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The Journal of Thoracic and Cardiovascular Surgery, Vol 100, 167-174, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
WM Jaffe, HA Coverdale, AH Roche, RM Whitlock, JM Neutze and BG Barratt-Boyes
Doppler echocardiography was used to measure gradients and valve areas at
rest and after supine bicycle exercise in 35 patients with valve
replacements 20 to 23 mm in size. Thirteen patients with a St. Jude Medical
valve (St. Jude Medical, Inc., St. Paul, Minn.) were matched to 13 patients
with an allograft valve, and seven patients with a Medtronic Intact
(porcine) valve (Medtronic, Inc., Minneapolis, Minn.) to seven patients
with an allograft valve. Patients were matched for age, sex, valve size,
body surface area, and left ventricular systolic function. There was no
statistically significant difference between the matched groups for body
surface areas, resting cardiac output, exercise heart rate, or workload
achieved. Mean pressure gradient was higher for St. Jude Medical than for
allograft groups, both at rest (11.8 +/- 6.67 mm Hg for St. Jude Medical
versus 6.67 +/- 2.98 mm Hg for allografts) and after exercise (16.4 +/-
8.47 mm Hg versus 9.7 +/- 3.94 mm Hg), but the differences were of
borderline significance (p = 0.016 and 0.027, respectively). Valve area at
rest was similar for both devices (1.4 +/- 0.45 cm2 for St. Jude Medical
versus 1.8 +/- 0.56 cm2 for allograft; p greater than 0.1). There were
highly significant differences between patients with Intact and those with
allograft valves for resting mean pressure gradient (19.3 +/- 4.23 mm Hg
for Intact versus 5.9 +/- 3.68 mm Hg for allograft; p less than 0.001) and
for exercise mean pressure gradient (27.8 +/- 8.63 mm Hg versus 8.1 +/-
8.43 mm Hg; p less than 0.001). The differences between the valve areas at
rest also were significant (1.1 +/- 0.12 cm2 versus 2.2 +/- 0.62 cm2; p
less than 0.01). It is concluded that when a tissue valve is indicated in
patients with a small aortic root, the freehand allograft aortic valve is
an ideal device from the hemodynamic perspective and is superior to the
Intact valve. It is also probably superior in this respect to the St. Jude
Medical valve, although the analysis may be biased slightly in favor of the
allograft valve.
ARTICLES
Rest and exercise hemodynamics of 20 to 23 mm allograft, Medtronic Intact (porcine), and St. Jude Medical valves in the aortic position
Department of Cardiology, Green Lane Hospital, Auckland, New Zealand.
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