SEARCH · PubMed Health

Results for “HEART VALVE PROSTHESIS”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 631 records · Page 35Linked to original sources

PubMed2002

Reoperation for a patient 25 years after a Starr-Edwards ball mitral valve was installed.

A 45-year-old female suffered from increasing dyspnea during exercise and edema of lower extremities from January 2000. She had undergone mitral valve replacement with Starr-Edwards ball prosthesis (model 6320) due to mitral valve regurgitation 25 years ago. The cardiac catheterization and echocardiography documented mitral, aortic and tricuspid valves regurgitation grade III. Left ventricular ejection fraction rate was 49% and the pressures of CVP, RA, RV and PA were also increased. Laboratory examination showed slight hemolytic anemia. Double valve replacement (ATS valve) and tricuspid annuloplasty were carried out in April 2000. Strut cloth wear was confirmed at operation. Her postoperative course was uneventful. We hereby review the published paper of all cases with an implanted Starr-Edwards ball valve who required redo valve replacement with over 15 years follow-up. We consider that cloth injury is the main cause for reoperation and it usually associated with hemolytic anemia; cloth wear not only involves the aortic position but also frequently involves the mitral position for over 15 years follow-up patients and can be corrected by reoperation. Cloth wear should be concerned for those surviving patients who have received the Starr-Edwards ball valve during long-term follow-up.

Anemia, Hemolytic↗

PubMed2005

Early and late results of the surgical correction of cardiac prosthetic paravalvular leaks.

BACKGROUND AND AIM OF THE STUDY: Although the incidence of paravalular leaks, the most common cause of non-structural dysfunction after valve replacement, is well defined, the results of their surgical correction are not. Given the growing enthusiasm for interventional catheter-based correction of paravalvular leaks, a current surgical baseline against which to compare these results is important. METHODS: All patients who had surgical correction of an aortic or mitral paravalvular leak unrelated to acute bacterial endocarditis between 1986 and 2001 were identified from a computerized registry. Hospital records were reviewed, and follow up data obtained. RESULTS: A total of 136 consecutive patients (73 males, 63 females; mean age 64 years) underwent surgical correction of a paravalvular leak. Of the valves, 44 (32%) were aortic and 92 (68%) mitral. More than one previous cardiac operation had been performed in 68 patients (50%). In 107 patients (79%; 32 aortic (73%), 75 mitral (82%)), the leak was the primary indication for reoperation, while for 29 patients (21%; 12 aortic (27%), 17 mitral (18%)) the correction was secondary to another cardiac procedure. In 65 patients (48%; 12 aortic (27%), 53 (58%) mitral)) the leak was repaired primarily, while in 71 patients (52%; 32 aortic (73%), 39 (42%) mitral)) the prosthesis was replaced. Operative mortality was 6.6% (n = 9). There were no significant multivariable predictors of hospital death. Perioperative stroke occurred in seven cases (5.1%), and hospital stay was >14 days in 40 patients (29%). The 10-year Kaplan-Meier survival was 30 (CI 20-39)%. Ten-year actual versus actuarial freedom from repeat paravalvular leak was 84 (CI 68-92)% versus 63 (CI 49-76)%. CONCLUSION: Surgical correction of cardiac paravalvular leaks can be performed with acceptable mortality and morbidity. Patients with surgically corrected paravalvular leaks have a limited life expectancy, but reasonable freedom from recurrent paravalvular leak.

Aortic Valve↗

PubMed2000

[Stuck prosthetic aortic valve resulting in intermittent chest pain and ST depression: a case report].

Dysfunction of any mechanical prosthesis due to thrombus or pannus requires prompt definite diagnosis and therapy. A 55-year-old woman had received a prosthetic valve for aortic regurgitation 3 years before and was admitted for intermittent chest pain. Electrocardiography showed remarkable ST depression in broad leads during chest pain. Coronary angiography and cinefluoroscopy performed for definite diagnosis at the time of the third attack revealed no stenotic lesion in the coronary artery, but an artificial valve stuck in the completely open position. The diagnosis was acute aortic regurgitation caused by the stuck open valve. Urgent reoperation was performed. Abnormal proliferation of pannus trapping the artificial aortic valve was found at the left ventricular-side orifice of the prosthetic valve. Intermittent valvular sticking can cause acute aortic regurgitation and caused the symptomatic intermittent chest pain and ST depression in this patient.

