Hemodynamics of 17-mm vs. 19-mm St. Jude Medical Regent and annulus enlargement. (July 2015)

• Record Type: Journal Article
• Authors: Prifti, Edvin; Bonacchi, Massimo; Baboci, Arben; Giunti, Gabriele; Esposito, Giampiero; Krakulli, Klodian; Ademaj, Fadil; Kajo, Efrosina; Vanini, Vitttorio
• Is Part Of: Asian cardiovascular & thoracic annals. Volume 23:Number 6(2015)
• Page Start: 670
• Page End: 683
• Publication Date: 2015-07
• Subjects: Aortic valve stenosis -- Heart valve prosthesis implantation -- Hemodynamics -- Prosthesis fitting -- Survival rate; Heart -- Diseases -- Asia -- Periodicals; Heart -- Diseases -- Pacific Area -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Surgery -- Asia -- Periodicals; Heart -- Surgery -- Pacific Area -- Periodicals; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Asia -- Periodicals; Chest -- Surgery -- Pacific Area -- Periodicals; Chest -- Surgery -- Periodicals; 617.412
• DOI: 10.1177/0218492315581574
• Languages: English
• ISSNs: 0218-4923

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.