title: Hemolysis, high-intensity transient signals (HITS) and hemodynamic results after aortic valve replacement with the Medtronic Hall Easy-Fit heart valve prosthesis.
abstract: OBJECTIVE
  Previous studies have shown a correlation between type, orientation and valve size of mechanical heart valve prostheses and the incidence of high-intensity transient signals (HITS). The study aim was to investigate the presence of HITS and hemolysis and the impact of valve size and hemodynamic parameters following aortic valve replacement (AVR) using the new Medtronic Hall Easy-Fit prosthesis.
  
  
  METHODS
  A total of 150 patients (120 males, 30 females; mean age 62 +/- 8 years; range: 32-78 years) underwent AVR (n = 94; 63% concomitant procedures) with the Easy-Fit valve in its optimal orientation. Patients were investigated at between three and 36 months after AVR using transcranial Doppler examination of the right and left middle cerebral artery, and the incidence of HITS was determined. For evaluation of hemolysis, serum lactate dehydrogenase (LDH), hemoglobin and bilirubin were measured. These parameters were related to valve size. Transthoracic echocardiography was performed in all patients.
  
  
  RESULTS
  Among the patients, 112 (75%) showed no or low HITS (34% none, 41% < 30/h), while only 38 (25%) had elevated HITS (range 31-100/h, 14%; range > 100/h, 11%). Statistical analysis showed a linear association between the HITS count and valve size. A positive correlation between valve size and LDH was observed; hemoglobin and bilirubin showed normal values.
  
  
  CONCLUSIONS
  The valve size-dependent increase in LDH after AVR corresponds with the observation that the presence of HITS increases with valve size. In light of these findings, the surgical approach to implant the largest size Easy-Fit valve possible should be discussed, given the excellent hemodynamic results provided by the valve, even in smaller sizes.
authors.affiliation: Department of Cardiothoracic Surgery, Cardiovascular Center Bad Bevensen, Bad Bevensen, Germany.
authors.forename: Roland H
authors.initials: RH
authors.lastname: Warnecke
authors.forename: Joachim
authors.initials: J
authors.lastname: Laas
authors.forename: Hartmut
authors.initials: H
authors.lastname: Hecker
authors.forename: Matthias
authors.initials: M
authors.lastname: Perthel
authors.forename: Aiman
authors.initials: A
authors.lastname: Alken
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D006461:Hemolysis; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011474:Prosthesis Design; D020521:Stroke / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D017585:Ultrasonography, Doppler, Transcranial