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Anakaputhur Rajan VK, Kaskar A, Selvam S, Rao R, Mehra S, Kumaran T, Shetty V. Aortic valve replacement in small aortic root- Bi-leaflet mechanical valve is superior to a Mono-leaflet mechanical valve. Indian J Thorac Cardiovasc Surg 2023:1-9. [PMID: 37359507 PMCID: PMC10199289 DOI: 10.1007/s12055-023-01520-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 04/08/2023] [Accepted: 04/11/2023] [Indexed: 06/28/2023] Open
Abstract
Background Patient prosthetic mismatch is a serious but avoidable complication of surgical aortic valve replacement (SAVR) complicated by a small aortic annulus. This study aims to compare early and midterm outcomes following aortic valve replacement (AVR) with a mono-leaflet (ML) valve and a bi-leaflet (BL) valve in a small aortic root. Methods and selection From January 1st, 2017 to December 31st, 2019, 98 patients diagnosed with small aortic root underwent isolated aortic valve replacement with either TTK Chitra valve (Mono-leaflet/ ML group) or St. Jude medical valve (Bi-leaflet/ BL group) of size 17/ 19 mm. Echocardiography was analyzed from medical records and telephonic follow-up. Results Baseline parameters were comparable. The ML group had 42 patients and the BL group had 56 patients. Aortic cross-clamp time, the incidence of severe patient prosthetic mismatch (p = 0.002) and mean, peak pressure gradients were high in the ML group. Duration of ventilation, intensive care unit (ICU) stay, the incidence of stroke, need for intra-aortic balloon pump, permanent pacemaker, dialysis, and left ventricular mass index in echocardiography were comparable between the two groups postoperatively. There was no early mortality in both group. Survival at the end of 5 years was 57 ± 14.4% in the ML group; 91.8 ± 4% in the BL group (p = 0.005). Univariate and multivariate analysis revealed elderly age as a risk factor for mortality. Conclusion We conclude that aortic valve replacement without any root widening procedure, using a small-sized mechanical valve provides acceptable early outcomes. Bi-leaflet mechanical valves provide better hemodynamics and survival percentage.
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Affiliation(s)
- Venkatesa Kumar Anakaputhur Rajan
- Department of Cardiothoracic Surgery, Narayana Institute of Cardiac Sciences, Narayana Health, #258/A, Bommasandra Industrial Area, Anekal Taluk, Bangalore, 560099 Karnataka India
| | - Ameya Kaskar
- Department of Cardiothoracic Surgery, Narayana Institute of Cardiac Sciences, Narayana Health, #258/A, Bommasandra Industrial Area, Anekal Taluk, Bangalore, 560099 Karnataka India
| | - Sendur Selvam
- Department of Cardiothoracic Surgery, Narayana Institute of Cardiac Sciences, Narayana Health, #258/A, Bommasandra Industrial Area, Anekal Taluk, Bangalore, 560099 Karnataka India
| | - Rahul Rao
- Department of Cardiothoracic Surgery, Narayana Institute of Cardiac Sciences, Narayana Health, #258/A, Bommasandra Industrial Area, Anekal Taluk, Bangalore, 560099 Karnataka India
| | - Siddhant Mehra
- Department of Cardiothoracic Surgery, Narayana Institute of Cardiac Sciences, Narayana Health, #258/A, Bommasandra Industrial Area, Anekal Taluk, Bangalore, 560099 Karnataka India
| | - Thiruthani Kumaran
- Department of Cardiothoracic Surgery, Narayana Institute of Cardiac Sciences, Narayana Health, #258/A, Bommasandra Industrial Area, Anekal Taluk, Bangalore, 560099 Karnataka India
| | - Varun Shetty
- Department of Cardiothoracic Surgery, Narayana Institute of Cardiac Sciences, Narayana Health, #258/A, Bommasandra Industrial Area, Anekal Taluk, Bangalore, 560099 Karnataka India
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Joury A, Duran A, Stewart M, Gilliland YE, Spindel SM, Qamruddin S. Prosthesis-patient mismatch following aortic and mitral valves replacement – A comprehensive review. Prog Cardiovasc Dis 2022; 72:84-92. [PMID: 35235847 DOI: 10.1016/j.pcad.2022.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Abdulaziz Joury
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, United States of America; King Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia.
| | - Antonio Duran
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, United States of America; Ochsner Clinical School, New Orleans, LA, United States of America.
| | - Merrill Stewart
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, United States of America; Ochsner Clinical School, New Orleans, LA, United States of America.
| | - Yvonne E Gilliland
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, United States of America; Ochsner Clinical School, New Orleans, LA, United States of America
| | - Stephen M Spindel
- Ochsner Clinical School, New Orleans, LA, United States of America; Division of Cardiothoracic Surgery, Ochsner Medical Center, New Orleans, LA, United States of America.
| | - Salima Qamruddin
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, United States of America; Ochsner Clinical School, New Orleans, LA, United States of America.
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Ogawa T, Onoe M, Moriwaki S, Shioji K, Iwamuro A, Uegaito T, Matsuda M. Aortic valve replacement with a 17-mm mechanical prosthesis in octogenarian or older patients. J Thorac Cardiovasc Surg 2016; 152:112-7. [DOI: 10.1016/j.jtcvs.2016.02.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 01/14/2016] [Accepted: 02/08/2016] [Indexed: 11/26/2022]
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You JH, Jeong DS, Sung K, Kim WS, Carriere KC, Lee YT, Park PW. Aortic Valve Replacement With Carpentier-Edwards: Hemodynamic Outcomes for the 19-mm Valve. Ann Thorac Surg 2016; 101:2209-16. [PMID: 26872735 DOI: 10.1016/j.athoracsur.2015.11.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 10/06/2015] [Accepted: 11/09/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND To compare hemodynamic performance and clinical outcomes after aortic valve replacement for aortic stenosis with the 19-mm Carpentier-Edwards pericardial bioprosthesis versus larger valves. METHODS Between January 1998 and December 2013, 447 consecutive patients underwent aortic valve replacement for aortic stenosis with the Carpentier-Edwards Perimount (n = 61) or Magna bioprostheses (n = 386). Based on the implanted valve size, the patients were classified into three groups: a 19-mm group (n = 54), a 21-mm group (n = 154), and a 23-mm to 27-mm group (n = 239). The in vivo effective orifice area index was measured by transthoracic echocardiography 12 months after operation (n = 331). The mean follow-up time was 4.9 ± 3.5 (maximum 15.4) years. RESULTS There were three early deaths (0.7%). At 10 years, overall survival (84.1%) was unaffected by patient-prosthesis mismatch (18.7%, 62 patients), and freedom from structural valve deterioration and endocarditis was 100% and 97.1%, respectively. Although the 19-mm group was significantly older and had a higher incidence of patient-prosthesis mismatch (n = 14, 30.4%), there were no significant differences in early outcomes, overall survival, cardiac-related mortality, or serial reduction of left ventricular mass index in comparison with patients with a larger bioprostheses. Independent risk factors for all-cause mortality were age, male gender, combined coronary artery bypass graft, and low hemoglobin level. CONCLUSION The Carpentier-Edwards pericardial bioprosthesis appears to be associated with acceptable clinical outcomes and hemodynamic profile.
