Document Detail


Prosthetic valve hemodynamics assessed by the left ventricular outflow tract area utilization index: a randomized study of the carbomedics reduced versus the Medtronic Hall valve.
MedLine Citation:
PMID:  16116879     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND AIM OF THE STUDY: Continuous changes are made in valve prosthesis design in order to improve hemodynamic performance. In this prospective, randomized study, hemodynamic properties of the bileaflet CarboMedics Reduced (CM-R) valve with a thinner sewing ring was compared to the Medtronic Hall (MH) disc valve. Special emphasis was placed on the ability of the two valve types to make the most effective use of the available left ventricular outflow tract (LVOT) area as defined by preoperative echocardiographic measurements. METHODS: Twenty patients scheduled for a mechanical aortic valve prosthesis were randomized to receive either a CM-R or MH valve. Only patients receiving a prosthesis < or = 25 mm were included. A complete Doppler echocardiographic study was performed preoperatively and at six months postoperatively. Transprosthetic gradients, effective orifice area (EOA), effective orifice area index (EOAI) and LVOT-utilization index (LVOT-UI; defined as EOA/preoperative LVOT area) were compared. RESULTS: The CM-R valve was superior to the MH valve for all hemodynamic parameters studied: EOA 2.03 +/- 0.50 versus 1.56 +/- 0.20 cm2 (p < 0.01); EOAI 1.07 +/- 0.22 versus 0.83 +/- 0.13 cm2/m2 (p = 0.01); and LVOT-UI 0.47 +/- 0.09 versus 0.38 +/- 0.05 (p = 0.001). Although cardiac output was significantly higher in the CM-R group, transprosthetic gradients were lower (peak 21 +/- 5 versus 27 +/- 5 mmHg (p = 0.02); mean 11 +/- 4 versus 13 +/- 2 mmHg (p = 0.07)). CONCLUSION: The results of this study showed that the CM-R aortic valve offers favorable hemodynamics compared to the MH valve. The inclusion of preoperative LVOT area measurements (as LVOT-UI) showed that the CM-R offers a more effective use of the available LVOT area.
Authors:
Rune Wiseth; Rune Haaverstad; Nicola Vitale; Asbjoern Karevold
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of heart valve disease     Volume:  14     ISSN:  0966-8519     ISO Abbreviation:  J. Heart Valve Dis.     Publication Date:  2005 Jul 
Date Detail:
Created Date:  2005-08-24     Completed Date:  2005-12-19     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9312096     Medline TA:  J Heart Valve Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  518-22     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Trondheim University Hospital and Institute of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway. rune.wiseth@medisin.ntnu.no
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MeSH Terms
Descriptor/Qualifier:
Aortic Valve / surgery*,  ultrasonography
Blood Flow Velocity / physiology
Cardiac Output / physiology
Echocardiography, Doppler
Female
Heart Rate / physiology
Heart Valve Prosthesis*
Heart Ventricles / ultrasonography
Humans
Male
Middle Aged
Prospective Studies
Prosthesis Design
Systole / physiology
Ventricular Dysfunction, Left / physiopathology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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