title: Clinical outcomes and hemodynamics of the 19-mm Perimount Magna bioprosthesis in an aortic position: comparison with the 19-mm Medtronic Mosaic Ultra Valve.
abstract: BACKGROUND
  When aortic valve replacement is performed in patients with a small aortic annulus, prosthesis-patient mismatch (PPM) is of concern because it can affect postoperative clinical outcomes. Although larger bioprosthetic valves have been well studied, the hemodynamics of 19-mm bioprostheses have been reported in only a small number of patients. The effectiveness as well as the impact of PPM on outcomes are thus still unclear.
  
  
  RESULTS
  Postoperative clinical and hemodynamic variables were compared in 67 patients with a 19-mm Carpentier Edwards Perimount Magna bioprosthesis and in 10 patients with a 19-mm Medtronic Mosaic Ultra valve. Mean follow-up time was 13 months. There was no in-hospital mortality. Echocardiography 6.5±4.0 months after surgery showed significant decreases in the mean left ventricular (LV)-aortic pressure gradient, and decreases in the mean LV mass index. Reduction in LV mass index did not differ between the valve groups, despite a higher pressure gradient in the Mosaic group. Although PPM was detected in 21 patients in the Magna group, it did not affect regression of the LV mass index during the follow-up period.
  
  
  CONCLUSIONS
  Use of the 19-mm Magna bioprosthesis appears to provide satisfactory clinical results. LV-aortic pressure gradient was lower in the Magna group. The present data suggest that PPM is not related to reduction in the LV mass index.
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: Takamichi
authors.initials: T
authors.lastname: Yoshizaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nagano
authors.forename: Satoshi
authors.initials: S
authors.lastname: Itoh
authors.forename: Hideki
authors.initials: H
authors.lastname: Morita
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Naito
authors.forename: Koichi
authors.initials: K
authors.lastname: Yuri
authors.forename: Hideo
authors.initials: H
authors.lastname: Adachi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000145:classification*; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D017755:Prosthesis Fitting; D012189:Retrospective Studies; D016896:Treatment Outcome