Aortic Valve↗

PubMed2006

Predicting the performance of mitral prostheses implanted in children under 5 years of age.

BACKGROUND: Mitral valve replacement (MVR) is occasionally indicated in infants and young children, necessitating the use of small prostheses. The performance of these small valves during somatic growth of the patient can lead to patient-prosthesis mismatch. This study examines performance of these valves over time to establish predicted performance and timing of replacement. METHODS: Records were reviewed of all patients under 5 years of who underwent small mechanical MVR between 1988 and 2004 (n=24). Valve sizes were between 17 and 23 mm (Bileaflet 91.6%, Tilting Disc 8.3%) with a median size of 19 mm. Mean age of patients was 1.4+/-1.3 years with a mean weight of 7.8+/-3.4 kg. RESULTS: Early deaths (n=5, 20.8%) were excluded. There were two late deaths and five patients required redo-MVR: four for outgrowth and one for acute thrombosis at 3 months. Age at redo for outgrowth was 8.6+/-6.6 years with mean body weight of 22.5+/-17.5 kg. Mean time between original operation and redo was 8.6+/-6.1 years in these four patients. Follow-up was a median of 7.5 years (range 0.1-15.7 years). Overall freedom from death or valve replacement was 82.6+/-9.1% at 5 years and 75.7+/-10.6% at 10 years. The performance of the original prostheses showed a peak blood flow velocity across the valves of 1.5+/-0.6 m/s at 5 years and 2.2+/-0.5 m/s at 10 years. Seventy-five percent of the survivors still have their original valve at a mean of 8.1+/-4.4 years postoperative with New York Heart Association status of I or II. Actuarial curves suggest that gradients across the valves reach a peak of >10 mmHg at a mean between 6.5 and 7 years postoperative. CONCLUSION: MVR in children under 5 years carries a high mortality. Nevertheless, small mechanical MVR perform remarkably well in young children with durable haemodynamics despite growth of the patients well beyond more than double the initial bodyweight. Valves can be expected to last over 8 years before requiring re-replacement.

Age Factors↗

PubMed1999

Replacement of the morphologically tricuspid valve in children with discordant atrioventricular connections.

BACKGROUND AND AIM OF THE STUDY: Our clinical experience was reviewed to determine the efficacy of replacement of the atrioventricular (AV) valve for the systemic circulation in children with discordant AV connections undergoing functional biventricular repair. METHODS: Nine children underwent replacement of the morphologically tricuspid valve at the age of 10 months to 15 years. Ventriculoarterial connections were discordant in five children, and double outlet right ventricle with pulmonary stenosis or atresia in four. In all children the prosthesis chosen was a mechanical valve; valve sizes ranged from 19 mm to 31 mm. RESULTS: One patient died of ventricular failure immediately after surgery. Two patients underwent reoperation for re-replacement at eight and 68 months after the initial replacement because of non-structural dysfunction. Complete AV block occurred after intracardiac maneuvers in the non-survivor. Transient AV dissociation was noted in another patient. General conditions improved greatly after surgery in all survivors. In the morphologically right ventricle placed for the systemic circulation the end-diastolic volume fell from 327 +/- 182% (range: 109-621%) to 169 +/- 97% (range: 85-352%) of the anticipated normal value (p = 0.03), while pressure fell from 13 +/- 4 (range: 7-19) mmHg to 8 +/- 3 (range: 2-12) mmHg (p = 0.005). The ejection fraction was only marginally reduced (47 +/- 13% (range: 26-62%) preoperatively versus 34 +/- 11% (range: 20-54%) postoperatively; p = 0.13). CONCLUSIONS: In children with discordant atrioventricular connections and severe regurgitation across the morphologically tricuspid valve, the valve can be efficiently replaced for the systemic circulation.

