title: Impact of intraoperative post-pump aortic regurgitation with stentless aortic bioprostheses.
abstract: Stentless aortic bioprosthesis performance may be affected by geometric distortion, and intraoperative echocardiography typically is used to assess prosthetic valve function. The impact of minimal or mild post-pump aortic regurgitation has not been previously investigated. Intraoperative post-pump transesophageal echocardiograms and follow-up transthoracic echocardiograms (up to 3 years' postoperatively) were reviewed for 96 patients who underwent implantation of Freestyle (Medtronic) stentless aortic bioprostheses. Minimal or mild aortic regurgitation was present post-pump in 50 of 96 (52%) patients. On early follow-up examination (n = 80), no patient had more than mild aortic regurgitation. Aortic regurgitation had completely resolved in 24 of 39 (62%) patients with post-pump aortic regurgitation, including 15 of 19 (79%) patients with minimal paravalvular regurgitation. The incidence of mild aortic regurgitation at 2 and 3 years did not appear different between patients with and those without post-pump aortic regurgitation. Minimal or mild aortic regurgitation is common on intraoperative post-pump transesophageal echocardiography immediately after implantation of stentless aortic bioprostheses. Resolution is common, especially of small paravalvular jets. Minimal or mild post-pump aortic regurgitation infrequently results in even mild aortic regurgitation on early follow-up evaluation and does not appear to predict clinically significant progression of aortic regurgitation on long-term follow-up evaluation.
authors.affiliation: Department of Medicine, University of Michigan, Ann Arbor 48109-0273, USA.
authors.forename: D S
authors.initials: DS
authors.lastname: Bach
authors.forename: M S
authors.initials: MS
authors.lastname: LeMire
authors.forename: D
authors.initials: D
authors.lastname: Eberhart
authors.forename: W F
authors.initials: WF
authors.lastname: Armstrong
authors.forename: G M
authors.initials: GM
authors.lastname: Deeb
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology*; D001705:Bioprosthesis / Q000009:adverse effects*; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design