title: The 17-mm St. Jude Medical Regent valve is a valid option for patients with a small aortic annulus.
abstract: BACKGROUND
  When aortic valve replacement is performed in patients with a small aortic annulus, prosthesis-patient mismatch is of concern. Such prosthesis-patient mismatch may affect postoperative clinical status and survival. We investigated the outcomes of isolated aortic valve replacement performed with a 17-mm mechanical prosthesis in patients with aortic stenosis.
  
  
  METHODS
  Twenty-three patients with aortic stenosis (mean age, 74.6 +/- 6.3 years) underwent isolated aortic valve replacement with a 17-mm St. Jude Medical Regent prosthesis. Mean body surface area was 1.41 +/- 0.13 m(2). Preoperative echocardiography yielded a mean aortic valve area of 0.36 +/- 0.10 cm(2)/m(2), a mean left ventricular-aortic pressure gradient of 68.4 +/- 25.3 mm Hg, and a mean left ventricular mass index of 200 +/- 69 g/m(2).
  
  
  RESULTS
  There was no operative mortality, and there were no valve-related events. Echocardiography at 14.0 +/- 10.0 months after aortic valve replacement showed a significant increase in the mean effective orifice area index (0.95 +/- 0.24 cm(2)/m(2)), decrease in the mean left ventricular-aortic pressure gradient (17.4 +/- 8.2 mm Hg), and decrease in the mean left ventricular mass index (124 +/- 37 cm(2)/m(2)). Prosthesis-patient mismatch (effective orifice area index < 0.85 cm(2)/m(2)) was present in 8 patients at discharge. In these patients as well as in those without prosthesis-patient mismatch, the left ventricular mass index decreased remarkably during follow-up.
  
  
  CONCLUSIONS
  Aortic valve replacement with a 17-mm Regent prosthesis appears to provide satisfactory clinical and hemodynamic results in patients with a small aortic annulus. Remarkable left ventricular mass regression during follow-up was achieved irrespective of the effective orifice area index at discharge.
authors.affiliation: Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan. homareokamura@hotmail.co.jp
authors.forename: Homare
authors.initials: H
authors.lastname: Okamura
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yamaguchi
authors.forename: Masashi
authors.initials: M
authors.lastname: Tanaka
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Naito
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Kimura
authors.forename: Chieri
authors.initials: C
authors.lastname: Kimura
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Kobinata
authors.forename: Takashi
authors.initials: T
authors.lastname: Ino
authors.forename: Hideo
authors.initials: H
authors.lastname: Adachi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001705:Bioprosthesis; D015331:Cohort Studies; D015150:Echocardiography, Doppler; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000503:physiopathology; D011336:Probability; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome