Heart and Vessels

, Volume 28, Issue 6, pp 769–774

Mid-term results of small-sized St. Jude Medical Regent prosthetic valves (21 mm or less) for small aortic annulus

Authors

    • Department of Cardiovascular SurgeryKansai Rosai Hospital
  • Masayuki Sakaki
    • Department of Cardiovascular SurgeryKansai Rosai Hospital
  • Kazushige Inoue
    • Department of Cardiovascular SurgeryKansai Rosai Hospital
  • Takashi Iwata
    • Department of Cardiovascular SurgeryKansai Rosai Hospital
  • Keikou Tei
    • Department of Cardiovascular SurgeryKansai Rosai Hospital
  • Takuya Miura
    • Department of Cardiovascular SurgeryKansai Rosai Hospital
Original Article

DOI: 10.1007/s00380-012-0306-x

Cite this article as:
Mizoguchi, H., Sakaki, M., Inoue, K. et al. Heart Vessels (2013) 28: 769. doi:10.1007/s00380-012-0306-x

Abstract

Prosthesis–patient mismatch (PPM) is always of concern when performing aortic valve replacement (AVR) in patients with a small aortic annulus. Although bioprosthetic AVR is preferred in patients older than 65 years, we have experienced cases in elderly patients with a small aortic annulus whereby we could not implant small-sized bioprosthetic valves. We have implanted St. Jude Medical Regent (SJMR) mechanical valves (St. Jude Medical, St. Paul, MN, USA) as necessary, even in elderly patients with no aortic annulus enlargement. We investigated our experiences of AVR with SJMR mechanical valves of 21 mm or less in size. Between January 2006 and December 2009, 40 patients underwent AVR with SJMR mechanical valves ≤21 mm in size: 9 patients received 21-mm valves, 19 received 19-mm valves, and 12 received 17-mm valves. The mean age was 65.9 ± 9.5 years, and 25 patients (62.5 %) were 65 years or older. We evaluated the clinical outcome and the echocardiographic data for each valve size. There was no operative or hospital mortality. The mean duration of clinical follow-up was 31.2 ± 17.6 months. During follow-up, there were no hospitalizations due to heart failure. The cumulative valve-related event-free survival was 93 % at 33 months, and the cumulative hemorrhagic event-free survival was 93 % at 33 months and 84 % at 43 months, using the Kaplan–Meier method. At follow-up, the mean values of the measured effective orifice area (EOA) for the 21-, 19-, and 17-mm prostheses were 2.00 ± 0.22, 1.74 ± 0.37, and 1.25 ± 0.26 cm2, and the mean measured EOA index (EOAI) were 1.17 ± 0.12, 1.11 ± 0.21 and 0.90 ± 0.22 cm2/m2, respectively. A PPM (EOAI ≤0.85) was documented in 5 patients, all of whom had received a 17-mm SJMR valve. AVR with SJMR valves of 21 mm or less in size appears to show satisfactory clinical and hemodynamic results.

Keywords

Aortic valve replacementSt. Jude Medical Regent prosthetic valvesSmall aortic annulusPatient–prosthesis mismatch

Copyright information

© Springer Japan 2012