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Affiliation(s)
- Ji Hoon You
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Thoracic and Cardiovascular Surgery, Seoul Veterans Hospital, Seoul, Korea
| | - Dong Seop Jeong
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kiick Sung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wook Sung Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - K C Carriere
- Department of Mathematical and Statistical Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Tak Lee
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pyo Won Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Early and late outcomes of AVR with aortic annular enlargement in octogenarian. Gen Thorac Cardiovasc Surg 2015; 63:453-8. [DOI: 10.1007/s11748-015-0559-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 05/01/2015] [Indexed: 11/25/2022]
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Celiento M, Saccocci M, De Martino A, Nardi C, Faggioni L, Milano AD, Bortolotti U. Stability of aortic annulus enlargement during aortic valve replacement using a bovine pericardial patch: An 18-year clinical, echocardiographic, and angio–computed tomographic follow-up. J Thorac Cardiovasc Surg 2014; 147:977-83. [DOI: 10.1016/j.jtcvs.2013.02.074] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 02/14/2013] [Accepted: 02/28/2013] [Indexed: 10/27/2022]
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Hu J, Qian H, Li YJ, Gu J, Zhao JJ, Zhang EY. Seventeen-millimeter St. Jude Medical Regent valve in patients with small aortic annulus: dose moderate prosthesis-patient mismatch matter? J Cardiothorac Surg 2014; 9:17. [PMID: 24438101 PMCID: PMC3896805 DOI: 10.1186/1749-8090-9-17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 01/02/2014] [Indexed: 02/05/2023] Open
Abstract
Background The study was designed to evaluate the effects of moderate prosthesis-patient mismatch (defined as 0.65 cm2/m2 < indexed effective orifice area ≤ 0.85 cm2/m2) on midterm outcomes after isolated aortic valve replacement with a 17-mm St. Jude Medical Regent valve in a large series of patients, and to determine if these effects are influenced by patient confounding variables. Methods One-hundred and six patients with and without moderate prosthesis-patient mismatch early after implantation of a 17-mm Regent valve at aortic position were included. Both clinical and echocardiographic assessments were performed preoperatively, at discharge and during follow-up period (mean follow-up time 52.6 ± 11.9 months). Results The prevalence of moderate prosthesis-patient mismatch was documented in 46 patients (43.4%) at discharge. During the follow-up period, no difference in the regression of left ventricular mass, decrease of transvalvular pressure gradients, mortality and prosthesis-related complications was observed between patients with and without moderate prosthesis-patient mismatch. After adjustment for several risk factors, moderate prosthesis-patient mismatch was associated with increased midterm mortality in patients with baseline left ventricular ejection fraction < 50% (HR: 1.80, p = 0.02), but with normal prognosis in those with preserved LV function. Younger age (cut off value = 65 years) was not an independent predictor of increased midterm mortality and valve-related complications in patients with moderate prosthesis-patient mismatch. Conclusions Moderate prosthesis-patient mismatch after aortic valve replacement with a small mechanical prosthesis is associated with increased mortality and adverse events in patients with pre-existing left ventricular dysfunction. Selected patients with small aortic annulus can experience satisfactory clinical improvements and midterm survival after aortic valve replacement with a 17-mm Regent valve.
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Affiliation(s)
| | | | | | | | | | - Er-yong Zhang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
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Wu Z, Cao H, Zhu D, Wang Q, Wang D. Replacement of the st jude medical regent valve in the aortic position with a continuous suture technique in the small aortic root. J Card Surg 2013; 29:170-4. [PMID: 24131494 DOI: 10.1111/jocs.12227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The aim of this study is to review the strategy of performing aortic valve replacement (AVR) by using the St. Jude Medical (SJM) Regent valve with a continuous suture technique in patients with a small aortic root. METHODS Forty-six patients with small aortic annulus underwent AVR by using 19 or 21 mm SJM Regent valves. There were 15 males and 31 females. The mean age of the patients was 51.8 ± 12.4 years. The aortic annular diameter was 20.2 ± 0.9 mm. AVR procedures were performed with continuous suture technique using SJM Regent valves under standard cardiopulmonary bypass. Echocardiaographic data were collected before operation, at discharge, and at a follow-up time, respectively. RESULTS The intraoperative course was uneventful and there was no operative mortality. The implanted SJM Regent valves consisted of 21 mm valves in 15 patients and 19 mm valves in 31 patients. Echocardiography at 5.6 ± 1.3 months after operation showed a significant increase in the mean effective orifice area index (0.97 ± 0.24 cm(2) /m(2) ), decrease in the mean and peak transvavluar pressure gradient (12.5 ± 5.9 and 22.3 ± 9.6 mmHg), and decrease in the mean left ventricular mass index (106 ± 41.3 g/m(2) ). Moderate prosthesis-patient mismatch (PPM) (effective orifice area index between 0.65 and 0.85 cm(2) /m(2) ) was present in three patients and no severe PPM (effective orifice area index <0.65 cm(2) /m(2) ) occurred at discharge and during follow-up. CONCLUSION Replacement of SJM Regent valve with a continuous suture technique maybe a good option to prevent PPM in the aortic position.
