Cargando…

Early and mid-term outcome in terms of functional and hemodynamic performance of the st. Jude regent 19-mm aortic mechanical prosthesis versus 19-mm carpentier edwards aortic biological prosthesis

BACKGROUND: The aim of the present study is to compare the early and mid-term clinical and hemodynamic results of the aortic valve replacement (AVR) with a St Jude Medical Regent 19-mm prosthesis (SJMR-19) versus Carpentied-Edwars bovine pericardial 19-mm valve (CE-19). METHODS: Between January 2002...

Descripción completa

Detalles Bibliográficos
Autores principales: Prifti, Edvin, Bonacchi, Massimo, Ademaj, Fadil, Giunti, Gabriele, Esposito, Giampiero, Baboci, Arben, Bajraktari, Gani, Veshti, Altin, Demiraj, Aurel, Vanini, Vittorio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4635601/
https://www.ncbi.nlm.nih.gov/pubmed/26541289
http://dx.doi.org/10.1186/s13019-015-0361-3
_version_ 1782399529927049216
author Prifti, Edvin
Bonacchi, Massimo
Ademaj, Fadil
Giunti, Gabriele
Esposito, Giampiero
Baboci, Arben
Bajraktari, Gani
Veshti, Altin
Demiraj, Aurel
Vanini, Vittorio
author_facet Prifti, Edvin
Bonacchi, Massimo
Ademaj, Fadil
Giunti, Gabriele
Esposito, Giampiero
Baboci, Arben
Bajraktari, Gani
Veshti, Altin
Demiraj, Aurel
Vanini, Vittorio
author_sort Prifti, Edvin
collection PubMed
description BACKGROUND: The aim of the present study is to compare the early and mid-term clinical and hemodynamic results of the aortic valve replacement (AVR) with a St Jude Medical Regent 19-mm prosthesis (SJMR-19) versus Carpentied-Edwars bovine pericardial 19-mm valve (CE-19). METHODS: Between January 2002 and January 2012, 265 patients (Group I) and 58 patients (Group II) with underwent AVR with a SJMR-19 and CE-19 respectively. There were no significant differences between groups regarding the demographic and preoperative echocardiographic data. Thirty-six patients in Group I and 4 in Group II required annulus enlargement in association or not with septal myectomy. The mean follow-up was 34 ± 18.5 months (range 5–60 months). RESULTS: There were 14 (5.3 %) hospital deaths in Group I versus 4 (6.8 %) in Group II (p = 0.86). The multivariate logistic regression analysis identified the LVEF ≤ 35 % (p = 0.001), combined operation (p = 0.0005), CPB (p = 0.033), age (p = 0.011), annulus enlargement (p = 0.0009), reoperation (p = 0.039) and chronic renal failure (p = 0.011) as strong predictors for early postoperative death. Within 1 year after surgery peak pulmonary artery pressure, interventricular septal and left ventricular posterior wall thickness decreased significantly in both groups. The M-TPG was 15.7 ± 6.5 mmHg in Group I versus 17 ± 7 mmHg in Group II (p = 0.19). The multivariate regression analysis revealed the annulus enlargement (p = 0.018), small EOA(i) (p = 0.00004), postoperative LVM(i) (p = 0.0001) and BSA (p = 0.019) as strong predictors for higher M-TPG. The postoperative LVM(i) was 119 ± 22.5 gm/m(2) in Group I and 122 ± 22 gm/m(2) in Group II (p = 0.37), significantly lower than the respective preoperative values 162.5 ± 34 gm/m(2) (Group I) and 168 ± 30 gm/m(2) (Group II). The actuarial survival and cumulative free-reoperation actuarial survival at 5 years follow-up were 96.7 and 94.5 % respectively in Group I and 97 and 91 % in Group II.. There were non significant differences between groups regarding the actuarial survival and cumulative free-reoperation survival. The Cox model identified the older age (p = 0.022), LVEF ≤ 35 % (p = 0.009), reoperation (p = 0.018), combined surgery (p = 0.00075) and annulus enlargement (p = 0.033) as strong predictors for poor actuarial free-reoperation survival. CONCLUSIONS: Both the SJMR-19 and CE-19 offers excellent postoperative clinical and hemodynamic outcome in patients with small aortic annulus. The LV hypertrophy and transvalvular gradients are reduced significantly indenpendently of the employed SJMR-19 or CE-19 prosthesis. Our data support recent suggestions that small valve size does not influence intermediate free-reoperation survival. The CE-19 is an excellent alternative to SJMR-19 in old patients.
