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PubMed2000

Independent factors associated with longevity of prosthetic pulmonary valves and valved conduits.

OBJECTIVE: To evaluate the age dependence of variables predictive of pulmonary valve prosthesis replacement, we conducted the following analysis. METHODS: Retrospective analysis of 945 operations in 726 patients undergoing placement of pulmonary valve prostheses was performed. Age was identified as a strong independent predictor of valve failure. The database was stratified into age-based subsets and predictors of valve replacement were identified within each subset. RESULTS: For the entire cohort, freedom from valve replacement at 5 years was 81%. Younger age was strongly associated with decreased time to valve replacement by multivariable analysis (hazard ratio: 0.71/log-year, P <.001). Other independent factors included diagnosis, type of prosthesis, and time-dependent requirement for pulmonary valve stent placement. Important predictors of valve failure varied among age groups and are as follows: for Age Less Than 3 Months: valve type; for Age 3 Months To Less Than 2 Years: smaller normalized valve prosthesis size; for Age 2 Years To Less Than 13 Years: sex, smaller normalized valve prosthesis size, placement of endovascular stents, and valve type; for Age 13 Years To 65 Years: smaller normalized valve prosthesis size, placement of endovascular stents, and increased number of previous valve placements. CONCLUSION: Age is a dominant risk factor predictive of pulmonary valve prosthesis failure. A significant interaction exists between age and the effects of diagnosis, valve type, and size on prosthetic pulmonary valve longevity.

Adolescent↗

PubMed2003

[Aortic valve replacement in patients over 70 years old: determinants of early death].

INTRODUCTION AND OBJECTIVES: There is controversy regarding the risk factors associated with early death in geriatric patients undergoing aortic valve replacement. We analyzed the risks in these patients and established an accurate model for predicting in-hospital mortality. PATIENTS AND METHOD: Univariate and multivariate analyses were made of the risk factors associated with early death in a group of 129 patients older than 70 years who underwent aortic valve replacement (May 1994-June 2001). The variables obtained by multivariate logistic regression were combined to produce an equation for the prediction of early death. The equation was tested using a receiver operating characteristic curve. RESULTS: Univariate analysis identified four factors related to early death: NYHA III-IV (p < 0.0001), ejection fraction < 40% (p < 0.05), aortic regurgitation (p < 0.05) and high left ventricular mass index (p < 0.05). Multivariate analysis revealed three independent risk factors: NYHA III-IV (p < 0.01), aortic regurgitation (p < 0.05), and small body surface area (p < 0.05). A lower mortality was observed in patients with a larger body surface area (0% for > 1.90 m2, 20% for < 1.40 m2). The estimated mortality with the predictive model was 7.06%, which was similar to the observed mortality of 7.80% (area under the ROC curve 0.87) and better than estimates obtained with the EuroSCORE (6.5%; area under the ROC curve 0.56). CONCLUSIONS: Risk factors associated with early death after aortic valve replacement in geriatric patients include functional status, aortic regurgitation, and small body surface area. Our model based on these factors accurately predicted operative mortality in our patients. Gender, prosthesis size, and pump time were not identified as risk factors.

Aged↗

PubMed2002

Routine enlargement of the small aortic root: a preventive strategy to minimize mismatch.

