Hemodynamics of 17-mm vs. 19-mm St. Jude Medical Regent and annulus enlargement

Asian Cardiovasc Thorac Ann. 2015 Jul;23(6):670-83. doi: 10.1177/0218492315581574. Epub 2015 Apr 29.

Abstract

Objective: We aimed to compare early and midterm clinical and hemodynamic outcomes of 17-mm vs. 19-mm St. Jude Medical Regent valves with concomitant aortic annulus enlargement.

Methods: Between 1999 and 2012, 20 patients (group 1) underwent first-time aortic valve replacement with a 17-mm St. Jude Medical Regent valve, and 35 patients (group 2) had a 19-mm valve and concomitant aortic annulus enlargement. The mean follow-up was 81 ± 37 months (range 20-110 months).

Results: There was one death in group 1 vs. 4 in group 2 (p > 0.05). The mean postoperative transprosthetic gradient was 17.5 ± 4.5 in group 1 and 17 ± 6.4 mm Hg in group 2 (p = 0.83), and 37 ± 10.7 and 32 ± 13 mm Hg, respectively, under stress (p = 0.17). Left ventricular mass and left ventricular mass index were reduced and similar in both groups. Postoperative effective orifice area index was higher in group 2 (0.85 ± 0.17 cm(2 )m(-2)) than group 1 (0.76 ± 0.2 cm(2 )m(-2); p > 0.05). A multivariate Cox model identified a 19-mm valve with aortic annulus enlargement (p = 0.032), functional class (p = 0.025), reoperation (p = 0.04), ejection fraction < 35% (p = 0.042), and combined surgery (p = 0.04) as strong predictors of poorer overall event-free survival.

Conclusions: The 17-mm St. Jude Medical Regent valve may be employed with satisfactory postoperative clinical and hemodynamic outcomes in patients with a small aortic annulus, as an alternative to a larger prothesis with aortic annulus enlargement.

Keywords: Aortic valve stenosis; Heart valve prosthesis implantation; Hemodynamics; Prosthesis fitting; Survival rate.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aortic Valve / surgery*
  • Female
  • Follow-Up Studies
  • Heart Valve Prosthesis Implantation / methods*
  • Heart Valve Prosthesis*
  • Hemodynamics / physiology*
  • Humans
  • Male
  • Postoperative Complications / epidemiology
  • Prospective Studies
  • Prosthesis Design
  • Treatment Outcome