title: Transvalvular velocities after full aortic root replacement: results from a prospective randomized trial between the homograft and the Medtronic Freestyle bioprosthesis.
abstract: OBJECTIVE
  Unstented bioprostheses offer better hemodynamics after aortic valve replacement. It has been reported recently that subcoronary implantation of the Freestyle valve may result in increased transvalvular velocities. In a prospective randomized trial, transvalvular velocities were investigated after implantation of a homograft or a Medtronic Freestyle bioprosthesis as a full root.
  
  
  METHODS
  A total of 137 patients was randomized to receive either a homograft (group H, n = 64) or a Freestyle (group F, n = 73) root replacement. Echocardiographic investigations were performed at six weeks, six months, and then yearly after surgery. Transvalvular and subvalvular velocities were recorded from each echocardiogram.
  
  
  RESULTS
  At follow up, none of the patients showed high transvalvular or subvalvular velocities (>2 m/s). At six weeks after surgery the transvalvular velocity was 1.5+/-0.3 m/s in group H (n = 51) and 1.7+/-0.3 m/s in group F (n = 56) (p = NS), while subvalvular velocities were 0.9+/-0.3 and 1.0+/-0.3 m/s, respectively (p = NS). These findings remained constant up to the three-year follow up, when transvalvular velocity was 1.6+/-0.4 m/s in group H (n = 10) and 1.6+/-0.2 m/s in group F (n = 15) (p = NS). Subvalvular velocities were 0.9+/-0.1 and 0.9+/-0.1 m/s, respectively (p = NS).
  
  
  CONCLUSIONS
  Full aortic root replacement and reimplantation of the coronary arteries either with the Medtronic Freestyle or the homograft valve produces near-normal transvalvular velocities less than were reported for the Freestyle in the subcoronary implantation.
authors.affiliation: Academic Department of Cardiothoracic Surgery, NHLI, The Royal Brompton & Harefield NHS Trust, London, UK.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Melina
authors.forename: Andrew
authors.initials: A
authors.lastname: Mitchell
authors.forename: Mohamed
authors.initials: M
authors.lastname: Amrani
authors.forename: Asghar
authors.initials: A
authors.lastname: Khaghani
authors.forename: Magdi H
authors.initials: MH
authors.lastname: Yacoub
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis; D001783:Blood Flow Velocity; D015150:Echocardiography, Doppler; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014184:Transplantation, Homologous; D016896:Treatment Outcome