LEFT-VENTRICULAR MASS REGRESSION AFTER IMPLANTATION OF ST.-JUDE MEDICAL CARDIAC VALVES IN SMALL AORTIC ROOTS

In this study, we analyzed the extent of regression of left ventricula r hypertrophy in patients who received small St. Jude Medical (SJM) ao rtic valves and compared the results with those of another group recei ving larger valves. Eighty-eight patients received either 19 or 21 mm valves (Group 1, 25 patients) or either 23 or 25 mm valves (Group 2, 5 3 patients). Echocardiographic studies were done before the operation and 5 years postoperatively. At follow-up a significant reduction in t he left ventricular mass was found for both patient groups (p < 0.0001 ). Doppler echocardiography derived pressure gradients for both groups were obtained during the follow up period. As expected, the patients in Group 1 had higher peak pressure gradients than did those in Group 2. However, there was no significant difference between the 2 groups o r any significant correlations between peak pressure gradients and bod y surface area (BSA). Actuarial survival was 84.7% at 15 years for Gro up 1 and 85.9% at 17 years for Group 2. Actuarial freedom from value r elated events was 91.4% at 15 years for Group 1 and 82.7% at 17 years for Group 2, There was no significant difference in survival or valve related event free curves between the 2 groups. After implantations of SJM valves in small aortic roots, significant left ventricular mass r egression was obtained, and the results were comparable to those for v alves of other sizes. The long-term performance of aortic valve replac ement with small valves was satisfactory as judged by improvement in t he functional class of patients and survival statistics, the durabilit y of the prosthesis, and valve related morbidity comparable to that of valves of other sizes.