BACKGROUND: We routinely use aortic root enlargement (ARE) as part of one strategy to avoid prosthesis-patient mismatch in patients with relatively small aortic roots who are undergoing aortic valve replacement (AVR). METHODS: We performed a retrospective review of 657 consecutive stented AVR patients at a single institution between 1995 to 2001. Of these, 114 (17%) patients underwent ARE. Root enlargement was selectively performed in patients at risk for prosthesis-patient mismatch, defined as calculated projected indexed effective orifice area (iEOA) less than 0.85 cm2/m2. This involved extension of the aortotomy between the left and noncoronary cusps, valve implantation, and Dacron patch closure of the aorta, thus permitting replacement with a valve size appropriate to body surface area. RESULTS: The mean age of ARE patients was 72.5 +/- 11.0 years, with 32% aged 80 years or more. Of the patients, 61% were female and 27% had undergone previous cardiac operations. Combined procedures included coronary bypass in 57 patients and mitral repair or replacement in 24. The prevalence of mismatch was less than 3%. The ARE required an average of 19 minutes of additional aortic clamp time. The 30-day mortality was 0.9%. Logistic regression showed perfusion time to be the only independent predictor of mortality. CONCLUSIONS: Our results show that ARE can be performed readily and with minimal added risk relative to standard AVR. We also present a preventive strategy to minimize mismatch predicted at time of operation from the reference value of effective orifice area for a given prosthesis and the patient's size. This includes use of ARE to enhance the potential benefit of AVR.

Adult↗

PubMed1998

Twelve-year experience with the 19 mm Carpentier-Edwards pericardial aortic valve.

BACKGROUND AND AIMS OF THE STUDY: In patients with small aortic annuli, the choice of prosthesis should be based on hemodynamics and valve durability. The Carpentier-Edwards pericardial valve offers good hemodynamic performance and long-term valve durability. We reviewed our 12-year experience with 121 patients who received a 19 mm prosthesis. METHODS: A total of 121 patients (97 females, 24 males; mean age 73.2 +/- 9.4 years) underwent isolated aortic valve replacement with a 19 mm Carpentier-Edwards pericardial bioprosthesis in our institution between July 1984 and December 1995. Patients were followed up for an average of 4.84 years after surgery; total follow up was 581 patient-years (pt-yr). RESULTS: The operative mortality rate was 3.3% (4/121). At the present time, 77 patients (86%) are in NYHA class I or II with a mean gradient of 18.0 +/- 6.9 mmHg and mean effective orifice area 1.1 +/- 0.23 cm2. There were 25 late deaths. After 12 years the actuarial survival rate was 42 +/- 26%. Eight patients died of valve-related cause (one endocarditis, one structural failure, two thromboembolisms, one anticoagulant-related hemorrhage, three sudden deaths). At 12 years, the actuarial rate of freedom from valve-related death was 61 +/- 37% and from non-sudden valve-related death 88 +/- 11%. Valve-related complications included six thromboembolic episodes (1.0%/pt-yr), one endocarditis (0.17%/pt-yr), two reoperations (0.34%/pt-yr) and two structural valve failures (0.34%/pt-yr). After 12 years, freedom from reoperation was 89 +/- 11%, from valve failure 92 +/- 8%, from thromboembolic episodes 82 +/- 16% and from endocarditis 99 +/- 1%. CONCLUSION: With a low rate of structural valve failure at 12 years and a good clinical performance, the Carpentier-Edwards prosthesis is a reliable alternative for small aortic annuli.

Adult↗

PubMed2006

Aortic valve replacement with a 16-mm CarboMedics valve in adult patients.

Management of the small aortic root is a significant problem for the surgeon with regard to operative technique and selection of the prosthesis. We report on four adults with a small aortic root who underwent aortic valve replacement with a 16-mm CarboMedics bileaflet valve. All patients now lead normal lives. Postoperative Doppler measurements demonstrated an acceptable transprosthetic gradient.

Aged↗

PubMed2000

Impact of high transvalvular velocities early after implantation of Freestyle stentless aortic bioprosthesis.

