SERIAL HEMODYNAMIC-STUDY AFTER AORTIC-VALVE REPLACEMENT IN PATIENTS WITH NARROW AORTIC ROOTS

Background and aims of the study: The purpose of this study was to eva luate the hemodynamic performance after aortic valve replacement using different surgical options in small (19-mm diameter) annuli. Methods: Postoperative hemodynamics were assessed in three groups according to the surgical method. A 19-mm St. Jude Medical (SJM) valve was used in nine patients (group A), a 19-mm SJM HP in nine patients (group B), a nd annular enlargement was performed in eight patients (group C). Echo cardiography was performed and percent fraction shortening, peak press ure gradient, effective orifice area and left ventricular mass were me asured. Results: Postoperative peak systolic pressure gradient was dec reased to 31.1 +/- 8.7 mmHg in group B, and to 22.3 +/- 11.7 mmHg in g roup C, but was 42.9 +/- 16.5 mmHg in group A (p <0.01). Percent fract ion shortening and left ventricular mass index were improved in groups B and C, soon after surgery compared with group A(p <0.01). The effec tive orifice area significantly increased during exercise in group C, from 1.59 to 1.87 cm(2) (p <0.01), but was not increased in groups A a nd B (N.S.). Conclusions: The small SJM HP provides a better hemodynam ic performance than the standard 19 mm SJM. However, annular enlargeme nt may be beneficial in patients with poor ejection fraction and sever e ventricular hypertrophy.