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Clinical and hemodynamic evaluation of the 19 mm Björk-Shiley aortic valve prosthesis
Insights
The 19 mm Björk-Shiley prosthesis offers a satisfactory aortic valve replacement option for patients with small aortic roots, demonstrating good long-term survival and improved left ventricular function.
Area of Science:
- Cardiovascular Surgery
- Biomaterials in Medicine
- Cardiac Valve Disease
Background:
- Isolated aortic valve replacement is a critical procedure for patients with aortic valve disease.
- The selection of appropriate prosthesis size is crucial, especially for patients with small aortic roots.
- The Björk-Shiley prosthesis has been utilized in aortic valve replacement procedures.
Purpose of the Study:
- To evaluate the outcomes of isolated aortic valve replacement using the 19 mm Björk-Shiley prosthesis.
- To assess the efficacy and safety of this specific prosthesis in patients with small aortic roots.
- To analyze long-term survival, functional status, and hemodynamic performance post-surgery.
Main Methods:
- Retrospective analysis of 43 patients who underwent isolated aortic valve replacement with 19 mm Björk-Shiley prostheses (1973-1980).
- Inclusion of echocardiographic and cardiac catheterization data for hemodynamic and structural assessments.
- Follow-up of survivors to determine long-term survival rates and functional class.
Main Results:
- Hospital mortality was 5.9% since 1975, with 81% actuarial survival at five years post-discharge.
- Significant decreases in left ventricular wall thickness and mass were observed post-operatively.
- Postoperative peak systolic gradient was related to body surface area, with an average effective valve orifice area of 1.06 cm2.
Conclusions:
- The 19 mm Björk-Shiley valve replacement is a safe and effective option for patients with small aortic roots.
- This prosthesis leads to favorable long-term functional outcomes and cardiac remodeling.
- It may be a preferable alternative to aortic annuloplasty for accommodating larger prostheses in select patients.
Abstract:
Between November, 1973, and March, 1980, 43 patients underwent isolated aortic valve replacement with 19 mm Björk-Shiley prostheses at the Johns Hopkins Hospital. There were 4 male and 39 female patients ranging from 12 to 75 years old (mean, 54.5 years). Average weight was 62 +/- 2 kg and average body surface area, 1.64 +/- 0.3 m2. Five patients died within thirty days of operation; however, since 1975, hospital mortality has been 5.9%. The 38 survivors have been followed up for as long as 85 months (mean, 40 months). There were 4 late deaths, and actuarial survival in patients discharged from the hospital was 81% at five years. All long-term survivors were in New York Heart Association Functional Class I (29 patients) or Class II (5 patients). Preoperative and postoperative echocardiograms in 17 patients demonstrated significant decreases in mean left ventricular wall thickness (12.9 +/- 1.8 mm vs 10.3 +/- 1.4 mm; p less than 0.001) and in left ventricular mass (262 +/- 95 gm vs 188 +/- 50 gm; p less than 0.02). Postoperative cardiac catheterization data were obtained from an additional 24 patients undergoing aortic valve replacement with the 19 mm Björk-Shiley prosthesis at the National Heart Institute. Average peak systolic gradient at rest was 16 mm Hg (range, 0 to 45 mm Hg) and was found to be directly related to body surface area (r = 0.60, p less than 0.002). Average effective valve orifice area was 1.06 cm2 (range, 0.63 to 2.02 cm2). For patients with small aortic roots, aortic valve replacement with the 19 mm Björk-Shiley valve is a satisfactory and, perhaps, preferable alternative to aortic annuloplasty to accommodate larger sized prostheses.