BACKGROUND AND AIM OF THE STUDY: Stentless aortic bioprostheses have excellent hemodynamics, although heterogeneity in gradients has been observed. The present study was intended to determine whether high early postoperative transvalvular velocities correlate with other measures of left ventricular outflow obstruction, whether the phenomenon is transient, and whether high velocities observed early after surgery predict differences in subsequent valve performance or left ventricular remodeling. METHODS: Sixty-eight consecutive patients who underwent implantation of Freestyle stentless aortic bioprosthesis and survived to hospital discharge underwent early postoperative echocardiography. Peak transvalvular velocity was used to define a 'high-velocity' group, based on mean (+ 1 SD) for the group. Mean pressure gradient, ratio of peak to proximal velocities, and effective orifice area were assessed; change in peak velocity and evidence of left ventricular mass regression were studied at one-year follow up. RESULTS: Of 68 patients, 14 (21%) had 'high velocities' based on early postoperative peak transvalvular velocity >3.0 m/s. There was a higher prevalence of women (64% versus 33%, p = 0.04), and both body surface area (1.79+/-0.17 versus 1.95+/-0.20 m2, p = 0.01) and implanted valve size (22.9+/-2.0 versus 24.9+/-2.1 mm, p = 0.003) were smaller among the 'high-velocity' group. High velocity correlated with other measures of resistance to left ventricular outflow, including higher mean gradient (20.9+/-6.5 versus 8.3 +/-4.2 mmHg, p <0.001) and lower effective orifice area (1.15+/-0.36 versus 1.69+/-0.62 cm2, p <0.001). High early postoperative velocities persisted at one year in eight of 13 (62%) patients. Left ventricular mass regression occurred less often in the 'high-velocity' group (38% versus 77% of patients, p = 0.03) and was present in only one of eight (12%) patients in whom high velocity persisted at one year. CONCLUSION: High early postoperative transvalvular velocity suggests resistance to left ventricular outflow. High velocities are transient in some patients, although persistence of high transvalvular velocity suggests 'prosthesis-patient mismatch' with incomplete relief of left ventricular outflow obstruction.

Aged↗

PubMed2006

Aortic annuloplasty with aortic root reconstruction to prevent patient-prosthesis mismatch.

Part of the ongoing argument concerning patient-prosthesis mismatch (PPM) following aortic valve replacement (AVR) is due to the perception that aortic annulus enlargement procedures increase the risk and technical difficulty of aortic valve surgery. Here, an aortic root reconstruction that involves enlargement of the annulus and tailoring of the aortic root to accommodate larger stented prostheses is presented that has been personally performed in 196 patients with no technique-related surgical deaths or complications, and thus can be carried out without additional risk. This aortic root enlargement aortoplasty and annuloplasty method can be calibrated to all AVRs involving stented manufactured prostheses when these are deemed the prosthesis of choice for the patient with a relatively small annulus and/or aortic root, severe left ventricular hypertrophy, compromised LV function or a very active lifestyle, to achieve predicted EOA values > or = 1.00 cm2/m2.

Animals↗

PubMedDate not supplied

Biocor No- React stentless aortic valve--short-term results.

OBJECTIVES: Short-term results of the bioprosthetic Biocor No-React composite porcine stentless aortic valve (Biocor Industria e Pesquisas LTDA, Belo Horizonte, Brazil) implanted in patients in whom anticoagulation was thought to be contraindicated or expected to be non-compliant. METHODS: Retrospective review of 52 consecutive prospective patients in whom this valve was implanted, between September 1994 and May 1998. RESULTS: Average age was 44 +/- 17 years; 75% of patients were operated on for rheumatic heart disease and combined procedures were done in 40% of cases. Early mortality was 5.8%, and related to pre-operative ejection fraction ( P < 0.03), New York Heart Association (NYHA) class (P < 0.01), and bacterial endocarditis (P < 0.04). On discharge, 84% of survivors were in NYHA class I and 16% in class II. The average postoperative prosthetic valve peak gradient on echocardiography was 19.9 +/- 11 mmHg and was related to pre-operative ejection fraction and smaller valve sizes. Postoperative residual trivial or mild aortic regurgitation was seen in 19 patients (36.6%), resolved on follow-up in 10 cases, and did not correlate with structural deterioration, re-operation, mortality, or widening of the non-coronary sinus. The non-coronary aortic sinus was widened on closure, because of perceived crowding of the adjacent stentless valve commisures, in 52% of cases. This was thought to be related to the use of an oblique as opposed to transverse aortotomy. Patient survival, inclusive of operative deaths, was 88.5%, and event-free survival was 80.0% at 4 years. CONCLUSION: The short-term results of this stentless aortic valve in a young predominantly third-world population group are acceptable, and appear to be superior to the results for mechanical valves in a similar patient group. We would recommend a transverse aortotomy above the sinotubular ridge to be the more appropriate aortotomy incision when using stentless aortic valves.