Adolescent↗

PubMed2005

Carpentier-Edwards pericardial aortic valve in middle-aged patients: comparison with the St. Jude Medical valve.

OBJECTIVE: The objective of the present study was to compare long-term results of single aortic valve replacement (AVR) with mechanical (St. Jude Medical valves: standard) and biologic (the Carpentier-Edwards pericardial) prostheses. METHOD: Between 1995 and 2002, 95 patients who underwent single AVR with mechanical (n= 46) or biologic (n= 49) prostheses were enrolled in this study. The mean age at the operation was 54.0 +/- 9.6 years (range: 20 to 69 years) with the mechanical and 68.8 +/- 7.1 years (range: 44 to 85 years) with the biologic prosthesis. RESULTS: The 9-year actuarial survival rate, which was calculated by taking perioperative mortality into account, was 90.3 +/- 4.6% for patients with mechanical valves and 87.6 +/- 4.8% for patients with bioprostheses, with no difference between the two groups (p=0.342). The 9-year freedom rate from thromboembolism, reoperation, endocarditis was 94.8 +/- 3.6%, 100% and 97.8 +/- 2.2% for patients with mechanical valves and 98.0 +/- 2.0%, 97.5 +/- 3.4% and 95.0 +/- 3.4% for those with bioprostheses, respectively. After 9 years, freedom from cardiac death averaged 97.8% in the group with mechanical valves compared with 95.3% in those with bioprostheses (p=0.541). CONCLUSION: We conclude that the mid-term durability of the Carpentier-Edwards pericardial valve in the aortic position for the elderly is excellent. Nevertheless, the risk of tissue valve reoperation progressively increases with time, and a longer follow-up may be necessary to provide its value compared with the mechanical valves in a country like Japan with a high life expectancy.

Adult↗

PubMedDate not supplied

Determinants of incomplete left ventricular mass regression following aortic valve replacement for aortic stenosis.

OBJECTIVE: Incomplete regression of left ventricular hypertrophy (Abn-LVMI) following AVR for aortic stenosis (AS) may decrease long-term survival. In this prospective study, we identified the predictors of Abn-LVMI. METHODS: Between 1990 and 2000, 529 patients undergoing AVR for AS had clinical and hemodynamic data collected prospectively. Preoperative and annual postoperative transthoracic echos were employed to assess left ventricular mass index (LVMI) and hemodynamics. Abn-LVMI was defined as the 75th percentile of the lowest postoperative LVMI (>128 mg/m2, n = 133). All other patients were included in the normal regression group (N-LVMI). Univariate and multivariable logistic regression analyses were used to determine the predictors of Abn-LVMI. RESULTS: Preoperative hypertension, diabetes, coronary disease, valve size, mean postoperative gradients, effective orifice area, and patient-prosthesis mismatch (PPM, indexed EOA <0.60 cm2/m2) did not predict Abn-LVMI. By logistic regression the most important positive predictor of Abn-LVMI was the extent of preoperative LVMI, with an odds ratio of 37.5 (p < 0.0001). Survival (93.4 +/- 1.8% vs 94.8 +/- 2.3%, p = 0.90) and freedom from NYHA III-IV (75.0 +/- 3.7% vs 76.6 +/- 5.3%, p = 0.60) were similar for both groups at 7 years. CONCLUSIONS: Measures of valve hemodynamics were not important predictors of incomplete regression of hypertrophy. The extent of preoperative hypertrophy was the most important predictor, suggesting that earlier surgical intervention may reduce the extent of hypertrophy postoperatively. Furthermore, the significance of LV hypertrophy to long-term survival must be reassessed, in the absence of scientific evidence.

Aged↗

PubMed2005

Surgical treatment in a patient with multiple systemic complications of prosthetic aortic valve endocarditis: case report.

A 31-year-old woman who had undergone aortic and mitral valve replacement 1 year previously was hospitalized with suspected prosthetic valve endocarditis. Freestyle stentless aortic xenograft was successfully replaced using freestanding total aortic root replacement techniques at the left ventricular outflow tract position, and aorta-to-right coronary artery bypass was also applied with a saphenous vein graft. The patient developed multiple systemic problems during the preoperative and postoperative periods and was successfully treated with intensive interventions. She was discharged at the postoperative fourth month, and the following 28 months were uneventful.