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Affiliation(s)
- Zhong Wu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Furukawa H, Tanemoto K. Current status and future perspectives of prosthetic valve selection for aortic valve replacement. Gen Thorac Cardiovasc Surg 2013; 62:19-23. [PMID: 23722587 DOI: 10.1007/s11748-013-0262-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Indexed: 02/01/2023]
Abstract
Aortic valve abnormality is the most frequent form of valvular heart disease. Notably, aortic stenosis in the elderly population has been increasingly common. Aortic valve replacement (AVR) using prosthetic valve has been still believed as a gold standard surgical intervention for various types of diseased aortic valve. The numerous reports and studies evaluating the clinical outcomes and durability of prosthesis were revealed, however, prosthesis selection for AVR is still debated. In twenty-first century, paradigm shift of prosthesis preference might be emerged from mechanical valves to bioprosthesis due to the development of the technology. Moreover, transcatheter aortic valve implantation accelerated among the worldwide trends. It could be developed having the potential to reduce the mortality and morbidity associated with high-risk traditional AVR. After the current guidelines for the management of patients with valvular heart disease, we should consider the valve choice in various patients' profile setting. This review summarizes the current status of prosthesis selection and future perspectives of ideal aortic valve intervention, including minimal invasive care.
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Affiliation(s)
- Hiroshi Furukawa
- Department of Cardiovascular Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan,
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Zhao D, Wang C, Hong T, Pan C, Guo C. Application of Regent mechanical valve in patients with small aortic annulus: 3-year follow-up. J Cardiothorac Surg 2012; 7:88. [PMID: 22999490 PMCID: PMC3488967 DOI: 10.1186/1749-8090-7-88] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 09/17/2012] [Indexed: 11/10/2022] Open
Abstract
Background Aortic valve replacement (AVR) with a small aortic annulus is always challenging for the cardiac surgeon. In this study, we sought to evaluate the midterm performance of implantation with a 17-mm or 19-mm St. Jude Medical Regent (SJM Regent) mechanical valve in retrospective consecutive cohort of patients with small aortic annulus (diameter ≤ 19 mm). Methods From January 2008 to April 2011, 40 patients (31 female, mean age = 47.2 ± 5.8 years) with small aortic annulus (≤19 mm in diameter) underwent aortic valve replacement with a 17-mm or 19-mm St. Jude Medical Regent (SJM Regent) mechanical valve. Preoperative mean body surface area, New York Heart Association class, and mean aortic annulus were 1.61 ± 0.26 m2, 3.2 ± 0.4, and 18 ± 1.4 mm respectively. Patients were divided into two groups, according to the implantation of 17 mm SJM Regent mechanical valve (group 1, n = 18) or 19 mm SJM Regent valve (group 2, n = 22). All patients underwent echocardiography examination preoperatively and at one year post-operation. Results There were no early deaths in either group. Follow-up time averaged 36 ± 17.6 months. The mean postoperative New York Heart Association class was 1.3 ± 0.6 (p < 0.001). By echocardiography, in group 1, the left ventricular ejection fraction (LVEF), left ventricular fraction shortening (LVFS), and the indexed effective orifice area (EOAI) increased from 43.7% ± 11.6%, 27.3% ± 7.6%, and 0.70 ± 0.06 cm2/m2 to 69.8 ± 9.3%, 41.4 ± 8.3%, and 0.92 ± 0.10 cm2/m2 respectively (P < 0.05), while the left ventricular mass index (LVMI), and the aortic transvalvular pressure gradient decreased from 116.4 ± 25.4 g/m2, 46.1 ± 8.5 mmHg to 86.7 ± 18.2 g/m2 , 13.7 ± 5.2 mmHg respectively. In group 2, the LVEF, LVFS and EOAI increased from 45.9% ± 9.7%, 30.7% ± 8.0%, and 0.81 ± 0.09 cm2/m2 to 77.4% ± 9.7%, 44.5% ± 9.6%, and 1.27 ± 0.11 cm2/m2 respectively, while the LVMI, and the aortic transvalvular pressure gradient decreased from 118.3 ± 27.6 g/m2, 44.0 ± 6.7 mmHg to 80.1 ± 19.7 g/m2, 10.8 ± 4.1 mmHg as well. The prevalence of PPM was documented in 2 patients in Group 1. Conclusions Patients with small aortic annulus and body surface area, experienced satisfactory clinical improvement after aortic valve replacement with modern SJM Regent bileaflet prostheses.