format Online
Article
Text
id pubmed-4635601
institution National Center for Biotechnology Information
language English
publishDate 2015
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-46356012015-11-07 Early and mid-term outcome in terms of functional and hemodynamic performance of the st. Jude regent 19-mm aortic mechanical prosthesis versus 19-mm carpentier edwards aortic biological prosthesis Prifti, Edvin Bonacchi, Massimo Ademaj, Fadil Giunti, Gabriele Esposito, Giampiero Baboci, Arben Bajraktari, Gani Veshti, Altin Demiraj, Aurel Vanini, Vittorio J Cardiothorac Surg Research Article BACKGROUND: The aim of the present study is to compare the early and mid-term clinical and hemodynamic results of the aortic valve replacement (AVR) with a St Jude Medical Regent 19-mm prosthesis (SJMR-19) versus Carpentied-Edwars bovine pericardial 19-mm valve (CE-19). METHODS: Between January 2002 and January 2012, 265 patients (Group I) and 58 patients (Group II) with underwent AVR with a SJMR-19 and CE-19 respectively. There were no significant differences between groups regarding the demographic and preoperative echocardiographic data. Thirty-six patients in Group I and 4 in Group II required annulus enlargement in association or not with septal myectomy. The mean follow-up was 34 ± 18.5 months (range 5–60 months). RESULTS: There were 14 (5.3 %) hospital deaths in Group I versus 4 (6.8 %) in Group II (p = 0.86). The multivariate logistic regression analysis identified the LVEF ≤ 35 % (p = 0.001), combined operation (p = 0.0005), CPB (p = 0.033), age (p = 0.011), annulus enlargement (p = 0.0009), reoperation (p = 0.039) and chronic renal failure (p = 0.011) as strong predictors for early postoperative death. Within 1 year after surgery peak pulmonary artery pressure, interventricular septal and left ventricular posterior wall thickness decreased significantly in both groups. The M-TPG was 15.7 ± 6.5 mmHg in Group I versus 17 ± 7 mmHg in Group II (p = 0.19). The multivariate regression analysis revealed the annulus enlargement (p = 0.018), small EOA(i) (p = 0.00004), postoperative LVM(i) (p = 0.0001) and BSA (p = 0.019) as strong predictors for higher M-TPG. The postoperative LVM(i) was 119 ± 22.5 gm/m(2) in Group I and 122 ± 22 gm/m(2) in Group II (p = 0.37), significantly lower than the respective preoperative values 162.5 ± 34 gm/m(2) (Group I) and 168 ± 30 gm/m(2) (Group II). The actuarial survival and cumulative free-reoperation actuarial survival at 5 years follow-up were 96.7 and 94.5 % respectively in Group I and 97 and 91 % in Group II.. There were non significant differences between groups regarding the actuarial survival and cumulative free-reoperation survival. The Cox model identified the older age (p = 0.022), LVEF ≤ 35 % (p = 0.009), reoperation (p = 0.018), combined surgery (p = 0.00075) and annulus enlargement (p = 0.033) as strong predictors for poor actuarial free-reoperation survival. CONCLUSIONS: Both the SJMR-19 and CE-19 offers excellent postoperative clinical and hemodynamic outcome in patients with small aortic annulus. The LV hypertrophy and transvalvular gradients are reduced significantly indenpendently of the employed SJMR-19 or CE-19 prosthesis. Our data support recent suggestions that small valve size does not influence intermediate free-reoperation survival. The CE-19 is an excellent alternative to SJMR-19 in old patients. BioMed Central 2015-11-06 /pmc/articles/PMC4635601/ /pubmed/26541289 http://dx.doi.org/10.1186/s13019-015-0361-3 Text en © Prifti et al. 2015 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Prifti, Edvin