Adult↗

PubMed2006

Commissural dehiscence: a rare and peculiar cause of porcine valve structural deterioration.

OBJECTIVE: Calcification is the main cause of structural valve deterioration; however, other causes of failure have been identified, and among them, dehiscence of a commissure from the stent has been reported in several models of porcine valves. The aim of this study was to analyze the rate and mode of occurrence of this complication in first- and second-generation porcine bioprosthetic explants. METHODS: Among 586 porcine xenografts explanted and analyzed at the Institute of Pathological Anatomy of the University of Padua, 17 (2.9%) have been replaced for incompetence because of commissural dehiscence. All these explants were in the mitral position, with the exception of a Carpentier-Edwards supra-annular aortic valve prosthesis. RESULTS: Dehiscence was observed in 9 (1.9%) of 455 Hancock standard explants, in 1 (3.2%) of 31 Hancock II, in 3 (8.6%, 2 standard and 1 supra-annular) of 35 Carpentier-Edwards, in 1 (2.4%) of 42 Bioimplants, and in 3 (50%) of 6 Xenotech after a mean time function of 157 +/- 50, 156, 96 +/- 29, 143, and 130 +/- 8 months, respectively. Dehiscence was the sole cause of incompetence in 6 cases. An impending commissural dehiscence caused by blood creeping was observed in one case. This might be an explanation for the dehiscence other than excessive trimming of the aortic wall. CONCLUSIONS: Commissural dehiscence is an uncommon and peculiar mode of failure of porcine valves implanted in the mitral position and was observed earlier and more frequently with Carpentier-Edwards porcine explants (P < .05). We speculate that pericardial strip protection of the suture between the Dacron fabric and porcine aortic wall, as used in the Biocor porcine valve, might prevent this complication.

Aged↗

PubMed2006

[Patient-prosthesis mismatch after aortic valve replacement; tolerable lower limit of indexed effective orifice area].

This study was aimed at determining the tolerable lower limit of the indexed effective orifice area (EOAI) to prevent patient-prosthesis mismatch (PPM). Echocardiography was performed in 87 consecutive patients who underwent aortic valve replacement (AVR). EOAI was estimated for each type and size of prosthesis and used to define PPM as moderate if >0.65 cm2/ m2 and < or = 0.85 cm2/m2, and severe if < or = 0.65 cm/m2. Aortic valve pressure gradients, left ventricular dimensions, and outcome (in-hospital and 1-year) were analyzed in the presence or absence of abnormal gradients (> or = 40 mmHg) to assess the influence of a small valve (19 mm or less labeled size). Severe PPM was found in 23% of all patients, and 50% of the severe PPM patients had an abnormal gradient. There was 1 death and 1 brain damage from ventricular fibrillation because of severe PPM in the abnormal gradient group with a small valve. In PPM patients with a small valve, EOAI (0.61 +/- 0.04 vs 0.69 +/- 0.07) and preoperative interventricular septal thickness (IVST : 16.4 +/- 2.6 mm vs 13.5 +/- 1.5 mm) were significantly different between abnormal and normal gradient groups. An EOAI > or = 0.69 appeared to be tolerable in patients with a lower level of hypertrophy (IVST < 16 mm).

Aged↗

PubMed1998

The CarboMedics valve: experience with 1,049 implants.