Adolescent↗

PubMed2005

Three years' experience with the sorin pericarbon stentless prosthesis: mid-term results with three different implantation techniques.

BACKGROUND AND AIM OF THE STUDY: Sorin Pericarbon stentless pericardial valves were implanted using three different surgical techniques, and early and mid-term clinical and hemodynamic results were analyzed according to the method used. METHODS: Between January 2000 and December 2002, 102 Pericarbon stentless valves were implanted in 101 patients (55 females, 46 males; mean age 67.6+/-7.1 years). Among these patients, 63 had isolated aortic valve replacement and 39 underwent a combined procedure. The inflow portion of a matching-size prosthesis was fixed to the aortic annulus either by semi-continuous Prolene suture (n = 48), interrupted simple Ethibond (n = 29) or interrupted Ethibond mattress stitches (n = 25). Valve sizes were not significantly different in the three subgroups. The aortic cross-clamp and cardiopulmonary bypass times were 145+/-31 min and 171+/-39 min, respectively, with interrupted stitches; these times were significantly longer than in the continuous suture group (115+/-27 min and 143+/-45 min) or with interrupted mattress stitches (111+/-28 min and 137+/-34 min). RESULTS: Early mortality was 6.8% (n = 7) for the entire patient group. None of the deaths was valve-related. Postoperatively, all patients were followed up (mean 26.6+/-9.4 months). There were two late deaths (both non-valve-related). One patient developed early endocarditis, and the infected valve was re-replaced with another Pericarbon stentless valve. During the follow up period the mean and peak transvalvular gradient was decreased from 12.8+/-8.5 mmHg to 9.1+/-2.3 mmHg and from 22.5+/-13.9 mmHg to 16.1+/-4.3 mmHg respectively, and left ventricular wall thickness from 15.5+/-2.1 mm to 12.8+/-1.4 mm. Regurgitation was not more than trivial for any of the implanted valves. The implantation technique did not significantly affect the hemodynamic performance of the Pericarbon stentless valve. CONCLUSION: The Sorin Pericarbon stentless pericardial prosthesis showed excellent hemodynamic performance, even if implanted in a matching-size aortic root. The implantation technique used had no significant influence on valve performance.

Adult↗

PubMed1999

The stentless quadrileaflet bovine pericardial mitral valve: echocardiographic assessment.

BACKGROUND AND AIMS OF THE STUDY: Recently, a stentless chordally supported quadrileaflet mitral valve (QMV) bioprosthesis made of selected tanned bovine pericardium treated to minimize calcification, has become available for clinical trial. The aim of this study was to report both the echocardiographic appearance and hemodynamic performance of this valve by means of echocardiography. METHODS: The QMV was implanted in 22 patients (mean age 38 +/- 12 years) requiring isolated mitral valve replacement for valve lesions not deemed suitable for repair. Echocardiography was performed pre-operatively, and at one and three months postoperatively. Transthoracic echocardiography (TTE) was used to monitor mean instantaneous pressure gradient as calculated from the long modified Bernoulli equation, cardiac index (CI), pressure half-time and effective orifice area (EOA) using the Hatle and continuity equations. Regurgitation patterns were sought by color Doppler transesophageal echocardiography in all valves intraoperatively following valve implantation, and by TTE in the outpatient clinic at follow up. RESULTS: After a mean follow up of 8.3 months (range: 1 to 18 months), all patients were well and symptomatically improved. At three months postoperatively, the mean pressure gradient ranged from 1.7 to 2.2 mmHg. The EOA was larger using the Hatle as compared with the continuity equation (2.4 +/- 0.7 cm2 versus 1.8 +/- 0.5 cm2, respectively; p < 0.005). Mitral regurgitation was trivial in 77% and mild in 14% of patients at 3 months after surgery; moderate mitral stenosis was noted in one patient. The CI improved significantly postoperatively (p < 0.005), and left ventricular function was maintained. CONCLUSIONS: The hemodynamic performance of this novel prosthesis is favorable. Although follow up is too short to assess durability, it is hoped that the unique design and improved valve preservation technique of this device will enhance long-term durability.

