Serial changes of hemodynamic performance with Medtronic Hall valve in aortic position.

Abstract

The aim of this study was to evaluate the long-term hemodynamic performance of the Medtronic Hall valve by analyzing serial changes in echocardiographic outcomes in aortic position. One hundred seventeen patients who underwent aortic valve replacement (AVR) using the Medtronic Hall valve between August 1997 and January 2004 were retrospectively studied. Fifty-five patients underwent isolated AVR (AVR group), and 62 patients underwent AVR and mitral valve replacement (double valve replacement group). Mean age was 51.2 ± 10.4 years (range, 26 to 67 years), and mean follow-up duration was 93.7 ± 25.6 months (913.6 patient-years; range, 17 to 140 months). Serial echocardiographic data were analyzed. Overall mortality was 12.8% (15 of 117), but no early mortality occurred. A greater than 15 mm Hg increment of aortic transprosthetic mean pressure gradient at last follow-up occurred in 13 patients (11.1%). Redo AVR was performed in 7 patients, 6 of whom had subaortic pannus ingrowths. Group cumulative survival rates at 10 years were similar (90.4%, AVR group versus 88.4%, double valve replacement group; p = 0.580), but the AVR group showed better adverse cardiac event-free survival at 10 years (80.1% versus 53.8%; p = 0.025). Multivariate analysis showed that double valve replacement and a small-sized valve (20 mm) significantly predicted the increment of aortic transprosthetic mean pressure gradient at last follow up greater than 15 mm Hg (p = 0.013; odds ratio, 13.9; p = 0.019; odds ratio, 4.2, respectively). The transprosthetic mean pressure gradient of the Medtronic Hall valve in the aortic position frequently increased as a function of time, and this increase was more common in patients who had undergone double valve replacement, especially in those implanted with a small valve.