BACKGROUND: The lack of valve rotatability, the structural deterioration, and the rate of valve-related complications with the standard mechanical bileaflet prosthesis led to the development of a new second-generation bileaflet valve in 1986. METHODS: Between January 1989 and March 1994, 1,049 CarboMedics valves were implanted in 859 patients. The rotatability was used in 109 mitral prostheses (21.5%) and in 61 aortic prostheses (11.6%). Follow-up was 97.1% complete, with 3,049 patient-years. RESULTS: The hospital mortality was 6.9% for the mitral group, 3.4% for the aortic group, and 10.7% for the double-valve group (p < 0.005). The actuarial survival curve at 5 years was 77.3% +/- 3.6%, 90.1% +/- 2.5%, and 79.2% +/- 3.7% (p = 0.0003), freedom from thromboembolism was 89.1% +/- 3.6%, 87.1% +/- 3.8%, and 68.8% +/- 8.2%, freedom from reoperation was 95.9% +/- 1.4%, 98.9% +/- 0.6%, and 94.9% +/- 2.4%, and freedom from valve-related complications was 68.8% +/- 4.1%, 79.5% +/- 3.5%, and 55.3% +/- 5.9% after mitral, aortic, and mitral and aortic valve replacement, respectively. There were five episodes of valve thrombosis, but no structural deterioration occurred. CONCLUSIONS: The clinical performance of the CarboMedics valve is quite satisfactory, with a low incidence of valve-related mortality and morbidity. The rotatability feature was useful when the native valve was preserved or for repeat valve replacement.

Adolescent↗

PubMed2003

Intact Medtronic and Carpentier Edwards S.A.V.: clinical and hemodynamic outcomes over 13 years.

UNLABELLED: We report on 215 consecutive patients with isolated aortic replacement of which 91 received an Intact Medtronic (IM) prosthesis and 124 a Carpentier Edwards SAV. (CE). More than 50% of patients were over 70 years old. Follow-up was complete for 95% of patients. Mean follow-up was 6.04 years (16 days-13 years); a total of 1244 patient-years (IM 6.61years, 590 patient-years, CE 5.95 years, 670 patient-years). RESULTS: the following results are expressed for IM and CE groups respectively. Early mortality: 3.3% and 8.13%. Late mortality: 23 and 27 patients. Survival at 13 years: 53.31+/-7.63% and 47.47+/-7.9%. Major thromboembolism: 0.34% and 0.30% per patient-year. SVD: 0.16% and 0.14% per patient-year. Endocarditis: 0.33% and 0.29%. Re-operation: 0.5% and 0.44%. Over 95% of patients are re-operation free at 13 years. CONCLUSION: Intact and Carpentier valves had similar durability and clinical/hemodynamic results. Both have proved excellent aortic valve substitutes in elderly patients.

Adult↗

PubMed2006

[Advantage of supra-annular patch enlargement in aortic stenosis with a small aortic annulus].

BACKGROUND: We routinely perform supra-annular patch enlargement as a strategy to avoid patient-prosthesis mismatch (PPM) in patients with a small aortic annulus who are undergoing aortic valve replacement (AVR). METHOD: We performed a retrospective review of 128 consecutive single AVR patients from 1999 to 2005. Of these, 34 patients underwent supra-annular patch enlargement. The enlargement was selectively performed in patients at risk of PPM. This involved patch extension of the aortotomy just above the annulus of noncoronary sinus, and valve implantation with stitches placed directly on the patch. Along with this procedure, AVR with a valve size appropriate to body surface area (BSA) was performed. RESULT: Of these patients, 74% were female and the mean BSA was less than 1.50 m2. The enlargement required an average of 33 minutes of additional aortic clamp time. The 30-day mortality was 0%. A favorable hemodynamic outcome was achieved. CONCLUSION: Our results show that supra-annular patch enlargement can be performed with minimal added risk, relative to standard root enlargement and a satisfactory hemodynamic status can be achieved by employing this procedure.

Aged↗

PubMed1999

Valve replacement for aortic stenosis in patients with poor left ventricular function: comparison of early changes with stented and stentless valves.