Adult↗

PubMed1997

Long-term clinical performance of Sorin tilting-disc mechanical prostheses in the mitral and aortic position.

OBJECTIVE: Analyzing the long term performance of sorin tilting-disc mechanical prostheses. EXPERIMENTAL DESIGN: Retrospective patient-oriented study. The total follow-up was 460.2 patient-years. Follow-up data was obtained from the patients themselves or from their relatives. SETTING: Department of Cardiovascular Surgery in a general community hospital. PATIENTS: Seventy four patients undergoing valve replacement with Sorin tilting-disc mechanical prostheses between May, 1982 and July 1991. INTERVENTIONS: Thirty one of those patients underwent isolated mitral valve replacement (MVR) and 43 isolated aortic valve replacement (AVR). MEASURES: The incidence of the different complications is expressed as linearized rates. Actuarial analysis was performed with the Kaplan-Meier method. RESULTS: Linearized rates for MVR and AVR for the different complications (events per 100 patient-years) were, respectively: Late mortality: 4.5 +/- 1.6 and 1.8 +/- 0.8; Thromboembolism: 3.4 +/- 1.4 and 1.1 +/- 0.6; Anticoagulant-related hemorrhage: 2.8 +/- 1.3 and 0.3 +/- 0.3; Prosthetic endocarditis: 1.1 +/- 0.8 and 0.7 +/- 0.5; Non-structural dysfunction: 0.5 +/- 0.5 and 1.1 +/- 0.6; Reoperation: 1.1 +/- 0.8 and 0.3 +/- 0.3. Actuarial probabilities of freedom from the different complications were, respectively, at 13 years follow-up for MVR and 12 years follow-up for AVR, the following: Late mortality: 45.7 +/- 12.4% and 70.3 +/- 7.9%; Thromboembolism: 74.6 +/- 10.8% and 90.7 +/- 5.1%; Anticoagulant-related hemorrhage: 79.4 +/- 11.6% and 97.3 +/- 2.7%; Prosthetic endocarditis: 92.7 +/- 4.9% and 91.2 +/- 6.4%; Non-structural dysfunction: 95.6 +/- 4.3% and 88.2 +/- 6.6%; Reoperation: 83.6 +/- 11.8% and 97.3 +/- 2.7%. All valve-related mortality and morbidity: 42.2 +/- 11.0% and 56.7 +/- 8.6%. There was no instances of prosthetic structural failure. CONCLUSIONS: The Sorin mechanical prosthesis presents a good durability and its performance in the long term is comparable to other tilting-disc devices of the same generation.

Actuarial Analysis↗

PubMed2005

Hemodynamic performance and incidence of patient-prosthesis mismatch of the complete supraannular perimount magna bioprosthesis in the aortic position.

