HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Ole Lund Hans K. Pilegaard Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lund, O. Articles by Kristensen, L. H. Search for Related Content PubMed PubMed Citation Articles by Lund, O. Articles by Kristensen, L. H.

Ann Thorac Surg 1997;63:1227-1234
© 1997 The Society of Thoracic Surgeons

---

Original Article: Cardiovascular

Impact of Size Mismatch and Left Ventricular Function on Performance of the St. Jude Disc Valve After Aortic Valve Replacement

Departments of Thoracic and Cardiovascular Surgery, Cardiology, and Clinical Physiology and Nuclear Medicine, Skejby Sygehus, Aarhus University Hospital, Aarhus, Denmark

Background. The hemodynamic function of the St. Jude valve may change relative to changes in left ventricular function after aortic valve replacement for aortic stenosis. From theoretical reasons one may hypothesize that prosthetic valve hemodynamic function is related to left ventricular failure and mismatch between valve size and patient/ventricular chamber size.

Methods. Forty patients aged 24 to 82 years who survived aortic valve replacement for aortic stenosis with a standard St. Jude disc valve (mean size, 23.5 mm; range, 19 to 29 mm) were followed up prospectively with Doppler echocardiography and radionuclide left ventriculography preoperatively and 9 days, 3 months, and 18 months after the operation with assessment of intravascular hemolysis at 18 months. Follow-up to a maximum of 7.4 years (mean, 6.3 years) was 100% complete.

Results. Left ventricular muscle mass index decreased from 198 ± 62 g•m^-2 preoperatively to 153 ± 53 g•m^-2 at 18 months (p < 0.001), paralleled by a significant increase in left ventricular ejection fraction, peak ejection rate, and peak filling rate; only 18% of the patients had normal left ventricular muscle mass index and only 32% normal ventricular function (normal left ventricular ejection fraction, peak ejection rate, peak filling rate, early filling fraction, and late filling fraction during atrial contraction) at 18 months. Prosthetic valve peak Doppler gradient dropped from 20 ± 6 mm Hg at 9 days to 17 ± 5 mm Hg at 18 months (p < 0.05). Reduction of left ventricular muscle mass index was unrelated to peak gradient and size of the valve. Peak gradient at 18 months rose with valve orifice diameter of 17 mm or less (by 6 mm Hg), orifice diameter/body surface area of 9 mm•m^-2 or less (by 5 mm Hg), left ventricular end-diastolic dimension (by 23 mm Hg per 10 mm increase), and impaired ventricular function (by 3 mm Hg). All but 2 patients (5%) had intravascular hemolysis; none had anemia. Two patients with moderate paravalvular leak had the highest serum lactic dehydrogenase levels; 4 patients with trivial leak had higher serum lactic dehydrogenase levels than those without leak. Serum lactic dehydrogenase levels rose with moderate paravalvular leak, impaired ventricular function, and valve orifice diameter. Six patients with trivial or moderate paravalvular leak had a cumulative 7-year freedom from bleeding and thromboembolism of 44% ± 22% compared with 87% ± 5% for those without leak (p < 0.05).

Conclusions. The peak gradient of the St. Jude aortic valve dropped marginally over the first 18 postoperative months in association with incomplete left ventricular hypertrophy regression and marginal improvement of ventricular function. Mismatch between valve size and ventricular cavity size or patient size and impaired function of a dilated ventricle significantly compromised the performance of the St. Jude valve. Probably explained by platelet destruction or activation, paravalvular leak was related to bleeding and thromboembolic complications.

