title: The Scandinavian multicenter hemodynamic evaluation of the SJM Regent aortic valve.
abstract: BACKGROUND
  112 patients who received small and medium sized St. Jude Regent heart valves (19-25 mm) at 7 Scandinavian centers were studied between January 2003 and February 2005 to obtain non-invasive data regarding the hemodynamic performance at rest and during Dobutamine stress echocardiography (DSE) testing one year after surgery.
  
  
  METHODS
  46 woman and 66 men, aged 61.8 ± 9.7 (18-75) years, were operated on for aortic regurgitation (17), stenosis (65), or mixed dysfunction (30). Valve sizes were 19 mm (6), 21 mm (33), 23 mm (41), 25 mm (30). Two patients receiving size 27 valves were excluded from the hemodynamic evaluation. Pledgets were used in 100 patients, everted mattress in 66 and simple interrupted sutures in 21. Valve orientation varied and was dependent on the surgeons' choice. 34 patients (30.4%) underwent concomitant coronary artery surgery.
  
  
  RESULTS
  There were two early deaths (1.8%) and three late deaths, one because of pancreatic cancer. Late events during follow-up were: non structural dysfunction (1), bleeding (2), thromboembolism (2). At one year follow up 93% of the patients were in NYHA classes 1-2 versus 47.8% preoperatively. Dobutamine stress echocardiography (DSE) was performed in a total of 66 and maximal peak stress was reached in 61 patients. During DSE testing, the following statistically significant changes took place: Heart rate increased by 73.0%, cardiac output by 85.5%, left ventriclular ejection fraction by 19.6%, and maximal mean prosthetic transvalvular gradient by 133.8%, whereas the effective orifice area index did not change. Left ventricular mass fell during one year from 215 ± 63 to 197 ± 62 g (p < 0.05).
  
  
  CONCLUSIONS
  The Dobutamine test induces a substantial stress, well suitable for echocardiographic assessment of prosthesis valve function and can be performed in the majority of the patients. The changes in pressure gradients add to the hemodynamic characteristics of the various valve sizes. In our patients the St. Jude Regent valve performed satisfactory at rest and under pharmacological stress situation.
authors.affiliation: Oslo University Hospital, Rikshospitalet, PO box 4950, Nydalen, NO 0424 Oslo, Norway.
authors.forename: Jon
authors.initials: J
authors.lastname: Offstad
authors.forename: Kai
authors.initials: K
authors.lastname: Andersen
authors.forename: Per
authors.initials: P
authors.lastname: Paulsson
authors.forename: Jesper
authors.initials: J
authors.lastname: Andreasson
authors.forename: Ulf
authors.initials: U
authors.lastname: Kjellman
authors.forename: Oluf
authors.initials: O
authors.lastname: Lundblad
authors.forename: Karl Gunnar
authors.initials: KG
authors.lastname: Engstrøm
authors.forename: Rune
authors.initials: R
authors.lastname: Haaverstad
authors.forename: Jan L
authors.initials: JL
authors.lastname: Svennevig
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D002302:Cardiac Output; D015150:Echocardiography, Doppler; D025401:Echocardiography, Stress; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D013318:Stroke Volume; D016896:Treatment Outcome; D055815:Young Adult