Are stentless valves hemodynamically superior to stented valves? A prospective randomized trial
| Autor: | Christopher D. Morgan, Campbell D. Joyner, Hari R. Mallidi, Gideon Cohen, Stephen E. Fremes, George T. Christakis, Miguel Tamariz, John P. Szalai, Vivek Rao, Bernard S. Goldman, Naoji Hanayama, Marko Katic |
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| Rok vydání: | 2002 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine Aortic valve medicine.medical_specialty medicine.medical_treatment Hemodynamics Prosthesis Design Ventricular Function Left law.invention law Internal medicine Cardiopulmonary bypass medicine Humans Ventricular outflow tract Prospective Studies Heart valve Aged Bioprosthesis business.industry Stent Aortic Valve Stenosis Perioperative Middle Aged Surgery medicine.anatomical_structure Aortic Valve Heart Valve Prosthesis Cardiology Female Cardiology and Cardiovascular Medicine business Complication |
| Zdroj: | The Annals of Thoracic Surgery. 73:767-778 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/s0003-4975(01)03338-0 |
| Popis: | Background . Although stentless aortic bioprostheses are believed to offer improved outcomes, hemodynamic benefits remain unsubstantiated. Methods . Fifty-three patients were randomized to receive the stented C-E pericardial valve (CE) and 46 patients the Toronto Stentless Porcine valve (SPV). Annuli were sized for the optimal insertion of both valve types, such that surgeons were required to commit to specific valve sizes before randomization. Echocardiographic measurements and functional status (Duke Activity Status Index) were assessed at 3 and 12 months postoperatively. Results . Although cardiopulmonary bypass times (CE: 118.6 ± 36.3 minutes; SPV: 148.5 ± 30.9 minutes; p = 0.0001) and aortic cross-clamp times (CE: 95.4 ± 28.6 minutes; SPV: 123.6 ± 24.1 minutes; p = 0.0001) were significantly prolonged in the SPV group, perioperative morbidity and mortality was similar between groups. Neither valve offered a superior internal diameter for any given annular diameter (mean decrease in left ventricular outflow tract diameter after valvular implantation: SPV: 3.4 ± 1.11 mm versus CE: 3.7 ± 1.33 mm;E p = 0.25). Although labeled mean valve size was significantly larger in the SPV group, the actual mean valve size based on internal valvular diameter was no different between groups (CE: 21.9 ± 2.0 mm; SPV: 22.3 ± 2.0 mm; p = 0.286). Although effective orifice areas increased, and mean and peak transvalvular gradients decreased in both groups over time, no differences were demonstrated between groups at 12 months. Similarly, although significant regression of left ventricular mass was accomplished in both groups over time, no differences were demonstrated between groups. Finally, Duke Activity Status Index scores of functional status improved in both groups over time; however, no differences were noted between groups at 12 months postoperatively. Conclusions . Although offering excellent outcomes, stentless valves did not demonstrate superior hemodynamic indices in comparison to stented valves up to 12 months after implantation. |
| Databáze: | OpenAIRE |
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