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(Circulation. 2004;110:II-74 – II-78.)
© 2004 American Heart Association, Inc.

Surgery for Valvular Heart Disease

Prospectively Randomized Evaluation of Stented Xenograft Hemodynamic Function in the Aortic Position

Thomas Walther, MD PhD; Sven Lehmann, MD; Volkmar Falk, MD PhD; Sebastian Metz, MD; Nicolas Doll, MD; Ardawan Rastan, MD; Marika Viehweg, RN; Markus Richter, MD; Jan Gummert, MD PhD; Friedrich W. Mohr, MD PhD

From Universität Leipzig, Herzzentrum, Klinik für Herzchirurgie, Germany.

Correspondence to Dr. Thomas Walther, Universität Leipzig, Herzzentrum, Klinik für Herzchirurgie, Strümpellstr. 39, 04289 Leipzig, Germany. E-mail walt{at}medizin.uni-leipzig.de

Background— Standard stented aortic xenograft valves have not yet been compared regarding their hemodynamic function using a stratified intraoperative randomization protocol.

Methods and Results— 100 patients were prospectively included after intraoperative metric sizing of the decalcified aortic annulus. They received Mosaic (M) or Perimount (P) aortic valve replacement. Patient age was 73±5 years, 51 were female, and New York Heart Association (NYHA) functional class was 2.8±0.5. The 21-mm annulus group consisted of 5 (M)/7 (P) patients, the 23-mm annulus group of 20 (M)/20 (P), the 25-mm annulus group of 18 (M)/19 (P), and the 27-mm annulus group of 4 (M)/7 (P) patients, respectively. Hemodynamic function was evaluated using transthoracic echocardiography before discharge and at follow-up (438±352 days). Surgery was uncomplicated in all patients. Labeled valve sizes were 0.93 (M) and 1.05 (P) mm smaller than the annulus diameters (p=NS). In-hospital mortality was 5%, all nonvalve-related. Transvalvular blood flow velocities and transvalvular pressure gradients were significantly lower in the 25 P versus the 25 M group at baseline and in the 23 P and 25 P groups at follow-up. There was a significant regression of left ventricular mass index in all patients at follow-up. However, left ventricular mass regression was more pronounced after P aortic valve replacement.

Conclusion— Labeled sizes of prosthetic heart valves implanted are smaller than the true aortic annulus. Both standard aortic xenografts compared in this prospectively randomized trial provide a sufficient hemodynamic and functional outcome.

Key Words: aortic valve replacement • stented bioprosthesis • aortic annulus diameter • hemodynamics