Related Experiment Videos
Standard versus hemodynamic plus 19-mm St Jude Medical aortic valves
G Ismeno1, A Renzulli, M De Feo
1Department of Cardio-Thoracic and Respiratory Sciences, V. Monaldi Hospital, Second University of Naples, Italy.
Insights
For aortic valve replacement in small body surface areas, both standard and Hemodynamic Plus 19-mm St Jude Medical prostheses offer similar long-term survival and complication rates. Hemodynamic performance was better with the Hemodynamic Plus model, but this did not translate to clinical benefits.
Area of Science:
- Cardiology
- Biomedical Engineering
- Prosthetic Devices
Background:
- Aortic valve replacement (AVR) is a critical procedure for patients with severe aortic stenosis.
- The choice of prosthetic valve size, particularly in patients with smaller body surface areas (BSA), can impact hemodynamic performance and clinical outcomes.
- Evaluating different prosthetic valve models is essential for optimizing patient care.
Purpose of the Study:
- To compare the clinical and hemodynamic outcomes of two 19-mm St Jude Medical aortic valve prostheses: the Standard model and the Hemodynamic Plus model.
- To assess early and late mortality, valve-related complications, hemodynamic performance, and hemolysis in patients undergoing AVR with these prostheses.
- To determine if the improved hemodynamic profile of the Hemodynamic Plus model translates to superior clinical results in patients with BSA < 1.7 m².
Main Methods:
- A retrospective review of 119 patients undergoing AVR with 19-mm St Jude Medical prostheses, divided into Standard (Group A, n=68) and Hemodynamic Plus (Group B, n=51) models.
- Comparison of preoperative variables, early and late mortality, and valve-related complications.
- Postoperative echocardiography to assess hemodynamic performance (gradients, effective orifice area).
- Laboratory tests to evaluate hemolysis due to transprosthetic turbulent flow.
Main Results:
- No significant differences in preoperative characteristics or 5-year survival rates between the groups.
- The Hemodynamic Plus model demonstrated significantly lower postoperative gradients and a larger effective orifice area.
- Despite hemodynamic advantages, no statistically significant differences were observed in overall postoperative complications or incidence of hemolysis between the two valve models.
- Postoperative left ventricular mass was similar in both groups.
Conclusions:
- Aortic valve replacement using 19-mm prostheses in patients with BSA < 1.7 m² yields favorable outcomes.
- While the Hemodynamic Plus model offers superior hemodynamic performance, this did not result in significant differences in clinical outcomes or hemolysis compared to the Standard model.
- Both valve types are suitable for AVR in this patient population, with no clear clinical advantage of one over the other despite hemodynamic differences.
Objective:
We reviewed our experience with aortic valve replacement using 19-mm St Jude Medical prostheses (St Jude Medical, Inc, St Paul, Minn) in 119 patients, among which 68 (group A) had a Standard model and 51 (group B) had a Hemodynamic Plus model.
Methods:
Comparison between the 2 models included analysis of early and late mortality and all valve-related complications. Postoperative echocardiography was performed to evaluate the hemodynamic performance of both prosthetic models. Laboratory tests were performed to evaluate the amount of red blood cell damage caused by the transprosthetic turbulent flow.
Results:
Average body surface area was 1.66 +/- 0.14 m(2) in group A and 1.65 +/- 0.16 m(2) in group B (P =.72). There was no statistically significant difference between the 2 groups in terms of preoperative variables (sex, cardiac rhythm, body surface area, preoperative gradients, and New York Heart Association class). Five-year follow-up was 100% complete. Although group A patients had significantly higher postoperative peak and mean gradients (P =.0001) and a lower effective orifice area (P =.0001), no statistical differences were found in terms of late (5-year) survival (P =.6) and postoperative complications (P =.09). Moreover, postoperative left ventricular mass was found to be similar in the 2 groups (P =.18). Hematologic evaluation did not show any significant difference between the 2 groups as to incidence of hemolysis.
Conclusions:
Aortic valve replacement with 19-mm aortic prostheses in patients with a body surface area of less than 1.7 m(2) allows good results. Although Hemodynamic Plus models have better hemodynamic results, no significant difference was found in terms of clinical results and clinical hemolysis.