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Ann Thorac Surg 2009;87:90-94. doi:10.1016/j.athoracsur.2008.09.051
© 2009 The Society of Thoracic Surgeons
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Right arrow Valve disease

Original Articles: Adult Cardiac

The 17-mm St. Jude Medical Regent Valve Is a Valid Option for Patients With a Small Aortic Annulus

Homare Okamura, MD*, Atsushi Yamaguchi, MD, Masashi Tanaka, MD, Kazuhiro Naito, MD, Naoyuki Kimura, MD, Chieri Kimura, MD, Toshiyuki Kobinata, MD, Takashi Ino, MD, Hideo Adachi, MD

Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan

Accepted for publication September 23, 2008.

* Address correspondence to Dr Okamura, Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho Omiya-ku Saitama-shi, Saitama, 330-8503, Japan (Email: homareokamura{at}hotmail.co.jp).

Background: When aortic valve replacement is performed in patients with a small aortic annulus, prosthesis–patient mismatch is of concern. Such prosthesis–patient mismatch may affect postoperative clinical status and survival. We investigated the outcomes of isolated aortic valve replacement performed with a 17-mm mechanical prosthesis in patients with aortic stenosis.

Methods: Twenty-three patients with aortic stenosis (mean age, 74.6 ± 6.3 years) underwent isolated aortic valve replacement with a 17-mm St. Jude Medical Regent prosthesis. Mean body surface area was 1.41 ± 0.13 m2. Preoperative echocardiography yielded a mean aortic valve area of 0.36 ± 0.10 cm2/m2, a mean left ventricular–aortic pressure gradient of 68.4 ± 25.3 mm Hg, and a mean left ventricular mass index of 200 ± 69 g/m2.

Results: There was no operative mortality, and there were no valve-related events. Echocardiography at 14.0 ± 10.0 months after aortic valve replacement showed a significant increase in the mean effective orifice area index (0.95 ± 0.24 cm2/m2), decrease in the mean left ventricular–aortic pressure gradient (17.4 ± 8.2 mm Hg), and decrease in the mean left ventricular mass index (124 ± 37 cm2/m2). Prosthesis–patient mismatch (effective orifice area index < 0.85 cm2/m2) was present in 8 patients at discharge. In these patients as well as in those without prosthesis–patient mismatch, the left ventricular mass index decreased remarkably during follow-up.

Conclusions: Aortic valve replacement with a 17-mm Regent prosthesis appears to provide satisfactory clinical and hemodynamic results in patients with a small aortic annulus. Remarkable left ventricular mass regression during follow-up was achieved irrespective of the effective orifice area index at discharge.




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