The risk of small St. Jude aortic valve prostheses

doi:10.1016/0003-4975(94)91339-0

The Annals of Thoracic Surgery

Volume 57, Issue 5, May 1994, Pages 1114-1119

https://doi.org/10.1016/0003-4975(94)91339-0 Get rights and content

Abstract

We reviewed our 12-year experience with 254 adult patients who had St. Jude valves in the aortic position and used multivariate analysis to examine risk factors possibly affecting long-term morbidity and mortality. Nineteen-millimeter or 21-mm valves were implanted in 115 patients. Poor preoperative congestive heart failure status was associated with persistent congestive heart failure on late foliow-up. Preoperative congestive heart failure and coronary artery disease were the only predictors of overall late death. Late deaths associated with heart failure and late sudden deaths were examined separately. Preoperative degree of heart failure was the only predictor of late death with associated heart failure. The implantation of a 19- or 21-mm valve in patients with a body surface area greater than 1.9 m² somewhat increased the risk of late sudden death. In patients with a body surface area greater than 1.9 m² and with a 19-mm or 21-mm annulus, consideration should be given to using a high-performance St. Jude valve or performing an annulus-enlarging procedure if this can be done with negligible morbidity.

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Cited by (87)

Aortic valve replacement in small patients
2018, Asian Journal of Surgery
Asians are smaller than Europeans and North Americans, but aortic valve replacement (AVR) in small patients has not been examined. We aimed to compare short- and mid-term outcomes of AVR between small and non-small patients.
We retrospectively divided 173 patients who underwent AVR into small (S, n = 95) and non-small (NS, n = 78) groups according to body surface area (≤1.6 in men, ≤1.5 in women) and analyzed differences in baseline characteristics, procedural and post-procedural variables, and survival.
Mean age differed significantly between the S and NS groups (71.9 ± 11.2 vs. 66.2 ± 9.8 years), as did the proportion of women (60.0% vs. 24.4%). Implanted valves (19.6 ± 1.6 mm vs. 20.7 ± 1.7 mm) were significantly smaller and more bioprosthetic valves (57.9% vs. 41.0%) were used in the S group. Effective orifice area index and the rate of moderate and severe patient-prosthesis mismatch were not significantly different. No significant intergroup differences were found in hospitalization duration, 30-day mortality, survival rates, or valve related complications.
Small patients were older and the proportion of women was higher. The implanted aortic valves were smaller and more were biological prostheses. However, mortality rate did not differ and short- and mid-term outcomes were safe and favorable.
Abnormal Tei index predicts poor left ventricular mass regression and survival after AVR in aortic stenosis patients
2009, Journal of Cardiology
A Tei index is known to reflect overall cardiac performance including systolic and diastolic function in a variety of heart disease. We investigated the relationship between preoperative Tei index and postoperative left ventricular (LV) mass regression and survival after aortic valve replacement (AVR) for aortic valve stenosis (AS).
One hundred fifty-four patients with AS were classified into a group with abnormal (Abn) LV function (n = 47, 0.45 ≤ Tei index) and a group with normal (Nor) LV function (n = 107, Tei index < 0.45). The pre- and postoperative echocardiographic variables including LV dimension, LV wall thickness, and LV mass regression as well as 6-year survival were compared between the two groups.
There was a significant difference in both absolute and relative LV mass index (LVMI) regression (P = 0.004 and 0.0007). Multiple linear regression analysis revealed that the preoperative LVMI, Tei index, and follow-up period were independent predictors of LVMI regression after AVR. Thirteen patients died (valve-related death in 5). Although the overall survival rate in the Nor-LV group (92.8%) was significantly better than that in the Abn-LV group (71.6%), there was no significant difference in survival free from valve-related death.
