Does the mitral valve prosthesis adversely affect the hemodynamic performance of the aortic valve prosthesis in patients with double valve replacement?

Abstract

This study was undertaken to examine the possible adverse effect of the mitral valve prosthesis on the hemodynamic performance of the aortic valve prosthesis in patients who have undergone double valve replacement. Patients who underwent double valve replacement were matched for age, body surface area, left ventricular function, and size and type of aortic valve prosthesis with patients who underwent isolated aortic valve replacement. Two types of prosthetic valves were examined: the St Jude Medical mechanical valve (St Jude Medical, St Paul, Minn) and the Hancock II bioprosthesis (Medtronic Inc, Minneapolis, Minn). Five patients for each size and type of aortic valve prosthesis in the double valve replacement group were matched at 1:2 with patients in the isolated aortic valve replacement group. Only valve sizes 21 to 27 were matched. Hemodynamic assessment of the aortic valve prosthesis was performed by transthoracic echocardiogram before hospital discharge. Matched patients had similar clinical profiles. There were no differences in the systolic gradients, effective aortic valve areas, or flow velocity across the aortic valve prostheses after isolated aortic valve replacement or double valve replacement. Early after surgery, the hemodynamic performance of aortic valve prostheses was not affected by the presence of mitral valve prostheses in patients who underwent combined aortic and mitral valve replacement.