Hemodynamic evaluation of 19-mm Carpentier-Edwards pericardial bioprosthesis in aortic position.
BACKGROUND
The aortic Carpentier-Edwards pericardial bioprosthesis offers good long-term clinical outcomes with a low rate of structural deterioration. However, little in vivo hemodynamic data is available for this bioprosthesis.


METHODS
To determine the hemodynamic performance of the 19-mm Carpentier-Edwards pericardial valve, both cardiac catheterization and dobutamine stress echocardiography were electively performed in 10 patients. The mean age at the study was 71.6 +/- 4.4 years and the mean body surface area was 1.39 +/- 0.11 m2. The peak-to-peak gradient, instantaneous peak gradient, mean gradient, and valve orifice area were measured by standard cardiac catheterization. The Doppler-derived gradients and valve orifice area were also measured both at rest and during dobutamine infusion.


RESULTS
The average peak-to-peak gradient, instantaneous peak gradient, mean gradient, and valve orifice area measured by catheterization were 13.0 +/- 5.4 mmHg, 28.5 +/- 7.7 mmHg, 12.0 +/- 4.9 mmHg, and 1.55 +/- 0.45 cm2, respectively. The peak and mean Doppler gradients, and valve orifice area by resting echocardiography were 27.7 +/- 9.5 mmHg, 12.3 +/- 4.8 mmHg, and 1.39 +/- 0.26 cm2, respectively. At a dosage of 10 microg/kg/min of dobutamine, the mean Doppler gradient rose mildly to 22.2 +/- 4.8 mmHg, while the cardiac output increased from 4.49 +/- 0.44 to 6.64 +/- 0.87 L/min. The valve orifice area during the 10 microg/kg/min dobutamine infusion (1.55 +/- 0.25 cm2) was significantly larger than its value at rest (p < 0.05).


CONCLUSIONS
With acceptable hemodynamic performance, use of the aortic 19-mm Carpentier-Edwards pericardial valve is a reliable option for elderly patients with a small annulus.
Department of Cardiovascular Surgery, Saitama Cardiovascular and Respiratory Center, Japan. idabagus@yj8.so-net.ne.jp
H
H
Takakura
T
T
Sasaki
K
K
Hashimoto
T
T
Hachiya
K
K
Onoguchi
M
M
Oshiumi
S
S
Takeuchi
D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology*