Seventeen-millimeter St. Jude Medical Regent valve in patients with small aortic annulus: dose moderate prosthesis-patient mismatch matter?
نویسندگان
چکیده
BACKGROUND The study was designed to evaluate the effects of moderate prosthesis-patient mismatch (defined as 0.65 cm(2)/m(2) <indexed effective orifice area ≤ 0.85 cm(2)/m(2)) on midterm outcomes after isolated aortic valve replacement with a 17-mm St. Jude Medical Regent valve in a large series of patients, and to determine if these effects are influenced by patient confounding variables. METHODS One-hundred and six patients with and without moderate prosthesis-patient mismatch early after implantation of a 17-mm Regent valve at aortic position were included. Both clinical and echocardiographic assessments were performed preoperatively, at discharge and during follow-up period (mean follow-up time 52.6 ± 11.9 months). RESULTS The prevalence of moderate prosthesis-patient mismatch was documented in 46 patients (43.4%) at discharge. During the follow-up period, no difference in the regression of left ventricular mass, decrease of transvalvular pressure gradients, mortality and prosthesis-related complications was observed between patients with and without moderate prosthesis-patient mismatch. After adjustment for several risk factors, moderate prosthesis-patient mismatch was associated with increased midterm mortality in patients with baseline left ventricular ejection fraction<50% (HR: 1.80, p=0.02), but with normal prognosis in those with preserved LV function. Younger age (cut off value=65 years) was not an independent predictor of increased midterm mortality and valve-related complications in patients with moderate prosthesis-patient mismatch. CONCLUSIONS Moderate prosthesis-patient mismatch after aortic valve replacement with a small mechanical prosthesis is associated with increased mortality and adverse events in patients with pre-existing left ventricular dysfunction. Selected patients with small aortic annulus can experience satisfactory clinical improvements and midterm survival after aortic valve replacement with a 17-mm Regent valve.
منابع مشابه
A case of aortic valve replacement with St. Jude Medical Regent valve (first implant in Japan).
The St. Jude Medical (SJM) Regent valve was developed as a new mechanical valve by improving the conventional SJM valve. The effective orifice area is wider than that of Hemodynamic Plus (HP) series. The efficacy of the new valve has been reported in Europe and the United States. On October 26, 2004, we first performed aortic valve replacement (AVR) with the SJM Regent valve for aortic valve st...
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