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Criteria to select proper valve prosthesis for aortic valve replacement. Comparative assessment of various valve

M Shigenobu1, S Sano

  • 1Department of Cardiovascular Surgery, Okayama University Medical School, Japan.

The Journal of Cardiovascular Surgery
|June 1, 1993
PubMed

Insights

This study compared pressure gradients across four aortic valve prostheses. St. Jude Medical and Björk-Shiley valves showed better performance, while Lillehei-Kaster and Omniscience valves had higher gradients, necessitating careful patient follow-up.

Area of Science:

  • Cardiovascular Surgery
  • Biomedical Engineering
  • Clinical Cardiology

Background:

  • Aortic valve prostheses are crucial for managing aortic valve disease.
  • Different prosthetic valve designs may impact hemodynamic performance.
  • Understanding pressure gradients is key to assessing valve function.

Purpose of the Study:

  • To compare pressure gradients (PG) across four types of aortic valve prostheses: St. Jude Medical (SJM), Björk-Shiley (B-S), Lillehei-Kaster (L-K), and Omniscience (O-S).
  • To evaluate the relationship between valve area index (VAI) and PG for each prosthesis type.
  • To identify optimal valve selection for specific patient body surface areas to maintain low pressure gradients.

Main Methods:

  • Continuous wave Doppler echocardiography was employed to measure pressure gradients in 147 patients across four prosthetic valves.
  • Cineradiography was used to determine disc-opening angles for the L-K and O-S valves.
  • Statistical analysis, including correlation studies between VAI and PG, was performed.

Main Results:

  • St. Jude Medical valves exhibited consistently low pressure gradients.
  • A significant negative correlation between VAI and PG was observed for SJM and B-S valves.
  • Lillehei-Kaster and Omniscience valves showed no significant VAI-PG correlation, with higher instances of elevated pressure gradients (>50 mmHg) due to suboptimal disc-opening angles.

Conclusions:

  • St. Jude Medical and Björk-Shiley valves demonstrate favorable hemodynamic profiles, with specific sizes recommended for patients with body surface areas of 1.3-1.7 m2 to maintain PG below 20 mmHg.
  • The suboptimal disc-opening angles of Lillehei-Kaster and Omniscience valves contribute to higher pressure gradients.
  • Patients with L-K and O-S prostheses require vigilant monitoring due to the increased risk of significant pressure gradients.

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