title: Application of Regent mechanical valve in patients with small aortic annulus: 3-year follow-up.
abstract: BACKGROUND
  Aortic valve replacement (AVR) with a small aortic annulus is always challenging for the cardiac surgeon. In this study, we sought to evaluate the midterm performance of implantation with a 17-mm or 19-mm St. Jude Medical Regent (SJM Regent) mechanical valve in retrospective consecutive cohort of patients with small aortic annulus (diameter ≤ 19 mm).
  
  
  METHODS
  From January 2008 to April 2011, 40 patients (31 female, mean age = 47.2 ± 5.8 years) with small aortic annulus (≤19 mm in diameter) underwent aortic valve replacement with a 17-mm or 19-mm St. Jude Medical Regent (SJM Regent) mechanical valve. Preoperative mean body surface area, New York Heart Association class, and mean aortic annulus were 1.61 ± 0.26 m2, 3.2 ± 0.4, and 18 ± 1.4 mm respectively. Patients were divided into two groups, according to the implantation of 17 mm SJM Regent mechanical valve (group 1, n = 18) or 19 mm SJM Regent valve (group 2, n = 22). All patients underwent echocardiography examination preoperatively and at one year post-operation.
  
  
  RESULTS
  There were no early deaths in either group. Follow-up time averaged 36 ± 17.6 months. The mean postoperative New York Heart Association class was 1.3 ± 0.6 (p < 0.001). By echocardiography, in group 1, the left ventricular ejection fraction (LVEF), left ventricular fraction shortening (LVFS), and the indexed effective orifice area (EOAI) increased from 43.7% ± 11.6%, 27.3% ± 7.6%, and 0.70 ± 0.06 cm2/m2 to 69.8 ± 9.3%, 41.4 ± 8.3%, and 0.92 ± 0.10 cm2/m2 respectively (P < 0.05), while the left ventricular mass index (LVMI), and the aortic transvalvular pressure gradient decreased from 116.4 ± 25.4 g/m2, 46.1 ± 8.5 mmHg to 86.7 ± 18.2 g/m2, 13.7 ± 5.2 mmHg respectively. In group 2, the LVEF, LVFS and EOAI increased from 45.9% ± 9.7%, 30.7% ± 8.0%, and 0.81 ± 0.09 cm2/m2 to 77.4% ± 9.7%, 44.5% ± 9.6%, and 1.27 ± 0.11 cm2/m2 respectively, while the LVMI, and the aortic transvalvular pressure gradient decreased from 118.3 ± 27.6 g/m2, 44.0 ± 6.7 mmHg to 80.1 ± 19.7 g/m2, 10.8 ± 4.1 mmHg as well. The prevalence of PPM was documented in 2 patients in Group 1.
  
  
  CONCLUSIONS
  Patients with small aortic annulus and body surface area, experienced satisfactory clinical improvement after aortic valve replacement with modern SJM Regent bileaflet prostheses.
authors.affiliation: Department of Cardiac Surgery, Zhongshan Hospital Fudan University & Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, People's Republic of China.
authors.forename: Dong
authors.initials: D
authors.lastname: Zhao
authors.forename: Chunsheng
authors.initials: C
authors.lastname: Wang
authors.forename: Tao
authors.initials: T
authors.lastname: Hong
authors.forename: Cuizhen
authors.initials: C
authors.lastname: Pan
authors.forename: Changfa
authors.initials: C
authors.lastname: Guo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000033:anatomy & histology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013318:Stroke Volume / Q000502:physiology; D016276:Ventricular Function / Q000502:physiology