BACKGROUND: Long-standing aortic stenosis causes significant left ventricular (LV) dysfunction, which may progress irreversibly. In many cases, LV function can be salvaged by aortic valve surgery, although debate exists regarding the best valve prosthesis to use. METHODS AND RESULTS: We studied 33 patients retrospectively who had significant aortic stenosis and impaired LV systolic function, as assessed by transthoracic Doppler echocardiography. Patients were assessed preoperatively and before discharge from the hospital. A total of 20 patients received a stentless (homograft or Toronto) valve, and 13, a stented valve. No patient had significant aortic regurgitation or other valvular disease. Preoperatively, fractional shortening was 18.8+/-5.5% in the stentless group and 18.6+/-3.8% in the stented group. Postoperatively, it was 25.6+/-6.9% (P<0.001 compared with baseline) and 17.0+/-2.8%, respectively (P<0.001 compared with stentless group). Fractional shortening improved because of a reduction in LV end-systolic and end-diastolic dimensions in the stentless group. Systolic long axis function at the LV free wall also recovered, with an increase in systolic excursion and both peak shortening and lengthening rates. No change was noted in mitral valve Doppler patterns. CONCLUSIONS: Patients who received a stentless valve demonstrated a significantly greater early improvement in LV systolic function compared with those who received a stented valve.

Aged↗

PubMed2004

The effective orifice area/patient aortic annulus area ratio: a better way to compare different bioprostheses? A prospective randomized comparison of the Mosaic and Perimount bioprostheses in the aortic position.

BACKGROUND AND AIM OF THE STUDY: The aim of this prospective, randomized study was to compare the hemodynamic performance of the Medtronic Mosaic and Edwards Perimount bioprostheses in the aortic position, and to evaluate prosthesis-specific differences in valve sizing and valve-size labeling. METHODS: Between August 2000 and September 2002, 139 patients underwent isolated aortic valve replacement (AVR) with the Mosaic (n = 67) or Perimount (n = 72) bioprosthesis. Intraoperatively, the internal aortic annulus diameter was measured by insertion of a gauge (Hegar dilator), while prosthesis size was determined by using the original sizers. Transthoracic echocardiography was performed to determine hemodynamic and dimensional data. As the aim of AVR is to achieve a maximal effective orifice area (EOA) within a given aortic annulus, the ratio of EOA to patient aortic annulus area was calculated, the latter being based on annulus diameter measured intraoperatively. RESULTS: Operative mortality was 2.2% (Mosaic 3.0%; Perimount 1.4%; p = NS). Upsizing (using a prosthesis larger in labeled valve size than the patient's measured internal aortic annulus diameter) was possible in 28.4% of Mosaic patients and 8.3% of Perimount patients. The postoperative mean systolic pressure gradient ranged from 10.5 to 22.2 mmHg in the Mosaic group, and from 9.4 to 12.6 mmHg in the Perimount group; it was significantly lower for 21 and 23 Perimount valves than for 21 and 23 Mosaic valves. The EOA ranged from 0.78 to 2.37 cm2 in Mosaic patients, and from 0.95 to 2.12 cm2 in Perimount patients. When indexing EOA by calculating the ratio of EOA to patient aortic annulus area to adjust for variables such as patient anatomy and valve dimensions, there was no significant difference between the two bioprostheses. CONCLUSION: Comparisons of absolute EOA values grouped by the manufacturers' valve sizes are misleading because of specific differences in geometric dimensions. The EOA:patient aortic annulus area ratio provides a new hemodynamic index which may facilitate objective comparisons between different valve types.

Aged↗

PubMed1999

The extended Biocor stentless aortic bioprosthesis. Early clinical experience.

In the "Extended" Biocor stentless aortic bioprosthesis, supra- and subvalvular extensions to a bovine pericardium ring carry three porcine leaflets. The extensions cover the "non-coronary" sinus of the prosthesis and allow optional enlargement of the aortic root down towards the mitral valve as well as upwards into the aortotomy. Seventy-one patients with this stentless valve (62 with predominantly aortic stenosis, 28 with concomitant CABG) are being prospectively studied. This paper reports follow-up one year after insertion. The upper and lower pericardial extensions were used in 61 and 11 patients, respectively. The average prosthetic valve size was 23.2 +/- 1.6 mm. Early mortality was 7% (5/71); late mortality (4/66, 5%/patient year) was not valve-related. Symptoms of thromboembolism (new neurological defects) occurred in four patients. There was no valve failure or late endocarditis. One year postoperatively the transvalvular mean pressure difference for all valves was 7.9 (3.1-18.4) mmHg. None of the patients had haemodynamically significant aortic regurgitation at follow-up; nine had trivial regurgitation. The "Extended" Biocor stentless bioprosthesis thus has a favourable haemodynamic profile and can be advantageous in elderly patients with narrow aortic roots, and often with thin and/or calcified aortic walls.