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Affiliation(s)
- Dong Zhao
- Department of Cardiac Surgery, Zhongshan Hospital Fudan University & Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, People's Republic of China
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Okamura H, Yamaguchi A, Nagano H, Itoh S, Morita H, Naito K, Yuri K, Adachi H. Mid-term outcomes after aortic valve replacement with the 17-mm St. Jude Medical Regent valve. Circ J 2011; 76:365-71. [PMID: 22130314 DOI: 10.1253/circj.cj-11-0733] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND When aortic valve replacement (AVR) is performed in patients with a small aortic annulus, prosthesis-patient mismatch (PPM) is of concern. We investigated the mid-term outcomes of AVR with a 17-mm mechanical prosthesis. METHODS AND RESULTS Seventy-eight patients with aortic stenosis underwent AVR with a 17-mm St. Jude Medical Regent prosthesis. Echocardiography was performed preoperatively, at discharge, and at follow-up (mean follow-up, 33 months). Patients were divided into 2 groups: with and without PPM at discharge. Between-group differences in postoperative variables, particularly survival, were analyzed. Overall hospital mortality was 2.6%. Actuarial 1- and 5-year survival rates were 95% and 79%, respectively. Diabetes and renal insufficiency were associated with long-term mortality. Freedom from major adverse valve-related cardiac events at 1 year and 5 years was 97.3% and 93.9%, respectively. Diabetes was shown to be an independent risk factor for major adverse valve-related cardiac events. Echocardiography 13 months after AVR showed a significant increase in mean effective orifice area index, decrease in mean left ventricular-aortic pressure gradient, and decrease in mean left ventricular mass index. PPM at discharge did not influence long-term survival or left ventricular mass regression. CONCLUSIONS The 17-mm Regent prosthesis provided satisfactory clinical and hemodynamic results. It is a reliable choice for patients with a small aortic annulus.
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Affiliation(s)
- Homare Okamura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Japan.
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Aortic Valve Replacement With 17-mm Mechanical Prostheses: Is Patient–Prosthesis Mismatch a Relevant Phenomenon? Ann Thorac Surg 2011; 91:71-7. [DOI: 10.1016/j.athoracsur.2010.08.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Revised: 08/18/2010] [Accepted: 08/19/2010] [Indexed: 11/22/2022]
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Taniguchi S, Noguchi M, Onohara D, Shibata R. Aortic valve replacement with 17-mm St. Jude Medical Regent prosthetic valves for a small calcified aortic annulus in elderly patients. Gen Thorac Cardiovasc Surg 2010; 58:506-10. [PMID: 20941563 DOI: 10.1007/s11748-010-0629-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Accepted: 04/11/2010] [Indexed: 01/20/2023]
Abstract
PURPOSE The aim of this study was to investigate the outcome of aortic valve replacement (AVR) performed with a 17-mm St. Jude Medical Regent prosthetic valve (17SJMR) for an aortic annulus ≤19 mm in elderly patients aged ≥65 years. METHODS Six female patients (age 73.0 ± 5.1 years, body surface area 1.43 ± 0.07 m²) underwent AVR between October 2005 and February 2008. RESULTS Peak transaortic pressure gradient, which was 80.8 ± 31.0 mmHg preoperatively, decreased to 31.0 ± 4.2 mmHg postoperatively (P < 0.01) and to 21.7 ± 1.5 mmHg long term (P < 0.01). The left ventricular mass index, which was 112.1 ± 10.6 g/m² preoperatively, also significantly decreased to 101.4 ± 15.0 g/m² postoperatively and to 88.3 ± 14.8 g/m² long term (P < 0.01). Subjective symptoms diminished in all patients, and neither mortality nor hemorrhagic complications occurred. The postoperative mean effective orifice area index was 0.91 ± 0.04 cm²/m². CONCLUSION A favorable outcome was obtained by aortic valve replacement with the 17SJMR. Patients showed improved postoperative hemodynamic performance without valve-related complications.