This article has been cited by other articles:

				A. Roscitano, U. Benedetto, A. Sciangula, E. Merico, F. Barberi, R. Bianchini, E. Tonelli, and R. Sinatra Indexed effective orifice area after mechanical aortic valve replacement does not affect left ventricular mass regression in elderly Eur. J. Cardiothorac. Surg., February 1, 2006; 29(2): 139 - 143. [Abstract] [Full Text] [PDF]

				G. Tasca, F. Brunelli, M. Cirillo, M. DallaTomba, Z. Mhagna, G. Troise, and E. Quaini Impact of Valve Prosthesis-Patient Mismatch on Left Ventricular Mass Regression Following Aortic Valve Replacement Ann. Thorac. Surg., February 1, 2005; 79(2): 505 - 510. [Abstract] [Full Text] [PDF]

				T. Okumiya, M. Ishikawa-Nishi, T. Doi, M. Kamioka, H. Takeuchi, Y. Doi, and T. Sugiura Evaluation of Intravascular Hemolysis With Erythrocyte Creatine in Patients With Cardiac Valve Prostheses Chest, June 1, 2004; 125(6): 2115 - 2120. [Abstract] [Full Text] [PDF]

				O. Lund, K. Emmertsen, I. Dorup, F. T. Jensen, and C. Flo Regression of left ventricular hypertrophy during 10 years after valve replacement for aortic stenosis is related to the preoperative risk profile Eur. Heart J., August 1, 2003; 24(15): 1437 - 1446. [Abstract] [Full Text] [PDF]

				M. Peschar, K. Vernooy, W. Y.R Vanagt, R. S Reneman, M. A Vos, and F. W Prinzen Absence of reverse electrical remodeling during regression of volume overload hypertrophy in canine ventricles Cardiovasc Res, June 1, 2003; 58(3): 510 - 517. [Abstract] [Full Text] [PDF]

				H. Niinami, S. Aomi, H. Tomioka, K. Nakano, and H. Koyanagi A comparison of the in vivo performance of the 19-mm St. Jude medical hemodynamic plus and 21-mm standard valve Ann. Thorac. Surg., October 1, 2002; 74(4): 1120 - 1124. [Abstract] [Full Text] [PDF]

				A. D. Milano, M. De Carlo, G. Mecozzi, A. D'Alfonso, G. Scioti, C. Nardi, and U. Bortolotti Clinical outcome in patients with 19-mm and 21-mm St. Jude aortic prostheses: comparison at long-term follow-up Ann. Thorac. Surg., January 1, 2002; 73(1): 37 - 43. [Abstract] [Full Text] [PDF]

				O. Lund, S. L. Nielsen, H. Arildsen, L. B. Ilkjaer, and H. K. Pilegaard Standard aortic St. Jude valve at 18 years: performance profile and determinants of outcome Ann. Thorac. Surg., May 1, 2000; 69(5): 1459 - 1465. [Abstract] [Full Text] [PDF]

				O. Lund, H. K. Pilegaard, L. B. Ilkjaer, S. L. Nielsen, and H. Arildsen Performance profile of the Starr-Edwards aortic cloth covered valve, track valve, and silastic ball valve Eur. J. Cardiothorac. Surg., October 1, 1999; 16(4): 403 - 413. [Abstract] [Full Text] [PDF]

				O. Lund, V. Chandrasekaran, R. Grocott-Mason, H. Elwidaa, R. Mazhar, A. Khaghani, A. Mitchell, C. Ilsley, and M. H. Yacoub PRIMARY AORTIC VALVE REPLACEMENT WITH ALLOGRAFTS OVER TWENTY-FIVE YEARS: VALVE-RELATED AND PROCEDURE-RELATED DETERMINANTS OF OUTCOME J. Thorac. Cardiovasc. Surg., January 1, 1999; 117(1): 77 - 91. [Abstract] [Full Text] [PDF]

				R. D. Paulis, MD, L. Sommariva, MD, L. Colagrande, MD, G. M. De Matteis, MD, S. Fratini, MD, F. Tomai, MD, C. Bassano, MD, A. P. de Peppo, MD, and L. Chiariello, MD REGRESSION OF LEFT VENTRICULAR HYPERTROPHY AFTER AORTIC VALVE REPLACEMENT FOR AORTIC STENOSIS WITH DIFFERENT VALVE SUBSTITUTES J. Thorac. Cardiovasc. Surg., October 1, 1998; 116(4): 590 - 598. [Abstract] [Full Text] [PDF]