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J Thorac Cardiovasc Surg 2005;129:961-965
© 2005 The American Association for Thoracic Surgery

Editorials

Prosthetic aortic valve replacement

Hans-Hinrich Sievers, MD*

Department of Cardiac Surgery, University of Schlewwig-Holstein, Campus Luebeck, Luebeck, Germany

Received for publication December 22, 2004; accepted for publication December 23, 2004.

* Address for reprints: Hans-Hinrich Sievers, MD, Department of Cardiac Surgery, University of Schlewwig-Holstein, Campus Luebeck, Ratzeburger Alle 160, Luebeck D-23538, Germany (E-mail: herzchir@medinf.mu-luebeck.de).

The first 300 words of the full text of this article appear below.


   The size-sizing problem
 
Aortic valve replacement is the second most frequently and increasingly performed cardiac operation worldwide.1 Although the operative techniques and the performance of valve substitutes have remarkably improved during recent decades, the search for an ideal replacement valve still continues. Among the various characteristics used to compare the functional quality of innovative heart valve substitutes, the transvalvular pressure gradient (PG) and effective orifice area (EOA) are the most common. In this regard the publication of Eichinger and colleagues2 in this issue contributes important data for comparing novel bioprostheses in the aortic position, all the more because these data are based on a prospective randomized study at rest and exercise. However, this report also brings out some items that complicate comparison of valve substitutes with relation to size-sizing of both the patient’s aortic root and the prosthetic substitute (Figure 1), some aspects of which will be addressed in this editorial.


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  		Figure 1. Interrelating different items in the size and sizing problem of prosthetic aortic valve replacement. IGOA, Indexed geometric orifice area; SGOD (z), standardized geometric orifice diameter; IEOA, indexed effective orifice area; EOA, effective orifice area; GOA, geometric orifice area.

 

   Rationale for sizing
 
Although the clinical significance of prosthesis-related postoperative obstruction remains not fully established, pathophysiologic considerations and a growing body of study data3 provide sound reasons to relieve the native valve stenosis as completely as possible, warranting optimal left ventricular mass regression,4 maximal functional improvement, and a low incidence of adverse cardiac events. Especially patients with impaired left ventricular function are reported to benefit from relief of stenosis.5 All valve substitutes, however, leave some kind of residual obstruction dependent on design, size, material, and implantation technique.

The residual transvalvular PG is the most commonly used indicator to assess the residual obstruction and thereby the functional quality of a prosthesis. . . . [Full Text of this Article]




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