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Affiliation(s)
- Shinichiro Taniguchi
- Department of Cardiovascular Surgery, Sasebo Chuo Hospital, Sasebo, Nagasaki, Japan.
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Okamura H, Yamaguchi A, Noguchi K, Naito K, Yuri K, Adachi H. Hemodynamics and Outcomes of Aortic Valve Replacement with a 17- or 19-mm Valve. Asian Cardiovasc Thorac Ann 2010; 18:450-5. [DOI: 10.1177/0218492310381174] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
When aortic valve replacement is performed in patients with a small aortic annulus, prosthesis-patient mismatch is of concern because it may affect postoperative clinical status. We conducted a retrospective study of outcomes in 65 patients with aortic stenosis requiring valve replacement. Fifty were given a 17-mm or 19-mm St. Jude Regent mechanical valve, and 15 were given a 19-mm Medtronic Mosaic bioprosthesis. Echocardiography was carried out preoperatively, at discharge, and at follow-up. There was 1 (2%) operative death in the Regent group and none in the Mosaic group. There was no valve-related event. Follow-up echocardiography in both groups revealed a significant increase in the mean effective orifice area index, a decrease in the mean left ventricular-aortic pressure gradient, and a decrease in the mean left ventricular mass index. Prosthesis-patient mismatch (effective orifice area index <0.85 cm2 · m−2) existed in 13 (26%) patients in the Regent group and 11 (73%) in the Mosaic group at discharge. All patients improved to New York Heart Association functional class II or better. A small-sized prosthesis may provide satisfactory clinical and hemodynamic results in patients with a small aortic annulus.
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Affiliation(s)
- Homare Okamura
- Department of Cardiovascular Surgery Saitama Medical Center, Jichi Medical University Saitama-shi, Saitama, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery Saitama Medical Center, Jichi Medical University Saitama-shi, Saitama, Japan
| | - Kenichiro Noguchi
- Department of Cardiovascular Surgery Saitama Medical Center, Jichi Medical University Saitama-shi, Saitama, Japan
| | - Kazuhiro Naito
- Department of Cardiovascular Surgery Saitama Medical Center, Jichi Medical University Saitama-shi, Saitama, Japan
| | - Koichi Yuri
- Department of Cardiovascular Surgery Saitama Medical Center, Jichi Medical University Saitama-shi, Saitama, Japan
| | - Hideo Adachi
- Department of Cardiovascular Surgery Saitama Medical Center, Jichi Medical University Saitama-shi, Saitama, Japan
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Kulik A. Aortic Root Enlargement: Worth the Effort? Ann Thorac Surg 2010; 90:703-5. [DOI: 10.1016/j.athoracsur.2010.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 05/04/2010] [Accepted: 05/10/2010] [Indexed: 10/19/2022]
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Sezai A, Kasamaki Y, Abe K, Hata M, Sekino H, Shimura K, Minami K. Assessment of the St. Jude Medical Regent Prosthetic Valve by Continuous-Wave Doppler and Dobutamine Stress Echocardiography. Ann Thorac Surg 2010; 89:87-92. [DOI: 10.1016/j.athoracsur.2009.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Revised: 08/31/2009] [Accepted: 09/01/2009] [Indexed: 11/28/2022]
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