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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

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  • Artificial Valve
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Abstract

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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Abbreviations

AVR:

Aortic valve replacement

BV:

Bioprosthetic valves

EOAI:

Effective orifice area index

INR:

International normalized ratio

LVMI:

Left ventricular mass index

MPG:

Mean transvalvular pressure gradient

MV:

Mechanical heart valves

PPG:

Peak transvalvular pressure gradient

PPM:

Prosthesis-patient mismatch

References

  1. Bonow RO, Carabello BA, Chatterjee K, De Leon AC Jr, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O’Gara PT, O’Rourke RA, Otto CM, Shah PM, Shanewise JS, Smith SC Jr, Jacobs AK, Adams CD, Anderson JL, Antman EM, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Lytle BW, Nishimura R, Page RL, Riegel B. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2006;48:e1–148.

    Article  PubMed  Google Scholar 

  2. van Geldorp MW, Eric Jamieson WR, Kappetein AP, Ye J, Fradet GJ, Eijkemans MJ, Grunkemeier GL, Bogers AJ, Takkenberg JJ. Patient outcome after aortic valve replacement with a mechanical or biological prosthesis: weighing lifetime anticoagulant-related event risk against reoperation risk. J Thorac Cardiovasc Surg. 2009;137:881–6.

    Article  PubMed  Google Scholar 

  3. Brown ML, Schaff HV, Lahr BD, Mullany CJ, Sundt TM, Dearani JA, McGregor CG, Orszulak TA. Aortic valve replacement in patients aged 50 to 70 years: improved outcome with mechanical versus biologic prostheses. J Thorac Cardiovasc Surg. 2008;135:878–84.

    Article  PubMed  Google Scholar 

  4. Yoshikawa K, Fukunaga S, Arinaga K, Hori H, Nakamura E, Ueda T, Tayama E, Aoyagi S. Long-term results of aortic valve replacement with a small St. Jude Medical valve in Japanese patients. Ann Thorac Surg. 2008;85:1303–9.

    Article  PubMed  Google Scholar 

  5. Okamura H, Yamaguchi A, Nagano H, Itoh S, Morita H, Naito K, Yuri K, Adachi H. Mid-term outcomes after aortic valve replacement with the 17-mm St. Jude Medical Regent valve. Circ J. 2012;76:365–71.

    Article  PubMed  Google Scholar 

  6. Kobayashi Y, Fukushima Y, Hayase T, Kojima K, Endo G. Clinical outcome of aortic valve replacement with 16-mm ATS-Advanced Performance valve for small aortic annulus. Ann Thorac Surg. 2010;89:1195–9.

    Article  PubMed  Google Scholar 

  7. Sawaki S, Usui A, Abe T, Yoshikawa M, Akita T, Ueda Y. Late mortality and morbidity in elderly patients with mechanical heart valves. Asian Cardiovasc Thorac Ann. 2006;14:189–94.

    Article  PubMed  Google Scholar 

  8. Hammermeister K, Sethi GK, Henderson WG, Grover FL, Oprian C, Rahimtoola SH. Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial. J Am Coll Cardiol. 2000;36:1152–8.

    Article  CAS  PubMed  Google Scholar 

  9. Hanania G. Which heart valve prosthesis for patients aged between 60 and 70 years? Heart. 2003;89:481–2.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Kahn SS, Trento A, DeRobertis M, Kass RM, Sandhu M, Czer LS, Blanche C, Raissi S, Fontana GP, Cheng W, Chaux A, Matloff JM. Twenty-year comparison of tissue and mechanical valve replacement. J Thorac Cardiovasc Surg. 2001;122:257–69.

    Article  Google Scholar 

  11. Chan V, Jamieson WR, Germann E, Chang F, Miyagishima RT, Burr LH, Janusz MT, Ling H, Fradet GJ. Performance of bioprostheses and mechanical prostheses assessed by composites of valve-related complications to 15 years after aortic valve replacement. J Thorac Cardiovasc Surg. 2006;131:1267–73.

    Article  CAS  PubMed  Google Scholar 

  12. Kulik A, Bedard P, Lam BK, Rubens FD, Hendry PJ, Masters RG, Mesana TG, Ruel M. Mechanical versus bioprosthetic valve replacements in middle-aged patients. Eur J Cardiothorac Surg. 2006;30:485–91.

    Article  PubMed  Google Scholar 

  13. Pibarot P, Dumesnil J. Patient–prosthesis mismatch and the predictive use of indexed effective orifice area: is it relevant? Cardiac Surg Today. 2003;1:143–51.

    Google Scholar 

  14. Rao V, Jamieson WR, Ivanov J, Armstrong S, David TE. Prosthesis–patient mismatch affects survival after aortic valve replacement. Circulation. 2000;102:115–9.

    Google Scholar 

  15. Hanayama N, Christakis GT, Mallidi HR, Joyner CD, Fremes SE, Morgan CD, Mitoff PRR, Goldman BS. Patient prosthesis mismatch is rare after aortic valve replacement: valve size may be irrelevant. Ann Thoracic Surg. 2002;73:1822–9.

