Key result
The 17-mm Regent valve shows satisfactory hemodynamics and LV mass regression despite ~43 mmHg stress gradients.
Why the study?
Does the 17-mm St. Jude Medical Regent prosthetic aortic heart valve provide satisfactory hemodynamic performance and left ventricular mass regression in relatively aged patients with small aortic roots?
Observational (n=19)
No
Does the 17-mm St. Jude Medical Regent prosthetic aortic heart valve provide satisfactory hemodynamic performance and left ventricular mass regression in relatively aged patients with small aortic roots?
Absolute Event Rate: 43.2% vs 16.6%
p-value: p=<0.0001
The 17-mm St. Jude Medical Regent prosthesis provides satisfactory hemodynamics and significant left ventricular mass regression in older patients with small aortic roots.
May support use of 17-mm Regent valve in select older patients with small roots; leaves open need for randomized long-term data.
BACKGROUND: The prosthesis used for aortic valve replacement in patients with small aortic root can be too small in relation to body size, thus showing high transvalvular gradients at rest and/or under stress conditions. This study was carried out to evaluate rest and Dobutamine stress echocardiography (DSE) hemodynamic response of 17-mm St. Jude Medical Regent (SJMR-17 mm) in relatively aged patients at mean 24 months follow-up. METHODS AND RESULTS: The study population consisted of 19 patients (2 men, 17 women, mean age 69.2 +/- 7.3 years). All patients underwent rest Doppler echocardiography before and after surgery and basal and DSE at follow up (infused at rate of 5 microg/Kg/min and increased by 5 microg/Kg/min at 5 min intervals up to 40 microg/Kg/min). The following parameters were evaluated at rest and/or under DSE: heart rate (HR), ejection fraction (EF), cardiac output (CO), peak and mean velocity and pressure gradients (MxV, MnV, MxPG, MnPG), effective orifice area (EOA), indexed EOA (EOAi), left ventricular mass (LVM), indexed LVM (LVMi), Velocity Time Integral at left ventricular outflow tract (VTI LVOT) and transvalvular (Aortic VTI), Doppler velocity index (DVI). At rest MxPG and MnPG were 29.2 +/- 7.1 and 16.6 +/- 5.8 mmHg, respectively; EOA and EOAi resulted 1.14 +/- 0.3 cm(2) and 0.76 +/- 0.2 cm(2)/m(2); DVI was normal (0.50 +/- 0.1). At follow-up LVM and LVMi decreased significantly from pre-operative value of 258 +/- 43 g and 157.4 +/- 27.7 g/m(2) to 191 +/- 23.8 g and 114.5 +/- 10.6 g/m(2), respectively. DSE increased significantly HR, CO, EF, MxGP (up to 83.4 +/- 2 1.9 mmHg), MnPG (up to 43.2 +/- 12.7 mmHg). EOA, EOAi, DVI increased insignificantly (from baseline up to 1.2 +/- 0.4 cm(2), 0.75 +/- 0.3 cm(2)/m(2) and 0.48 +/- 0.1 respectively). Two patients developed significant intraventricular gradients. CONCLUSION: These data show that SJMR 17-mm prostheses can be safely implanted in aortic position in relatively aged patients, offering a satisfactory hemodynamic performance at rest and under DSE, with full utilization of its available orifice, suggesting that a possible mild prosthesis-patient mismatch is not an issue of clinical relevance when this small prosthesis is used. Rest and Dobutamine stress echocardiography is a useful and effective means for evaluating prosthesis hemodynamics and for monitoring the expected LVH regression.
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Minardi et al. (2006) conducted an observational in Aortic valve stenosis with small aortic root (n=19). 17-mm St. Jude Medical Regent prosthetic aortic heart valve vs. Rest conditions (for stress testing) and pre-operative baseline was evaluated on Mean pressure gradient (MnPG) during peak dobutamine stress echocardiography compared to rest (p=<0.0001). In older patients with a small aortic root, the 17-mm St. Jude Medical Regent aortic prosthesis demonstrated satisfactory hemodynamics, with mean pressure gradients increasing from 16.6 mmHg at rest to 43.2 mmHg during dobutamine stress, alongside significant left ventricular mass regression.
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