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Serial hemodynamic study after aortic valve replacement in patients with narrow aortic roots
U Hachida1, H Koyanagi, M Nonoyama
1Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical College.
Insights
The St. Jude Medical HP valve offers better hemodynamic performance than the standard SJM valve in small aortic annuli. Annular enlargement may benefit patients with reduced ejection fraction and severe ventricular hypertrophy.
Area of Science:
- Cardiac Surgery
- Cardiovascular Hemodynamics
- Prosthetic Heart Valves
Background:
- Small aortic annuli (19-mm diameter) pose challenges for effective aortic valve replacement.
- Traditional valve prostheses can lead to suboptimal hemodynamic outcomes in these cases.
Purpose of the Study:
- To compare the hemodynamic performance of different aortic valve replacement strategies in patients with small aortic annuli.
- Evaluate outcomes with a standard 19-mm St. Jude Medical (SJM) valve, a 19-mm SJM HP valve, and annular enlargement.
Main Methods:
- Postoperative hemodynamics were assessed in three patient groups: standard 19-mm SJM, 19-mm SJM HP, and annular enlargement.
- Echocardiography measured percent fraction shortening, peak pressure gradient, effective orifice area, and left ventricular mass.
Main Results:
- The 19-mm SJM HP valve and annular enlargement groups showed significantly lower postoperative peak systolic pressure gradients compared to the standard SJM group.
- Improved percent fraction shortening and reduced left ventricular mass index were observed in the SJM HP and annular enlargement groups.
- Effective orifice area increased significantly during exercise only in the annular enlargement group.
Conclusions:
- The 19-mm SJM HP valve demonstrates superior hemodynamic performance compared to the standard 19-mm SJM valve in small aortic annuli.
- Annular enlargement is a potentially beneficial strategy for patients with impaired ejection fraction and significant ventricular hypertrophy.
Background And Aims Of The Study:
The purpose of this study was to evaluate the hemodynamic performance after aortic valve replacement using different surgical options in small (19-mm diameter) annuli.
Methods:
Postoperative hemodynamics were assessed in three groups according to the surgical method. A 19-mm St. Jude Medical (SJM) valve was used in nine patients (group A), a 19-mm SJM HP in nine patients (group B), and annular enlargement was performed in eight patients (group C). Echocardiography was performed and percent fraction shortening, peak pressure gradient, effective orifice area and left ventricular mass were measured.
Results:
Postoperative peak systolic pressure gradient was decreased to 31.1+/-8.7 mmHg in group B, and to 22.3+/-11.7 mmHg in group C, but was 42.9+/-16.5 mmHg in group A (p <0.01). Percent fraction shortening and left ventricular mass index were improved in groups B and C, soon after surgery compared with group A (p <0.01). The effective orifice area significantly increased during exercise in group C, from 1.59 to 1.87 cm2 (p <0.01), but was not increased in groups A and B (N.S.).
Conclusions:
The small SJM HP provides a better hemodynamic performance than the standard 19 mm SJM. However, annular enlargement may be beneficial in patients with poor ejection fraction and severe ventricular hypertrophy.