Prospectively randomized evaluation of stented xenograft hemodynamic function in the aortic position.
BACKGROUND
Standard stented aortic xenograft valves have not yet been compared regarding their hemodynamic function using a stratified intraoperative randomization protocol.


RESULTS
100 patients were prospectively included after intraoperative metric sizing of the decalcified aortic annulus. They received Mosaic (M) or Perimount (P) aortic valve replacement. Patient age was 73+/-5 years, 51 were female, and New York Heart Association (NYHA) functional class was 2.8+/-0.5. The 21-mm annulus group consisted of 5 (M)/7 (P) patients, the 23-mm annulus group of 20 (M)/20 (P), the 25-mm annulus group of 18 (M)/19 (P), and the 27-mm annulus group of 4 (M)/7 (P) patients, respectively. Hemodynamic function was evaluated using transthoracic echocardiography before discharge and at follow-up (438+/-352 days). Surgery was uncomplicated in all patients. Labeled valve sizes were 0.93 (M) and 1.05 (P) mm smaller than the annulus diameters (p=NS). In-hospital mortality was 5%, all nonvalve-related. Transvalvular blood flow velocities and transvalvular pressure gradients were significantly lower in the 25 P versus the 25 M group at baseline and in the 23 P and 25 P groups at follow-up. There was a significant regression of left ventricular mass index in all patients at follow-up. However, left ventricular mass regression was more pronounced after P aortic valve replacement.


CONCLUSIONS
Labeled sizes of prosthetic heart valves implanted are smaller than the true aortic annulus. Both standard aortic xenografts compared in this prospectively randomized trial provide a sufficient hemodynamic and functional outcome.
Walther
Thomas
T
Universität Leipzig, Herzzentrum, Klinik für Herzchirurgie, Germany. walt@medizin.uni-leipzig.de
Lehmann
Sven
S
Falk
Volkmar
V
Metz
Sebastian
S
Doll
Nicolas
N
Rastan
Ardawan
A
Viehweg
Marika
M
Richter
Markus
M
Gummert
Jan
J
Mohr
Friedrich W
FW
D000368:Aged; D000818:Animals; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001705:Bioprosthesis / Q000592:standards; D001830:Body Surface Area; D002114:Calcinosis / Q000517:prevention & control; D002417:Cattle; D020099:Coated Materials, Biocompatible; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D003902:Detergents / Q000008:administration & dosage; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000592:standards; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology / Q000601:surgery; D007239:Infections / Q000453:epidemiology; D008297:Male; D009102:Multiple Organ Failure / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D015607:Stents; D020521:Stroke / Q000453:epidemiology; D013501:Surface-Active Agents / Q000008:administration & dosage; D034421:Sus scrofa; D016896:Treatment Outcome
D020099:Coated Materials, Biocompatible; D003902:Detergents; D013501:Surface-Active Agents