Key result
Implantation of a 19-mm SJM Regent mechanical valve resulted in a significantly larger indexed effective orifice area compared to a 17-mm valve (1.27 vs 0.92 cm2/m2, p<0.01).
Why the study?
Does aortic valve replacement with a 17-mm or 19-mm St. Jude Medical Regent mechanical valve improve cardiac function and hemodynamics in patients with a small aortic annulus?
Cohort (n=40)
No
Does aortic valve replacement with a 17-mm or 19-mm St. Jude Medical Regent mechanical valve improve cardiac function and hemodynamics in patients with a small aortic annulus?
Absolute Event Rate: 1.27% vs 0.92%
p-value: p=<0.01
In patients with a small aortic annulus, the 17-mm and 19-mm SJM Regent mechanical valves provide significant hemodynamic improvement and left ventricular mass regression with a low rate of patient-prosthesis mismatch, offering a simpler alternative to aortic root enlargement.
May favor 19-mm over 17-mm SJM Regent valves for larger EOA when feasible; leaves open randomized trials on clinical outcomes.
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.
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Zhao et al. (2012) conducted a cohort in Small aortic annulus (n=40). 19-mm SJM Regent mechanical valve vs. 17-mm SJM Regent mechanical valve was evaluated on Indexed effective orifice area (EOAI) at 1 year post-operation (p=<0.01). Implantation of a 19-mm SJM Regent mechanical valve resulted in a significantly larger indexed effective orifice area compared to a 17-mm valve (1.27 vs 0.92 cm2/m2, p<0.01).
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