The Scandinavian multicenter hemodynamic evaluation of the SJM Regent aortic valve

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.

On-X versus St Jude Medical Regent mechanical aortic valve prostheses: early haemodynamics

“…These valves are shown to provide excellent early 2 and long-term 3 haemodynamic results with stable haemodynamics in the first year after implantation. 4 It has a higher orifice to annulus ratio than predecessor valves such as the SJM Masters HP, yet the suggestion for its use in small aortic roots. 6 The 19 mm SJM Regent has been shown to have a larger effective orifice area than a 19 mm On-X valve.…”

Hemodynamic assessment of Perceval sutureless bioprosthesis by dobutamine stress echocardiography

“…This is a general finding when the performances of aortic prostheses are investigated under stress. Offstad et al . reported a 134% increase in mean transvalvular gradients at peak stress in a cohort of patients receiving mechanical prostheses.…”

Emerging Trends in Heart Valve Engineering: Part II. Novel and Standard Technologies for Aortic Valve Replacement

“…55 This valve was successfully implanted in a human in 1960, and while revolutionary, due to its design, it has high transvalvular gradients in smaller sizes that disrupt hemodynamics and the patient requires lifetime anticoagulation. Although the ball-and-cage valve is not used today because of its shortcomings, 62 mechanical valve technology has improved, by leaps and bounds, and still provides the patient with a durable valve that rarely has mechanical failure. In fact, according to the Society of Thoracic Surgeons adult cardiac surgery database, mechanical valves were implanted into 34% of all patients 30 years of age or younger undergoing aortic valve surgery.…”