Preoperative Tei index can be one of the significant predictors of LVMI regression and overall survival after AVR.
Influence of Sex on Perioperative Outcomes in Patients Undergoing Valve Replacement for Severe Aortic Stenosis
2009, Revista Espanola de Cardiologia
La influencia pronóstica del sexo de los pacientes sometidos a sustitución valvular aórtica por estenosis severa tiene un papel controvertido, y algunos estudios le atribuyen un papel relevante como marcador de riesgo independiente. El objetivo del estudio es valorar la influencia pronóstica perioperatoria del sexo de los pacientes sometidos a sustitución valvular por estenosis aórtica severa.
Estudio retrospectivo en el que se analizó una cohorte de 577 pacientes sometidos a cirugía de reemplazo valvular aórtico por estenosis aórtica entre 1996 y abril de 2007.
Las mujeres (44%) tenían mayor edad (70,3 ± 7,9 frente a 66,8 ± 9,8 años; p < 0,001), menos superficie corporal (1,68 ± 0,15 frente a 1,83 ± 0,16 m2; p < 0,001), más hipertensión arterial (el 73 frente al 49%; p < 0,001), diabetes mellitus (el 33,5 frente al 24,5%; p = 0,001) e hipertrofia ventricular (el 89,1 frente al 83,1%; p < 0,001), menos enfermedad coronaria (el 19,1 frente al 31,8%; p < 0,001) y menos disfunción ventricular severa (el 7,9 frente al 17,4%; p < 0,001). A pesar de esto, las mujeres tuvieron más infarto agudo de miocardio perioperatorio (el 3,9 frente al 0,9%; p = 0,016), bajo gasto en el postoperatorio (el 30,3 frente al 22,3%; p = 0,016) y mortalidad perioperatoria que los varones (el 13 frente al 7,4%; p = 0,019). El sexo femenino no se mostró, al ajustar por los diferentes factores de confusión, como factor independiente relacionado con la mortalidad (odds ratio = 2,4; intervalo de confianza del 95%, 0,79-7,26; p = 0,119).
La mortalidad perioperatoria de las mujeres con estenosis aórtica severa sometidas a sustitución valvular es alta. Al ajustar por potenciales factores de confusión, especialmente superficie corporal, el sexo femenino no se comporta como factor independiente de mortalidad.
The influence of sex on the prognosis of patients undergoing aortic valve replacement for severe stenosis is unclear. Nevertheless, a number of studies have regarded sex as an independent risk factor. The aim of this study was to evaluate the influence of sex on perioperative outcomes in patients undergoing valve replacement for severe aortic stenosis.
This retrospective study involved 577 consecutive patients who underwent aortic valve replacement surgery for severe aortic stenosis between 1996 and April 2007.
Women (44% of patients) were older than men (70.3±7.9 years vs. 66.8±9.8 years; P<.001), had a smaller body surface area (1.68±0.15 m² vs. 1.83±0.16 m²; P<.001), more often had arterial hypertension (73% vs. 49%; P<.001), diabetes mellitus (33.5% vs. 24.5%; P=.001) and ventricular hypertrophy (89.1% vs. 83.1%; P<.001), and less often had coronary artery disease (19.1% vs. 31.8%; P<.001) and severe ventricular dysfunction (7.9% vs. 17.4%; P<.001). Nevertheless, women more often suffered acute myocardial infarction perioperatively (3.9% vs. 0.9%; P=.016), had a low cardiac output in the postoperative period (30.3% vs. 22.3%; P=.016) and experienced greater perioperative mortality (13% vs. 7.4%; P=.019) than men. However, after adjustment for various confounding factors, female sex was not a significant independent risk factor for mortality (odds ratio = 2.40; 95% confidence interval, 0.79-7.26; P=.119).
Perioperative mortality in women with severe aortic stenosis who underwent valve replacement was high. However, after adjustment for potential confounding factors, particularly body surface area, female sex was not an independent risk factor for mortality.
The 17-mm St. Jude Medical Regent Valve Is a Valid Option for Patients With a Small Aortic Annulus
2009, Annals of Thoracic Surgery