BACKGROUND: Complete supraannular placement and smaller stent design allow the implantation of a Perimount Magna bioprosthesis with a larger inner diameter than that of a standard Perimount. This study compares the hemodynamic performance and the incidence of patient-prosthesis mismatch (PPM) of both prostheses. METHODS: 128 patients underwent aortic valve replacement, receiving either a Magna (n = 57) or a standard (n = 71) prosthesis. Inner aortic annulus diameter was measured intraoperatively by a hegar dilator to match echocardiographically obtained results to the annulus diameter instead of matching them to labelled valve size. RESULTS: The Magna was significantly superior with respect to mean pressure gradient and effective orifice area in patients with an annulus diameter of 22-23 mm. In patients with an annulus diameter < 22 mm or > 23 mm, there was a non-significant trend towards superior hemodynamics in the Magna group. Severe PPM (effective orifice area index < or = 0.65 cm (2)/m (2)) was present in 11.1% (Magna) vs. 42.1% (Standard) of patients with an annulus diameter < 22 mm; in 0% (Magna) vs. 13.8% (Standard) with an annulus diameter of 22-23 mm; no PPM was seen in patients with annulus diameter > 23 mm in both groups. CONCLUSIONS: The Perimount Magna had a significantly reduced incidence of patient-prosthesis mismatch and superior hemodynamics compared to the standard Perimount.

Age Factors↗

PubMed1998

15-year experience with the Carpentier-Edwards pericardial bioprosthesis.

BACKGROUND: The aim of the study was to evaluate the late results of the Carpentier-Edwards pericardial bioprosthesis, which we have been implanting since 1981. METHODS: The 812 patients who underwent heart valve replacement with a Carpentier-Edwards pericardial bioprosthesis between 1981 and 1996 were reviewed. Their clinical, operative, and follow-up data were prospectively recorded in a computerized database. All but 29 patients were available for follow-up (96% completeness), which averaged 58 months and totaled 3,000 patient-years. RESULTS: There were 598 aortic valve replacements (74%), 149 mitral valve replacements (18%), and 65 double valve replacements (8%). The mean age at the time of surgery was 65 years (range, 18 to 88 years), with 24% of the patients under the age of 60 years. Preoperatively, 558 patients (69%) were in New York Heart Association functional class III or IV. Associated surgical procedures included coronary artery bypass grafting in 219 patients (27%) and tricuspid or mitral valve repair in 40 (5%). Previous cardiac operations had been performed in 149 patients, including 134 valve-related procedures. There were 49 early deaths overall (6%): 29 after aortic valve replacement (4.8%), 11 after mitral valve replacement (7.4%), and 9 with double valve replacement (13.8%). There were 120 late deaths for a 10-year actuarial survival rates of 69%+/-3%, 58%+/-7%, and 38%+/-10% for aortic, mitral, and double valve replacement, respectively. The 14-year survival rate for aortic valve replacement patients is 68%+/-3%. The 10-year and 14-year actuarial freedom rates from events after aortic valve replacement are 92% +/-2% and 88%+/-4% for thromboembolism, 96%+/-1% and 92%+/-4 for endocarditis, 91%+/-2 and 72%+/-6% for reoperation, and 93%+/-2% and 80%+/-5% for structural dysfunction of the valve. The 10-year actuarial freedom rates from events after mitral and double valve replacement are 93%+/-3% and 89%+/-4% for thromboembolism, 95%+/-3% and 88%+/-5% for endocarditis, 76%+/-7% and 70%+/-14% for reoperation, and 81%+/-7% and 72%+/-15% for structural dysfunction. No primary tissue failure of the prosthesis in any position was observed in the 357 patients aged 70 years or more at the time of valve implantation. CONCLUSIONS: The Carpentier-Edwards pericardial valve offers excellent clinical results and durability, particularly in the aortic position and for patients older than 70 years of age.

Actuarial Analysis↗

PubMed2005

First report on a human percutaneous transluminal implantation of a self-expanding valve prosthesis for interventional treatment of aortic valve stenosis.

