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J Thorac Cardiovasc Surg 1996;111:408-415
© 1996 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

COMPARISON OF HEMODYNAMIC PERFORMANCES OF ST. JUDE MEDICAL AND CARBOMEDICS 21 MM AORTIC PROSTHESES BY MEANS OF DOBUTAMINE STRESS ECHOCARDIOGRAPHY

Bristol, United Kingdom

Supported by the British Heart Foundation and the Garfield Weston Trust.

Received for publication Jan. 16, 1995. Accepted for publication May 9, 1995. Address for reprints: Gianni D. Angelini, FRCS, British Heart Foundation, Professor of Cardiac Surgery, Bristol Royal Infirmary, Bristol BS2 8HW, United Kingdom.

Abstract

Dobutamine stress Doppler echocardiography was used to compare the hemodynamic performance of two small aortic bileaflet prostheses. Nineteen patients (14 female, mean age 64 years) who had undergone aortic valve replacement with 21 mm bileaflet valve prostheses (St. Jude Medical valve, n= 9, or CarboMedics valve, n= 10) were studied. Dobutamine infusion was started at a rate of 5µg ·kg^-1 ·min^-1and increased to 10 and 20µg · kg^-1 ·min^-1at 15-minute intervals. Under maximum stress, heart rate and cardiac output increased by 70% and 120%, respectively, and mean arterial blood pressure decreased by 9%. Pulsed-wave and continuous-wave Doppler studies were performed at rest and at the end of each stage. Velocity ratio, effective orifice area, performance index, and discharge coefficient of the valve were calculated, and peak and mean velocities and pressure drops across the prostheses were measured. Dobutamine infusion produced similar increases in cardiac output in all patients. Effective orifice areas, discharge coefficients, and performance indexes were comparable for the two valve groups both at rest and maximum stress. Transvalvular velocities and pressure drops were also similar in the two valve groups. Transvalvular pressure drops were also comparable in patients with large body surface area. Dobutamine stress echocardiography is useful in the evaluation of the hemodynamic performance of prosthetic heart valves. St. Jude Medical and CarboMedics 21 mm prostheses have equally favorable hemodynamic performances in most patients under conditions of high cardiac output. (J THORACCARDIOVASCSURG1996;111:408-15)

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