Abstract
Between 1993 and 1996 the CarboMedics Top Hat supraannular aortic valve was implanted in 41 patients at the Wessex Cardiothoracic Centre (age, 39 to 74 years; mean, 61.3+/-8.9 years). Comparisons of annular dimensions made at surgery indicate that conventional annular valve replacement would have required at least a size smaller valve. This was particularly marked when a prosthetic mitral valve was in place. Operative mortality was 2.4%. There were also three late deaths. Echocardiography before and after symptom-limited treadmill testing has been performed in 21 patients. The mean time to follow-up was 16.1 months. The Doppler-derived indices of forward flow pre- and postexercise were expressed as mean+/-standard deviation. For 23-mm valves the values were: peak valve gradient 21.43+/-7.46 mm Hg and 35.86+/-14.4 mm Hg, aortic valve area 1.13+/-0.39 cm2 and 1.24+/-0.54 cm2. For 21-mm valves the values were: peak valve gradient 24.84+/-8.2 mm Hg and 31.29+/-5.84 mm Hg, aortic valve area 1.08+/-0.44 cm2 and 0.95 +/-0.2 cm2. The Top Hat valve has a good hemodynamic profile at rest and during exercise. Surgical considerations make it particularly useful in patients with a small aortic annulus and in patients undergoing combined aortic and mitral valve replacement.
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