Influence of St. Jude Medical Valve in Patients with Aortic Stenosis and Small Aortic Annulus on Cardiac Function and Late Survival Result

Abstract

This clinical study analyzes our experience of postoperative cardiac function and long-term survival rate in patients with aortic stenosis and small-size St. Jude Medical (SJM) valve. Sixty-eight patients who underwent aortic valve replacement by SJM valve were divided into two groups by preoperative aortic annulus diameter. Group 1 consisted of 44 patients with small aortic annulus and small-size SJM valve (19 mm or 21 mm). In Group 1, small SJM standard valves were implanted in 16 patients, and small SJM Hemodynamic Plus (HP) valves were implanted in 28 patients. Group 2 consisted of 24 patients with large-size SJM standard valve (23 mm or larger). Preoperative left ventricular mass index, left ventricular dimension, the dimension of ascending aorta, and body surface area were significantly smaller in Group 1 than in Group 2. Average age at surgery was older in Group 1 than in Group 2. Effective orifice area index of the SJM valve measured by the manufacturer's data was smaller in Group 1 than in Group 2. Postoperative left ventricular mass indexes of Group 1 (standard valve or HP valve) and Group 2 significantly decreased in comparison with the preoperative mass indexes. Postoperative left ventricular ejection fraction and the peak ejection rate of Group 1 were not different from those of Group 2. The 10 year survival rate of Group 1 was 79%, and the rate of Group 2 was 77%. At 10 years after surgery, freedom from valve-related complication of Group 1 was 80%, and freedom from complication of Group 2 was 81%. Our results demonstrated that small-size SJM valve afforded satisfactory long-term survival rate and valve-related event-free rate for elderly patients with small body surface area and small aortic annulus.

Does the St. Jude Regent 17-mm Offer Better Outcomes Than the Hemodynamic Plus 17-mm Aortic Valve Mechanical Prothesis?

“…Recently, different authors have reported excellent clinical and hemodynamic outcomes in patients undergoing AVR with a SJMR mechanical aortic prosthesis . The SJMR has a significantly better hemodynamic performance in terms of postoperative EOA and transprosthetic gradients versus SJMHP for the respective valve sizes . In the present study we report two series of patients undergoing SJMR‐17 and SJMHP‐17, respectively.…”

“…Niinami et al demonstrated similar hemodynamic performance in terms of transprosthetic gradients in patients undergoing AVR with SJMHP‐19 compared to SJMSD‐19. Other studies demonstrated acceptable clinical and hemodynamic outcomes in patients undergoing AVR with a small SJMHP . Carrel et al demonstrated that the hemodynamic performance of the 21 HP in vivo has been better than that of the 21 SD and that it corresponded closely to that of the 23 SD.…”

“…The SJMHP valve prostheses have excellent in vitro and in vivo hemodynamics with an excellent record for safety and freedom from adverse events . Niinami et al demonstrated similar hemodynamic performance in terms of transprosthetic gradients in patients undergoing AVR with SJMHP‐19 compared to SJMSD‐19.…”

“…The employment of a 17‐mm mechanical prosthesis is very rare and usually is indicated in small aortic roots when all the other alternatives such as annulus enlargement are not effective. Different studies have well demonstrated the superiority of different size SJMHP versus the SJMSD; there are no data in the current literature regarding the postoperative clinical and hemodynamic outcome in patients undergoing AVR with a SJMR‐17 versus SJMHP‐17. The aim of the present study is to report the early and mid‐term clinical and hemodynamic results of a prospective trial investigating the clinical performance of the SJMR‐17 versus SJMHP‐17.…”