1. Hemodynamic benefits of the Toronto Stentless Valve.
- Author
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Del Rizzo DF, Goldman BS, Christakis GT, and David TE
- Subjects
- Actuarial Analysis, Aged, Aged, 80 and over, Aortic Valve Insufficiency complications, Aortic Valve Insufficiency diagnostic imaging, Aortic Valve Insufficiency surgery, Disease-Free Survival, Echocardiography, Female, Follow-Up Studies, Humans, Hypertrophy, Left Ventricular diagnostic imaging, Hypertrophy, Left Ventricular etiology, Male, Middle Aged, Prospective Studies, Stents, Treatment Outcome, Aortic Valve Insufficiency physiopathology, Heart Valve Prosthesis methods, Hemodynamics, Hypertrophy, Left Ventricular physiopathology
- Abstract
We report on 254 consecutive patients (170 male, 84 female) undergoing aortic valve replacement with the Toronto SPV Stentless Valve (St. Jude Medical, Inc., St. Paul, Minn.). Mean age (+/- standard deviation) was 62.1 +/- 11.6 years. Three patients (1%) received sizes 21 or 22 mm, 24 (9%) received size 23 mm, and 227 patients (89%) received sizes 25, 27, or 29 mm. Serial echocardiography was used to assess valve performance during a 3-year follow-up. Mean gradient decreased by 35.8% (p < 0.0001; 95% confidence interval -39.6%, -31.7%) from postoperative values to the 3- to 6-month follow-up and by 6.1% (p = 0.004; 95% confidence interval -10.1%, -2%) at each subsequent interval; effective orifice area increased by 17.2% (p = 0.0001; 95% confidence interval 12.0%, 22.6%) initially and by 4.4% (p < 0.001; 95% confidence interval 1.8%, 7.0%) thereafter. At 2 years of follow-up, mean gradient was 3.3 +/- 2.1 mm Hg and mean effective orifice area was 2.2 +/- 0.8 cm2. Studies on left ventricular mass were carried out on 84 patients. Left ventricular mass decreased by 14.3% (37.8 +/- 57.9 gm; p < 0.0001; 95% confidence interval -53.7, -21.9 gm) and left ventricular mass index decreased by 15.2% (21.1 +/- 30.5 gm/m2; p < 0.0001; 95% confidence interval -29.5, -12.7 gm/m2) from postoperative values to the 3- to 6-month follow-up interval. The reduction in residual gradient and potential regression in left ventricular hypertrophy may have a beneficial prognostic implication. We believe that the unique stentless design of the Toronto SPV Stentless Valve allows this to occur.
- Published
- 1996
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