Valve Replacement in Narrow Aortic Roots: Serial Hemodynamics and Long-Term Clinical Outcome

Foster, Andrew H.; Tracy, Cynthia M.; Greenberg, Gail J.; McIntosh, Charles L.; Clark, Richard E.

doi:10.1016/s0003-4975(10)60572-3

Cited by 24 publications

(6 citation statements)

References 33 publications

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“…A small prosthesis in a normal aortic annulus may not provide clinical or hemodynamic benefits to a large or physically active individual. Foster and colleagues 10 found no correlation between aortic transvalvular gradients and clinical status during long-term follow-up of patients with a body surface area of 1.6 m 2 who had received 17-mm or 19-mm Bjork-Shiley valves. In our patients whose mean body surface area was 1.33 m 2 , aortic valve replacement with a 19-mm valve (Medtronic-Hall or St. Jude Medical) was found to be adequate with acceptable gradients and good functional benefits.…”

Section: Discussionmentioning

confidence: 97%

Enlargement of Small Aortic Annulus by Modified Manouguian's Technique

Sankar

Rajan

Singh

et al. 1999

Asian Cardiovasc Thorac Ann

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From January 1981 to June 1994, 17 patients underwent aortic annulus enlargement by a modified Manouguian's technique. A small aortic root associated with stenotic lesions was the main indication. The ages of the patients ranged from 5 to 55 years (mean, 21 ± 14 years). There were 10 males and 7 females. Four had concomitant mitral valve replacement, 2 had open mitral valvotomy, 1 underwent ventricular septal defect closure, excision of a subaortic membrane, and ascending aortic replacement. The aortic roots were enlarged to between 20 to 30 mm. A Dacron patch was used in 16 patients and glutaraldehyde-treated autologous pericardium was used in 1. Two patients (12%) died in the postoperative period, 1 due to hemorrhage and the other due to septicemia. Mitral regurgitation (grade 1) was seen in 1 patient postoperatively but there was no further deterioration on serial evaluation. Four patients were lost to follow-up. Of the 11 followed up over a period of 10 years, 7 were in New York Heart Association functional class I and 4 were in class II.

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Section: Discussionmentioning

confidence: 97%

Enlargement of Small Aortic Annulus by Modified Manouguian's Technique

Sankar

Rajan

Singh

et al. 1999

Asian Cardiovasc Thorac Ann

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“…For the future it appears worthwhile to try to avoid use of 19-mm and 21-mrn prosthetic valves by: (1) using annular enlarging techniques, (2) using allografts or the Ross procedure, or (3) designing devices with greater effective orifice areas. Considerations of patient age, activity level, potential longevity, and cardiac anatomy enter into these clinical decisions.…”

Section: Discussionmentioning

confidence: 99%

Prosthetic Valves for the Small Aortic Root

Barner

Labovitz²,

Fiore³

1994

J Cardiac Surgery

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Mechanical aortic valves (AVs) are frequently implanted in small (19 and 21 mm) aortic roots because bioprosthetic valves have unacceptably high gradients and many surgeons do not implant allograft valves. Three mechanical valves in common use today in the United States are the Starr-Edwards (SE), St. Jude Medical (SJ), and the Medtronic-Hall (MH). Clinical hemodynamic studies reveal that the 21-mm SE valve (size 8A) has peak systolic gradients of 13 to 58 mmHg (N = 6) with a calculated effective orifice of 0.7 to 1.4 cm2. The 19-mm SJ valve has a gradient at peak pressure of 17 mmHg and a mean gradient of 22 mmHg (N = 6) with respective exercise gradients of 32 and 38 mmHg (N = 5). For the 21-mm SJ valve the mean gradient was 5.2 +/- 5.3 (N +/- 12) and the gradient at peak pressure was 6.0 mmHg (N = 15). The 21-mm MH valve had resting gradients at peak pressure of 10.5 (N = 3) and 12.4 mmHg (N = 9) and exercise gradients of 15.8 mmHg (N = 9). Six months after AV replacement with small SJ or MH (N = 14) or large (23 mm or greater) (N = 83) valves, cardiac output was 4.7 versus 6.4 L/min (p < 0.03), percent reduction in left ventricular mass index (LVMI) was -8% versus -21% (p < 0.01), exercise duration was 370 versus 555 seconds, and congestive heart failure (CHF) class was 1.9 versus 1.1 (p < 0.0001). Change in LVMI and valve size were the only independent predictors of CHF class.(ABSTRACT TRUNCATED AT 250 WORDS)

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“…The initial measure can be the implantation of a small high performance hemodynamic prosthesis, such as those produced by St. Jude and CarboMedics [6,7]. This is acceptable in elderly patients or patients with smaller body surfaces [8], but the resultant residual gradient can cause limited longitudinal incision in the interventricular septum is performed, permitting an additional enlargement.…”

Section: Commentsmentioning

confidence: 99%