BACKGROUND: Percutaneous aortic valve replacement is a new technology for the treatment of patients with significant aortic valve stenosis. We present the first report on a human implantation of a self-expanding aortic valve prosthesis, which is composed of three bovine pericardial leaflets inserted within a self-expanding nitinol stent. The 73-year-old woman presented with severe symptomatic aortic valve stenosis (mean transvalvular gradient of 45 mmHg; valve area of 0.7 cm2). Surgical valve replacement had been declined for the patient because of comorbidities, including previous bypass surgery. METHOD AND RESULTS: A retrograde approach via the common iliac artery was used for valve deployment. The contralateral femoral vessels were used for a temporary extracorporal circulation, unloading the left ventricle during the actual stent expansion. Clinical, hemodynamic, and echocardiographic outcomes were assessed serially during the procedure. Clinical and echocardiographic follow-up at day 1, 2, and 14 post procedure was performed to evaluate the short-term outcome. The prosthesis was successfully deployed within the native aortic valve, with accurate and stable positioning and with no impairment of the coronary artery or vein graft blood flow. 2D and doppler echo immediately after device deployment showed a significant reduction in transaortic mean pressure gradient (from 45 to 8 mmHg) without evidence of aortic or mitral valve insufficiency. The clinical status has then significantly improved. These results remained unchanged up to the day 14 follow-up. CONCLUSION: This case report demonstrates a successful percutaneous implantation of a self-expanding aortic valve prosthesis with remarkable functional and clinical improvements in the acute and short-term outcome.

Aged↗

PubMed1999

Stuck valve leaflet detected by intraoperative transesophageal echocardiography.

We encountered a rare complication of mitral valve replacement with the CarboMedics prosthesis: a "stuck" leaflet detected by transesophageal echocardiography even though weaning from cardiopulmonary bypass had been uneventful. The patient was immediately managed without significant problems. We emphasize the importance of performing routine intraoperative transesophageal echocardiography in valve replacement as well as in valve repair, from the initial phase of operation.

Echocardiography, Transesophageal↗

PubMed2002

Early postoperative outcome and hemodynamic performance of the sorin pericarbon stentless aortic valve.

BACKGROUND AND AIMS OF THE STUDY: Stentless aortic bioprostheses offer potential advantages in terms of durability and hemodynamic performance. The study aim was to evaluate the early postoperative performance of the Sorin Pericarbon stentless bioprosthesis. METHODS: Between November 1999 and December 2000, 34 patients (12 males, 22 females; mean age 71.2 +/- 4.8 years; range: 48-85 years) underwent aortic valve (AV) replacement with the Sorin Pericarbon stentless bioprosthesis. Twenty-two patients were in NYHA classes III-IV, and 12 were in classes I-II. Twenty-one patients had AV stenosis, nine AV regurgitation, and four mixed pathology. Doppler-echocardiography was performed before surgery, at hospital discharge and at six-month follow up. At this time, 20 patients also underwent echo-Doppler stress testing, with peak transvalvular gradient measured at rest and during exercise. RESULTS: There were two hospital deaths (not valve-related). No significant perioperative complications were recorded. At hospital discharge, the aortic peak gradient was 15.7 +/- 10.6 mmHg; nil or trivial aortic regurgitation was found in three patients. During six months follow up no endocarditis or thromboembolic events were registered. At six months postoperatively, the transvalvular peak gradient showed a small but significant decrease (11.3 +/- 3.5 mmHg at six months, p = 0.036). Mean left ventricular mass index was also decreased significantly (118.4 +/- 28.5 versus 98.4 +/- 17.8 g/m2, p = 0.024). Left ventricular ejection fraction and effective orifice area were not changed significantly during follow up. In patients undergoing exercise testing (mean maximal workload 96 +/- 48 W), the peak aortic gradient was increased (not significantly) at exercise peak (from 14.7 +/- 6.5 to 17.2 +/- 6.7 mmHg, p = 0.086). CONCLUSION: The excellent early postoperative outcome of this experience with the Sorin Pericarbon stentless valve encourages the use of this prosthesis. Long-term follow up and further evaluations are required with regard to hemodynamic performance and durability.

Aged↗

PubMed1998

Hemodynamic performance of four mechanical bileaflet prosthetic valves in the mitral position: an echocardiographic study.

