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J Thorac Cardiovasc Surg 2001;122:645-646
© 2001 The American Association for Thoracic Surgery

Editorials

Is it better on top? The triumph of supra-annular valves

From the Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif.

Received for publication May 3, 2001. Accepted for publication May 17, 2001. Address for reprints: Steven Khan, MD, Division of Cardiothoracic Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Room 6215, Los Angeles, CA 90048.

See related article on page 691.

Valve selection in the patient with a small aortic root remains a difficult decision for cardiac surgeons. Use of smaller stented porcine tissue valves in these patients may result in high gradients and low effective orifice areas. ^1,2 In some cases, there may be prosthesis-patient mismatch, ³ which can result in persistent left ventricular hypertrophy after valve replacement and has been reported in up to 52% of patients. ⁴ Jin and colleagues ⁵ found no significant regression of left ventricular hypertrophy in patients after implantation of either stented tissue valves or mechanical valves, although patients receiving unstented tissue valves and homografts did demonstrate significant regression.

Recognition of the potential importance of prosthesis-patient mismatch has led to interest in developing valve substitutes with improved hemodynamics. Although much of the recent literature has focused on stentless tissue valves, more traditional valve designs have also evolved to meet this challenge. The St Jude Medical HP (High Performance) valve was designed to allow supra-annular placement of the valve . . . [Full Text of this Article]

Related Article

Clinical evaluation of St Jude Medical Hemodynamic Plus versus standard aortic valve prostheses: The Italian multicenter, prospective, randomized study

Nicola Vitale, Ilaria Caldarera, Claudio Muneretto, Riccardo Sinatra, Antonio Scafuri, Elio Di Rosa, Andrea Contini, Nicola Tedesco, Angelo Pierangeli, Mauro Abbate, Tiziano Gherli, Dino Casarotto, Michele Di Summa, Benedetto Marino, Luigi Chiariello, and Luigi de Luca T.S.
J. Thorac. Cardiovasc. Surg. 2001 122: 691-698. [Abstract] [Full Text] [PDF]

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