    Article  Google Scholar 

  16. Amarelli C, Della Corte A, Romano G, Iasevoli G, Dialetto G, De Santo LS, De Feo M, Torella M, Scardone M, Cotrufo M. Left ventricular mass regression after aortic valve replacement with 17-mm St Jude Medical mechanical prostheses in isolated aortic stenosis. J Thorac Cardiovasc Surg. 2005;129:512–7.

    Article  PubMed  Google Scholar 

  17. Minardi G, Manzara C, Creazzo V, Maselli D, Casali G, Pulignano G, Musumeci F. Evaluation of 17-mm St. Jude Medical Regent prosthetic aortic heart valves by rest and dobutamine stress echocardiography. J Cardiothorac Surg. 2006;1:27.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Garatti A, Mori F, Innocente F, Canziani A, Gagliardotto P, Mossuto E, Santoro T, Montericcio V, Frigiola A, Menicanti L. Aortic valve replacement with 17-mm mechanical prostheses: is patient–prosthesis mismatch a relevant phenomenon? Ann Thorac Surg. 2011;91:71–7.

    Article  PubMed  Google Scholar 

  19. Akins CW, Miller DC, Turina MI, Kouchoukos NT, Blackstone EH, Grunkemeier GL, Takkenberg JJ, David TE, Butchart EG, Adams DH, Shahian DM, Hagl S, Mayer JE, Lytle BW, Councils of the American Association for Thoracic Surgery, Society of Thoracic Surgeons, European Association for Cardio-Thoracic Surgery, Ad Hoc Liaison Committee for Standardizing Definitions of Prosthetic Heart Valve Morbidity. Guidelines for reporting mortality and morbidity after cardiac valve interventions. J Thorac Cardiovasc Surg. 2008;135:732–8.

    Article  PubMed  Google Scholar 

  20. Kvidal P, Bergstrom R, Malm T, Stahle E. Long-term follow-up of morbidity and mortality after aortic valve replacement with a mechanical valve prosthesis. Eur Heart J. 2000;21:1099–111.

    Article  CAS  PubMed  Google Scholar 

  21. Edmunds LH Jr, Clark RE, Cohn LH, Grunkemeier GL, Miller DC, Weisel RD. Guidelines for reporting morbidity and mortality after cardiac valvular operations. Ann Thorac Surg. 1996;62:932–5.

    Article  PubMed  Google Scholar 

  22. Jamieson WR, Janusz MT, Burr LH, Ling H, Miyagishima RT, Germann E. Carpentier-Edwards supraannular porcine bioprosthesis: second-generation prosthesis in aortic valve replacement. Ann Thorac Surg. 2001;71:S224–7.

    Article  CAS  PubMed  Google Scholar 

  23. The 2011 annual survey of life expectancy reported by the Japanese Ministry of Health, Labor and Welfare at http://www.mhlw.go.jp/toukei/saikin/hw/life/life11/dl/life11-14.pdf. Accessed September 4, 2013.

  24. Matsuyama K, Matsumoto M, Sugita T, Nishizawa J, Yoshida K, Tokuda Y, Matsuo T. Anticoagulant therapy in Japanese patients with mechanical mitral valves. Circ J. 2002;66:668–70.

    Article  CAS  PubMed  Google Scholar 

  25. Vicchio M, Della Corte A, De Santo LS, De Feo M, Caianiello G, Scardone M, Cotrufo M. Tissue versus mechanical prostheses: quality of life in octogenerians. Ann Thorac Surg. 2008;85:1290–5.

    Article  PubMed  Google Scholar 

  26. Mori T, Asano M, Ohtake H, Bitoh A, Sekiguchi S, Matsuo Y, Aiba M, Yamada M, Kawada T, Takaba T. Anticoagulant therapy after prosthetic valve replacement -optimal PT-INR in Japanese patients-. Ann Thorac Cardiovasc Surg. 2002;8:83–7.

    PubMed  Google Scholar 

  27. Butchart EG, Payne N, Li HH, Buchan K, Mandana K, Grunkemeier GL. Better anticoagulation control improves survival after valve replacement. J Thorac Cardiovasc Surg. 2002;123:715–23.

    Article  PubMed  Google Scholar 

  28. MOS 36-item Short Form Health Survey, at http://www.sf-36.org/. Accessed September 4, 2013.

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Acknowledgments

The authors would like to thank Mr. M. Inoue, Faculty of Nursing University of Kochi, Kochi, Japan, for his contribution to statistical analysis.

Conflict of interest

The authors declare that there is no conflict of interest associated with the present study.

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Authors and Affiliations

  1. Cardiovascular Surgery, Chikamori Hospital Heart Center, 1-1-16 Ohkawasuji, Kochi, 780-8522, Japan

    Hideki Teshima, Masahiko Ikebuchi, Toshikazu Sano, Ryuta Tai, Naohiro Horio & Hiroyuki Irie

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  1. Hideki Teshima
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  2. Masahiko Ikebuchi
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Correspondence to Hideki Teshima.

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Teshima, H., Ikebuchi, M., Sano, T. et al. 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. J Artif Organs 17, 258–264 (2014). https://doi.org/10.1007/s10047-014-0770-4

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  • DOI: https://doi.org/10.1007/s10047-014-0770-4

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