Aged↗

PubMed1998

Long-term results with the Sorin Pericarbon valve in the aortic position: a multicenter study.

BACKGROUND AND AIM OF THE STUDY: A multicenter study was designed to evaluate the Pericarbon pericardial bioprosthesis for up 10 years after implantation in the aortic position. METHODS: Between January 1986 and November 1996, 321 patients (mean age 75.8 +/- 7.3 years) received 325 Pericarbon pericardial valves in the aortic position. Four patients underwent redo surgery and each received a second Pericarbon prosthesis. Associated cardiac procedures in 80 patients were mainly coronary bypass (n = 66). Follow up extended up to 10 years (cumulative follow up of 931.0 patient-years; mean follow up 3.1 +/- 2.2 years). RESULTS: There were 19 late deaths, with seven valve-related. Twelve patients suffered an embolic complication (transient cerebral attack in four, peripheral in six and induction of a myocardial infarction in two). Of these complications, five occurred within 30 days of surgery and seven beyond the first year. Ten patients were reoperated on, six for primary tissue failure, two for prosthetic endocarditis and two for paraprosthetic leak. Primary failure was due in all cases to leaflet mineralization. No primary tear of the leaflet was reported. Actuarial freedom after 10 years from primary tissue failure was 83.9 +/- 7.4% and from major embolic events 97.6 +/- 1.0%. Freedom from valve-related mortality at 10 years was 92.1 +/- 4.9%. CONCLUSIONS: These results indicate that, over a period of up to 10 years, the Pericarbon pericardial bioprosthesis compares favorably with other replacement valves.

Aged↗

PubMed1997

Hemodynamic performance evaluation of small aortic ATS Medical valves by Doppler echocardiography.

BACKGROUND AND AIMS OF THE STUDY: The ATS Medical valve was first implanted in 1992. The purpose of this report was to establish the normal range of each hemodynamic parameter, measured by Doppler echocardiography, in small aortic ATS Medical valves. METHODS: Twenty-five patients with small aortic ATS Medical valves, operated on over six months, and with no cardiac or prosthetic dysfunction, in sinus rhythm, on adequate oral anticoagulant therapy, and no other valve prosthesis or significant valvulopathy, were reviewed on the basis of physical examination and transthoracic Doppler echocardiography. RESULTS: For the aortic 21 Standard ATS Medical valve (n = 10), the following values were registered: peak velocity 2.40 +/- 0.39 m/s; peak gradient 23.7 +/- 6.8 mmHg; mean gradient 12.6 +/- 4.0 mmHg; valve effective orifice area 1.73 +/- 0.41 cm2; Doppler velocity index 0.47 +/- 0.11. For the aortic 19 Standard ATS Medical valve (n = 9), these values were: 3.41 +/- 0.43 m/s; 47.0 +/- 12.6 mmHg; 26.2 +/- 7.9 mmHg; 0.96 +/- 0.18 cm2; and 0.32 +/- 0.06, respectively. For the aortic 16 AP ATS Medical valve (n = 6), these parameters were 3.44 +/- 0.47 m/s; 47.7 +/- 12.0 mmHg; 27.0 +/- 7.3 mmHg; 0.61 +/- 0.09 cm2; and 0.30 +/- 0.04, respectively. CONCLUSIONS: Using Doppler echocardiography, the present study establishes the normal range of parameters which define the hemodynamic performance of the aortic 21 and 19 Standard and 16 AP ATS Medical valves, and demonstrates satisfactory hemodynamic performance of the aortic 21 and 19 Standard ATS Medical valves. It should be noted that the valve effective orifice area determined for the aortic 16 AP ATS Medical valve was smaller than that for the aortic 19 Standard ATS Medical valve, though these two prostheses have the same physical orifice area.

Adult↗