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J Thorac Cardiovasc Surg 1996;112:1431-1446
© 1996 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

HEMODYNAMIC BENEFITS OF THE TORONTO STENTLESS VALVE

Dario F. Del Rizzo, MD, PhDa, Bernard S. Goldman, MDa, George T. Christakis, MDa, Tirone E. David, MDb


Toronto, Ontario, Canada

Received for publication May 6, 1996 Revisions requested July 1, 1996; revisions received July 29, 1996 Accepted for publication July 31, 1996. Address for reprints: Dario F. Del Rizzo, MD, PhD, London Health Sciences Centre, University Campus, Division of Cardiovascular Surgery, 339 Windermere Rd., P.O. Box 5339, Suite 6-L24, London, Ontario, N6A 5A5, Canada.

Abstract

We report on 254 consecutive patients (170 male, 84 female) undergoing aortic valve replacement with the Toronto SPV Stentless Valve (St. Jude Medical, Inc., St. Paul, Minn.). Mean age (± standard deviation) was 62.1 ± 11.6 years. Three patients (1%) received sizes 21 or 22 mm, 24 (9%) received size 23 mm, and 227 patients (89%) received sizes 25, 27, or 29 mm. Serial echocardiography was used to assess valve performance during a 3-year follow-up. Mean gradient decreased by 35.8% (p < 0.0001; 95% confidence interval -39.6%, -31.7%) from postoperative values to the 3- to 6-month follow-up and by 6.1% (p = 0.004; 95% confidence interval -10.1%, -2%) at each subsequent interval; effective orifice area increased by 17.2% (p = 0.0001; 95% confidence interval 12.0%, 22.6%) initially and by 4.4% (p < 0.001; 95% confidence interval 1.8%, 7.0%) thereafter. At 2 years of follow-up, mean gradient was 3.3 ± 2.1 mm Hg and mean effective orifice area was 2.2 ± 0.8 cm2. Studies on left ventricular mass were carried out on 84 patients. Left ventricular mass decreased by 14.3% (37.8 ± 57.9 gm; p < 0.0001; 95% confidence interval -53.7, -21.9 gm) and left ventricular mass index decreased by 15.2% (21.1 ± 30.5 gm/m2; p < 0.0001; 95% confidence interval -29.5, -12.7 gm/m2) from postoperative values to the 3- to 6-month follow-up interval. The reduction in residual gradient and potential regression in left ventricular hypertrophy may have a beneficial prognostic implication. We believe that the unique stentless design of the Toronto SPV Stentless Valve allows this to occur. (J THORAC CARDIOVASC SURG 1996;112:431-46)




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