Abstract
Background112 patients who received small and medium sized St.Jude Regent heart valves (19-25 mm) at 7 Scandinavian centers were studied between January 2003 and February 2005 to obtain non-invasive data regarding the hemodynamic performance at rest and during Dobutamine stress echocardiography (DSE) testing one year after surgery.Material and methods46 woman and 66 men, aged 61.8 ± 9.7 (18-75) years, were operated on for aortic regurgitation (17), stenosis (65), or mixed dysfunction (30). Valve sizes were 19 mm (6), 21 mm (33), 23 mm (41), 25 mm (30). Two patients receiving size 27 valves were excluded from the hemodynamic evaluation. Pledgets were used in 100 patients, everted mattress in 66 and simple interrupted sutures in 21. Valve orientation varied and was dependent on the surgeons' choice. 34 patients (30.4%) underwent concomitant coronary artery surgery.ResultsThere were two early deaths (1.8%) and three late deaths, one because of pancreatic cancer. Late events during follow-up were: non structural dysfunction (1), bleeding (2), thromboembolism (2). At one year follow up 93% of the patients were in NYHA classes 1-2 versus 47.8% preoperatively.Dobutamine stress echocardiography (DSE) was performed in a total of 66 and maximal peak stress was reached in 61 patients.During DSE testing, the following statistically significant changes took place: Heart rate increased by 73.0%, cardiac output by 85.5%, left ventriclular ejection fraction by 19.6%, and maximal mean prosthetic transvalvular gradient by 133.8%, whereas the effective orifice area index did not change.Left ventricular mass fell during one year from 215 ± 63 to 197 ± 62 g (p < 0.05).ConclusionThe Dobutamine test induces a substantial stress, well suitable for echocardiographic assessment of prosthesis valve function and can be performed in the majority of the patients. The changes in pressure gradients add to the hemodynamic characteristics of the various valve sizes.In our patients the St. Jude Regent valve performed satisfactory at rest and under pharmacological stress situation.
Highlights
The current increase in life expectancy implies increasing need for small and medium size valve replacement since the augmented number of aortic stenosis in the elderly is frequently accompanied by a narrow aortic root
Dobutamine stress echocardiography (DSE) was performed in a total of 66 and maximal peak stress was reached in 61 patients
During DSE testing, the following statistically significant changes took place: Heart rate increased by 73.0%, cardiac output by 85.5%, left ventriclular ejection fraction by 19.6%, and maximal mean prosthetic transvalvular gradient by 133.8%, whereas the effective orifice area index did not change
Summary
The current increase in life expectancy implies increasing need for small and medium size valve replacement since the augmented number of aortic stenosis in the elderly is frequently accompanied by a narrow aortic root. Bileaflet mechanical valves are considered good longterm substitutes, but are still undergoing improvements As for their assessment, dobutamine stress echocardiography (DSE) has emerged as a measure of the valve hemodynamics adding to the information obtained at rest [3,4,5,6,7,8,9,10,11,12]. The purpose of the present multicenter study was to investigate the performance of small and intermediate sizes of the St. Jude Medical Regent aortic valve, with respect to EOA at various stress levels. 112 patients who received small and medium sized St.Jude Regent heart valves (19-25 mm) at 7 Scandinavian centers were studied between January 2003 and February 2005 to obtain non-invasive data regarding the hemodynamic performance at rest and during Dobutamine stress echocardiography (DSE) testing one year after surgery
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