Application of Regent mechanical valve in patients with small aortic annulus: 3-year follow-up

作者：Zhao, Dong; Wang, Chunsheng^*; Hong, Tao; Pan, Cuizhen; Guo, Changfa

来源：Journal of Cardiothoracic Surgery, 2012, 7: 88.

DOI：10.1186/1749-8090-7-88

• Small aortic annulus
• St.Jude Medical Regent mechanical valve
• Left cardiac function
• Prothesis-Patient Mismatch

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 m(2), 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 cm(2)/m(2) to 69.8 +/- 9.3%, 41.4 +/- 8.3%, and 0.92 +/- 0.10 cm(2)/m(2) respectively (P < 0.05), while the left ventricular mass index (LVMI), and the aortic transvalvular pressure gradient decreased from 116.4 +/- 25.4 g/m(2), 46.1 +/- 8.5 mmHg to 86.7 +/- 18.2 g/m(2), 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 cm(2)/m(2) to 77.4% +/- 9.7%, 44.5% +/- 9.6%, and 1.27 +/- 0.11 cm(2)/m(2) respectively, while the LVMI, and the aortic transvalvular pressure gradient decreased from 118.3 +/- 27.6 g/m(2), 44.0 +/- 6.7 mmHg to 80.1 +/- 19.7 g/m(2), 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.

• 出版日期2012-9-21
• 单位复旦大学