Bonacchi, Massimo
Ademaj, Fadil
Giunti, Gabriele
Esposito, Giampiero
Baboci, Arben
Bajraktari, Gani
Veshti, Altin
Demiraj, Aurel
Vanini, Vittorio
Early and mid-term outcome in terms of functional and hemodynamic performance of the st. Jude regent 19-mm aortic mechanical prosthesis versus 19-mm carpentier edwards aortic biological prosthesis
title Early and mid-term outcome in terms of functional and hemodynamic performance of the st. Jude regent 19-mm aortic mechanical prosthesis versus 19-mm carpentier edwards aortic biological prosthesis
title_full Early and mid-term outcome in terms of functional and hemodynamic performance of the st. Jude regent 19-mm aortic mechanical prosthesis versus 19-mm carpentier edwards aortic biological prosthesis
title_fullStr Early and mid-term outcome in terms of functional and hemodynamic performance of the st. Jude regent 19-mm aortic mechanical prosthesis versus 19-mm carpentier edwards aortic biological prosthesis
title_full_unstemmed Early and mid-term outcome in terms of functional and hemodynamic performance of the st. Jude regent 19-mm aortic mechanical prosthesis versus 19-mm carpentier edwards aortic biological prosthesis
title_short Early and mid-term outcome in terms of functional and hemodynamic performance of the st. Jude regent 19-mm aortic mechanical prosthesis versus 19-mm carpentier edwards aortic biological prosthesis
title_sort early and mid-term outcome in terms of functional and hemodynamic performance of the st. jude regent 19-mm aortic mechanical prosthesis versus 19-mm carpentier edwards aortic biological prosthesis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4635601/
https://www.ncbi.nlm.nih.gov/pubmed/26541289
http://dx.doi.org/10.1186/s13019-015-0361-3
work_keys_str_mv AT priftiedvin earlyandmidtermoutcomeintermsoffunctionalandhemodynamicperformanceofthestjuderegent19mmaorticmechanicalprosthesisversus19mmcarpentieredwardsaorticbiologicalprosthesis
AT bonacchimassimo earlyandmidtermoutcomeintermsoffunctionalandhemodynamicperformanceofthestjuderegent19mmaorticmechanicalprosthesisversus19mmcarpentieredwardsaorticbiologicalprosthesis
AT ademajfadil earlyandmidtermoutcomeintermsoffunctionalandhemodynamicperformanceofthestjuderegent19mmaorticmechanicalprosthesisversus19mmcarpentieredwardsaorticbiologicalprosthesis
AT giuntigabriele earlyandmidtermoutcomeintermsoffunctionalandhemodynamicperformanceofthestjuderegent19mmaorticmechanicalprosthesisversus19mmcarpentieredwardsaorticbiologicalprosthesis
AT espositogiampiero earlyandmidtermoutcomeintermsoffunctionalandhemodynamicperformanceofthestjuderegent19mmaorticmechanicalprosthesisversus19mmcarpentieredwardsaorticbiologicalprosthesis
AT babociarben earlyandmidtermoutcomeintermsoffunctionalandhemodynamicperformanceofthestjuderegent19mmaorticmechanicalprosthesisversus19mmcarpentieredwardsaorticbiologicalprosthesis
AT bajraktarigani earlyandmidtermoutcomeintermsoffunctionalandhemodynamicperformanceofthestjuderegent19mmaorticmechanicalprosthesisversus19mmcarpentieredwardsaorticbiologicalprosthesis
AT veshtialtin earlyandmidtermoutcomeintermsoffunctionalandhemodynamicperformanceofthestjuderegent19mmaorticmechanicalprosthesisversus19mmcarpentieredwardsaorticbiologicalprosthesis
AT demirajaurel earlyandmidtermoutcomeintermsoffunctionalandhemodynamicperformanceofthestjuderegent19mmaorticmechanicalprosthesisversus19mmcarpentieredwardsaorticbiologicalprosthesis
AT vaninivittorio earlyandmidtermoutcomeintermsoffunctionalandhemodynamicperformanceofthestjuderegent19mmaorticmechanicalprosthesisversus19mmcarpentieredwardsaorticbiologicalprosthesis