Mid-Term Outcomes After Aortic Valve Replacement With the 17-mm St. Jude Medical Regent Valve

Okamura, Homare; Yamaguchi, Atsushi; Nagano, Hiroshi; Itoh, Satoshi; Morita, Hideki; Naito, Kunihiko; Yasuda, Kôichi; Adachi, Hideo

doi:10.1253/circj.cj-11-0733

Cited by 22 publications

(17 citation statements)

References 28 publications

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“…Okamura group reported a cohort of elderly patients (mean age >70 years) demonstrating satisfactory clinical improvement and regression of LVM after AVR with the 17-mm SJMR [2,10,11]. Similarly, a series of studies demonstrated favorable clinical outcomes, as well as improved hemodynamic performance both at rest and under an exercise load [2,8-11,18,19], after AVR with a 17-mm SJMR valve. However, these studies are mostly presented with a small number of elderly patients during a relatively short follow-up period.…”

Section: Discussionmentioning

confidence: 99%

“…However, these studies are mostly presented with a small number of elderly patients during a relatively short follow-up period. As the moderate P-PtM frequently occurred after implantation of a small aortic Regent valve [1,2,9-11], its potential adverse effects on postoperative outcomes are not well characterized. Therefore, we need to investigate furtherly into the safety and effectiveness of the 17-mm SJMR in a large number of patients of all ages.…”

Section: Discussionmentioning

confidence: 99%

“…a stentless bioprosthesis or a new generation of stented bioprosthesis) or modern bileaflet mechanical valve implanted in the supra-annular position. However, these strategies are technically more difficult, require longer cardiopulmonary bypass times, and fail to point uniformly toward an improved clinical outcome [2,3]. …”

Section: Introductionmentioning

confidence: 99%

“…Although the Regent valves offer a larger EOA than that of conventional prosthetic valves, the occurrence of P-PtM in patients with 17-mm SJMR valves is reported as high as 31%-94.1% [1,2,9-11]. The main hemodynamic consequence of P-PtM, especially the severe P-PtM (EOAi ≤ 0.65 cm 2 /m 2 ), is to generate higher than expected transvalvular gradients, which is responsible for incomplete left ventricular mass (LVM) regression, increased valve-related complications and postoperative mortality [6,7,12-15].…”

Section: Introductionmentioning

confidence: 99%

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Seventeen-millimeter St. Jude Medical Regent valve in patients with small aortic annulus: dose moderate prosthesis-patient mismatch matter?

Qian

et al. 2014

J Cardiothorac Surg

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BackgroundThe study was designed to evaluate the effects of moderate prosthesis-patient mismatch (defined as 0.65 cm2/m2 < indexed effective orifice area ≤ 0.85 cm2/m2) on midterm outcomes after isolated aortic valve replacement with a 17-mm St. Jude Medical Regent valve in a large series of patients, and to determine if these effects are influenced by patient confounding variables.MethodsOne-hundred and six patients with and without moderate prosthesis-patient mismatch early after implantation of a 17-mm Regent valve at aortic position were included. Both clinical and echocardiographic assessments were performed preoperatively, at discharge and during follow-up period (mean follow-up time 52.6 ± 11.9 months).ResultsThe prevalence of moderate prosthesis-patient mismatch was documented in 46 patients (43.4%) at discharge. During the follow-up period, no difference in the regression of left ventricular mass, decrease of transvalvular pressure gradients, mortality and prosthesis-related complications was observed between patients with and without moderate prosthesis-patient mismatch. After adjustment for several risk factors, moderate prosthesis-patient mismatch was associated with increased midterm mortality in patients with baseline left ventricular ejection fraction < 50% (HR: 1.80, p = 0.02), but with normal prognosis in those with preserved LV function. Younger age (cut off value = 65 years) was not an independent predictor of increased midterm mortality and valve-related complications in patients with moderate prosthesis-patient mismatch.ConclusionsModerate prosthesis-patient mismatch after aortic valve replacement with a small mechanical prosthesis is associated with increased mortality and adverse events in patients with pre-existing left ventricular dysfunction. Selected patients with small aortic annulus can experience satisfactory clinical improvements and midterm survival after aortic valve replacement with a 17-mm Regent valve.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Seventeen-millimeter St. Jude Medical Regent valve in patients with small aortic annulus: dose moderate prosthesis-patient mismatch matter?

Qian

et al. 2014

J Cardiothorac Surg

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“…It is not clear whether the better survival rate rate of IE in elderly population. 5 There is a striking difference in the cardiac and noncardiac predisposing conditions among countries. A high incidence of underlying cardiac disease (82%) was observed in CADRE-IE, as well as in the prior report by the Japanese Circulation Society's (JCS) committee for guidelines.…”

Section: Treatment and Outcomesmentioning

confidence: 99%

Current Profile of Infective Endocarditis in Japan

Iwakura

2013

Circ J

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Mid-term results of 17-mm St. Jude Medical Regent prosthetic valves in elder patients with small aortic annuli: comparison with 19-mm bioprosthetic valves

et al. 2014

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This study was designed to compare the mid-term outcomes after aortic valve replacement (AVR) between 17-mm mechanical heart valves (MV) and 19-mm bioprosthetic valves (BV) in elderly patients with small aortic annuli. Between 2000 and 2011, 127 consecutive patients (mean age 79 years; 87 % female) underwent AVR for aortic valve stenosis with a small aortic annulus. 19-mm BV (n = 67) was implanted. When the 19-mm BV did not fit the annulus, 17-mm St. Jude Medical Regent prosthetic mechanical valve (n = 60) was used instead of an aortic root-enlargement procedure. The follow-up rate was 94.0 % in the BV group, and 98.5 % in the MV group. No significant differences in survival rate and valve-related complications were found between the 2 groups. In-hospital mortality rates were 1.5 % (n = 1) in the BV group and 5.0 % (n = 3) in the MV group. Late mortality rates were 3.9 % per patient-years (p-y; n = 8) in the BV group, and 6.0 % per p-y (n = 10) in the MV group. Five-year Kaplan-Meier survival rates were 62 % in the BV group, and 72 % in the MV group (log-rank P = 0.280). Freedom from major adverse valve-related stroke and cerebral bleeding events was 92.5 and 98.5 % in the BV group, and 94.7 and 100 % in the MV group. AVR using 17-mm MV in elder patients with small aortic annuli provided equivalent mid-term clinical results to that with 19-mm BV.

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Mid-Term Outcomes After Aortic Valve Replacement With the 17-mm St. Jude Medical Regent Valve

Cited by 22 publications

References 28 publications

Seventeen-millimeter St. Jude Medical Regent valve in patients with small aortic annulus: dose moderate prosthesis-patient mismatch matter?

Seventeen-millimeter St. Jude Medical Regent valve in patients with small aortic annulus: dose moderate prosthesis-patient mismatch matter?

Current Profile of Infective Endocarditis in Japan

Mid-term results of 17-mm St. Jude Medical Regent prosthetic valves in elder patients with small aortic annuli: comparison with 19-mm bioprosthetic valves

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