title: Intraoperative transesophageal echocardiographic assessment of the effect of protamine on paraprosthetic aortic insufficiency immediately after stentless tissue aortic valve replacement.
abstract: Mild paravalvular aortic insufficiency (AI) is common immediately after stentless bioprosthetic aortic valve replacement. Although resolution of paraprosthetic jets with protamine has been described, the predictability of resolution has not been addressed. Intraoperative transesophageal echocardiography was performed before and after protamine administration among 2 groups. The first group (n = 20) was used to define the prevalence and severity of paravalvular AI after stentless tissue AVR, and define a threshold value for jet size associated with resolution with protamine. A second group (n = 18) was used to prospectively test the determined threshold. Paravalvular AI occurred in 13 of 20 (65%) patients. Using a threshold value of 0.3 cm or less jet width, prospective testing revealed positive and negative predictive values for AI resolution with protamine of 93% (14 of 15) and 100% (3 of 3), respectively. Protamine administration is associated with resolution of small AI jets immediately after implantation of a stentless aortic bioprosthesis, with a jet width 0.3 cm or less strongly predictive of resolution.
authors.affiliation: Department of Anesthesiology, University of Michigan, Ann Arbor 48109, USA. weiclau@umich.edu
authors.forename: Wei C
authors.initials: WC
authors.lastname: Lau
authors.forename: James R
authors.initials: JR
authors.lastname: Carroll
authors.forename: G Michael
authors.initials: GM
authors.lastname: Deeb
authors.forename: Alan R
authors.initials: AR
authors.lastname: Tait
authors.forename: David S
authors.initials: DS
authors.lastname: Bach
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy*; D002315:Cardiopulmonary Bypass; D003131:Combined Modality Therapy; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis; D006494:Heparin Antagonists / Q000008:administration & dosage*; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D011474:Prosthesis Design; D019919:Prosthesis Implantation; D011479:Protamines / Q000008:administration & dosage*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome
chemical_list: D006494:Heparin Antagonists; D011479:Protamines