When aortic valve replacement is performed in patients with a small aortic annulus, prosthesis–patient mismatch is of concern. Such prosthesis–patient mismatch may affect postoperative clinical status and survival. We investigated the outcomes of isolated aortic valve replacement performed with a 17-mm mechanical prosthesis in patients with aortic stenosis.
Twenty-three patients with aortic stenosis (mean age, 74.6 ± 6.3 years) underwent isolated aortic valve replacement with a 17-mm St. Jude Medical Regent prosthesis. Mean body surface area was 1.41 ± 0.13 m². Preoperative echocardiography yielded a mean aortic valve area of 0.36 ± 0.10 cm²/m², a mean left ventricular–aortic pressure gradient of 68.4 ± 25.3 mm Hg, and a mean left ventricular mass index of 200 ± 69 g/m².
There was no operative mortality, and there were no valve-related events. Echocardiography at 14.0 ± 10.0 months after aortic valve replacement showed a significant increase in the mean effective orifice area index (0.95 ± 0.24 cm²/m²), decrease in the mean left ventricular–aortic pressure gradient (17.4 ± 8.2 mm Hg), and decrease in the mean left ventricular mass index (124 ± 37 cm²/m²). Prosthesis–patient mismatch (effective orifice area index < 0.85 cm²/m²) was present in 8 patients at discharge. In these patients as well as in those without prosthesis–patient mismatch, the left ventricular mass index decreased remarkably during follow-up.
Aortic valve replacement with a 17-mm Regent prosthesis appears to provide satisfactory clinical and hemodynamic results in patients with a small aortic annulus. Remarkable left ventricular mass regression during follow-up was achieved irrespective of the effective orifice area index at discharge.
Reply
2008, Annals of Thoracic Surgery
Comparison of transprosthetic mean pressure gradients between Medtronic Hall and ATS valves in the aortic position
2005, International Journal of Cardiology
Aim of the study: Several studies have shown the inferior performance of small prostheses in the narrow aortic root. However, modern low-profile mechanical prostheses have improved hemodynamic performance characteristics. By measuring the transprosthetic pressure gradient in vivo, we were able to characterize the hemodynamic features of two prostheses: the ATS Medical (ATS) and the Medtronic Hall (MH) valves. Methods: From October 1994 to April 2002, 113 patients received an aortic valve replacement (AVR) with either an ATS or a MH valve. The transprosthetic pressure gradients, calculated from a simplified Bernoulli equation during immediate postoperative Doppler echocardiographic examination, were compared for differently sized prostheses with respect to body surface area (BSA). Results: The mean pressure gradients and the mean BSAs were: 27.8±14.8 mm Hg and 1.50±0.10 m² in ATS 19 mm (n=7), 20.4±8.5 mm Hg and 1.54±0.11 m² in ATS 21 mm (n=22), 13.0±5.7 mm Hg, 1.70±0.13 m² in ATS 23 mm (n=22), 10.9±3.5 mm Hg and 1.81±0.16 m² in ATS 25 mm (n=19), 9.3±0.6 mm Hg and 1.72±0.17 m² in ATS 27 mm (n=4), 13.5±6.5 mm Hg and 1.54±0.13 m² in MH 20 mm (n=9), 10.9±4.7 mm Hg and 1.64±0.15 m² in MH 22 mm (n=22), 9.3±3.1 mm Hg and 1.72±0.12 m² in MH 24 mm (n=7). Conclusions: With the exception of the ATS 19-mm valve, the variously sized prostheses have acceptable transprosthetic pressure gradient measurements. In addition, even-sized MH valves (20 and 22 mm) with a thinner sewing cuff showed better hemodynamic performances than similarly sized ATS valves.

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^☆: Presented at the Fortieth Annual Meeting of the Southern Thoracic Surgical Association, Panama City Beach, FL, Nov 4–6, 1993.

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Original articleThe risk of small St. Jude aortic valve prostheses☆

Abstract

Ann Thorac Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

Ann Thorac Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

J Am Coll Cardiol

Am J Cardiol

Ann Thorac Surg

Ann Thorac Surg

Original article
The risk of small St. Jude aortic valve prostheses☆