure-fixed valves showed a significant improvement over those of the same leaflets in the high-pressure-fixed valves. Inflation to 80 mm Hg results in a variable "peeling back" of the coaptive margins of the low-pressure-fixed valves but not of the high-pressure-fixed valves. Comparable coaptive ratios are therefore expected during full inflation of the unconstrained valves fixed both at low pressure and at high pressure. Constraining the low-pressure-fixed valves during inflation to simulate the effect of mounting on a rigid stent produced either a reduction or virtual elimination of this "peeling back" motion or in some instances a slight reversal of the effect, thus increasing the width of the coaptive margin. Hence it is expected that the stented low-pressure-fixed valve will manifest better coaptation than the high-pressure-fixed valve. Finally, the experimental findings of this study, combined with the improved mechanical function of the leaflet tissue already known to occur in the low-pressure-treated valves, provide a convincing case for valve fixation to be carried out under lower pressures.
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