Hydrodynamics of the Certas™ programmable valve for the treatment of hydrocephalus

BACKGROUND: The new Certas™ shunt for the treatment of hydrocephalus has seven standard pressure settings that according to the manufacturer range from 36 to 238 mmH(2)O, and an additional “Virtual Off” setting with an opening pressure >400 mmH(2)O. Information on actual pressure response and reliability of shunt performance is important in clinical application, especially the “Virtual Off” setting as a non-surgical replacement for shunt ligation. The objective of this study was to evaluate the in-vitro hydrodynamic performance of the Certas™ shunt. METHODS: Six new Certas™ shunts with proximal and distal catheters were tested with an automated, computerized test system that raised the pressure from zero to a maximum pressure and back to zero at each valve setting. Opening pressure and flow resistance were determined. RESULTS: For settings 1–7 the measured opening pressure range was 26 to 247 mmH(2)O, and the mean change in opening pressure for a one-step adjustment was between 33 and 38 mmH(2)O. For setting 8 (“Virtual Off”) the measured mean opening pressure was 494 ± 34 mmH(2)O (range 451 to 556 mmH(2)O). The mean outflow resistance was 7.0 mmHg/ml/min (outflow conductance 17.9 μl/s/kPa). CONCLUSIONS: The six shunts had similar characteristics and closely matched the manufacturer’s specifications for opening pressure at settings 1–7. The opening pressure for the “Virtual Off” setting was nearly 500 mmH(2)O, which is 100 mmH(2)O higher than the manufacturer’s specification of “>400” and should be functionally off for most patients with communicating hydrocephalus. Clinical studies are needed to evaluate if the CSF dynamic profile persists after implantation in patients.