Hemodynamics of 17-mm vs. 19-mm St. Jude Medical Regent and annulus enlargement.
OBJECTIVE
We aimed to compare early and midterm clinical and hemodynamic outcomes of 17-mm vs. 19-mm St. Jude Medical Regent valves with concomitant aortic annulus enlargement.


METHODS
Between 1999 and 2012, 20 patients (group 1) underwent first-time aortic valve replacement with a 17-mm St. Jude Medical Regent valve, and 35 patients (group 2) had a 19-mm valve and concomitant aortic annulus enlargement. The mean follow-up was 81 ± 37 months (range 20-110 months).


RESULTS
There was one death in group 1 vs. 4 in group 2 (p > 0.05). The mean postoperative transprosthetic gradient was 17.5 ± 4.5 in group 1 and 17 ± 6.4 mm Hg in group 2 (p = 0.83), and 37 ± 10.7 and 32 ± 13 mm Hg, respectively, under stress (p = 0.17). Left ventricular mass and left ventricular mass index were reduced and similar in both groups. Postoperative effective orifice area index was higher in group 2 (0.85 ± 0.17 cm(2 )m(-2)) than group 1 (0.76 ± 0.2 cm(2 )m(-2); p > 0.05). A multivariate Cox model identified a 19-mm valve with aortic annulus enlargement (p = 0.032), functional class (p = 0.025), reoperation (p = 0.04), ejection fraction < 35% (p = 0.042), and combined surgery (p = 0.04) as strong predictors of poorer overall event-free survival.


CONCLUSIONS
The 17-mm St. Jude Medical Regent valve may be employed with satisfactory postoperative clinical and hemodynamic outcomes in patients with a small aortic annulus, as an alternative to a larger prothesis with aortic annulus enlargement.
Division of Cardiac Surgery, University Hospital Center of Tirana, Albania edvinprifti@hotmail.com.
Edvin
E
Prifti
Division of Cardiac Surgery, Policlinicco Careggi, Florence, Italy.
Massimo
M
Bonacchi
Division of Cardiac Surgery, University Hospital Center of Tirana, Albania.
Arben
A
Baboci
Division of Cardiac Surgery, Policlinicco Careggi, Florence, Italy.
Gabriele
G
Giunti
Division of Cardiac Surgery, Humanitas Gavazzeni Clinic, Bergamo, Italy.
Giampiero
G
Esposito
Division of Cardiac Surgery, University Hospital Center of Tirana, Albania.
Klodian
K
Krakulli
Division of Cardiac Surgery, University Hospital Center of Tirana, Albania.
Fadil
F
Ademaj
Division of Cardiac Surgery, University Hospital Center of Tirana, Albania.
Efrosina
E
Kajo
Division of Cardiac Surgery, Humanitas Gavazzeni Clinic, Bergamo, Italy.
Vitttorio
V
Vanini
D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D011474:Prosthesis Design; D016896:Treatment Outcome
Aortic valve stenosis; Heart valve prosthesis implantation; Hemodynamics; Prosthesis fitting; Survival rate