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THE JOURNAL OF CARDIOVASCULAR SURGERY
Rivista di Chirurgia Cardiaca, Vascolare e Toracica
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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ORIGINAL ARTICLES CARDIAC SECTION
The Journal of Cardiovascular Surgery 2008 August;49(4):539-43
Patient-prosthesis mismatch and left ventricular remodelling after implantation of Shelhigh SuperStentless aortic valve prostheses
Germing A. 1, Lindstaedt M. 1, Holt S. 1, Reber D. 2, Mügge A. 1, Laczkovics A. 2, Fritz M. 2
1 Cardiology and Angiology Medical Clinic II University Hospital Bergmannsheil, Bochum, Germany
2 Department of Cardiothoracic Surgery University Hospital Bergmannsheil, Bochum, Germany
Aim. Aortic valve replacement is a standard procedure for the treatment of severe aortic valve stenosis. Due to lower flow velocities stentless valves are associated with a more effective regression of left ventricular hypertrophy in comparison to stented valves. However, mismatch between body surface area and valve size supports unfavourable hemodynamic results. The aim of the study was to analyze hemodynamic parameters by echocardiography after implantation of the Shelhigh SuperStentlessTM bioprosthesis and to analyze the occurrence of patient-prosthesis mismatch and left ventricular remodelling in this specific valve type.
Methods. A total of 20 patients with severe aortic stenosis underwent implantation of a Shelhigh Super StentlessTM prosthesis. Clinical and echocardiographic assessment was done prior to, immediate after and six months after surgery.
Results. All surgical procedures were successful, no surgery-related complication was documented perioperatively. One patient died after development of multiorgan failure. Echocardiography during the first eight days after surgery showed mean gradients of 16 mmHg, mean valve orifice areas of 1.8 cm2 and indexed effective orifice areas at 0.95 cm2/m2. Six-months follow-up data were obtained in 19/20 patients. There were no relevant changes in echocardiographic hemodynamic findings at the time of follow-up measurements. Significant regression of left ventricular hypertrophy was shown (P=0.0088). A patient-prosthesis mismatch occurred in one patient (0.54 cm2/m2). No recurrent symptoms were documented.
Conclusion. Patient-prosthesis mismatch after implantation of SuperStentless ShelhighTM prosthesis is rare. A significant regression of left ventricular hypertrophy could be shown after six months. Hemodynamic valve function assessed by echocardiography may be predicted early after surgery.