OBJECTIVES: The CarboMedics, Duromedics, Sorin Bicarbon and the St. Jude Medical valves are bileaflet mechanical prostheses of modern but different design. Choosing a valve with the best hemodynamic profile is of clinical importance in patients with small ventricles and a small mitral annulus. METHODS: The hemodynamic performance of these valves in the mitral position was compared in 76 asymptomatic, ambulatory patients with normally functioning prosthesis and left ventricle, using Doppler echocardiography. Of the 76 patients studied, 22 had the CarboMedics, 16 had the Duromedics, 17 had the Sorin Bicarbon and 21 had the St. Jude prosthesis. The patients ages ranged from 18 to 81 years. There were 44 women and 32 men. The time from implantation to echocardiographic study ranged from 1 to 55 months. RESULTS: The echocardiographic study was performed earlier after surgery in the Sorin Bicarbon group. There was no significant difference in women/man ratio, incidence of atrial fibrillation, left ventricular or left atrial diameters between the four groups. The mean prosthesis size was significantly smaller for Sorin Bicarbon and Duromedics valves compared to the CarboMedics and the St. Jude valves (mean+/-SD, 27.2+/-1.3, 27.1+/-1.1 and 30.0+/-1.9 and 30.0+/-2.7 mm, respectively, P<0.001). Despite its smaller size the Sorin Bicarbon valve had significantly larger effective valve area by Doppler compared to the CarboMedics valve (290+/-40 vs 250+/-60 mm2, respectively, P=0.014). The ratio of effective valve area to prosthesis size was significantly larger for the Sorin Bicarbon valve when compared with any other type of prosthesis. CONCLUSIONS: (1) The Sorin Bicarbon bileaflet valve offered the best hemodynamic results that may be explained by the valve's large leaflet opening angle and small thickness of the leaflets. (2) Since the Sorin Bicarbon is the newest bileaflet valve, durability of this valve remains uncertain.

Adolescent↗

PubMed2003

Prosthesis size and long-term survival after aortic valve replacement.

OBJECTIVE: This study was undertaken to quantify the relationship between prosthesis size adjusted for patient size (prosthesis-patient size) and long-term survival after aortic valve replacement. METHODS: Data from nine representative sources on 13,258 aortic valve replacements provided 69,780 patient-years of follow-up (mean 5.3 +/- 4.7 years), with reliable survival estimates to 15 years. Prostheses included 5757 stented porcine xenografts, 3198 stented bovine pericardial xenografts, 3583 mechanical valves, and 720 allografts. Manufacturers' labeled prosthesis size was 19 mm or smaller in 1109 patients. Expressions of prosthesis-patient size assessed were indexed internal prosthesis orifice area (in centimeters squared per square meter of body surface area) and standardized internal prosthesis orifice size (Z, the number of SDs from mean normal native aortic valve size). Multivariable hazard domain analysis with balancing score and risk factor adjustment quantified the association of prosthesis-patient size with survival. RESULTS: Prosthesis-patient size down to at least 1.1 cm(2)/m(2) or -3 Z did not adversely affect intermediate- or long-term survival (P >.2). However, 30-day mortality increased 1% to 2% when indexed orifice area fell below 1.2 cm(2)/m(2) (P =.002) or standardized orifice size fell below -2.5 Z (P =.0003). The increased early risk affected fewer than 1% of patients receiving bioprostheses but about 25% of those receiving mechanical devices. CONCLUSIONS: Aortic prosthesis-patient size down to 1.1 cm(2)/m(2) or -3 Z did not reduce intermediate- or long-term survival after aortic valve replacement. However, patient-prosthesis size under 1.2 cm(2)/m(2) or -2.5 Z was associated with a 1% to 2% increase in 30-day mortality. Prosthesis-patient sizes this small or smaller were rarely implanted in patients receiving bioprostheses.

Aged↗