Long term hemodynamic behaviour of the Ionescu Shiley pericardial xenograft heart valve

ABSTRACTS

TREATMENT

OF

A TWENTY E.

Stanley

MD;

ARCH

EXPERIENCE

Crawford,

MD,

Douglas

J.

Aneurysms the great perfusion operation

AORTIC

YEAR

Milfeld,

ANEURYSM:

FACC;

Raul

LONG TERM HEMODYNAMIC BEHAVIOUR OF THE IONESCU SHILEY PERICARDIAL XENOGRAFT HEART VALVE Anand P.Tandon,MD,Donald R.Smith, MD, Marian I. The General Infirmary,Leeds,England. Ionescu,MD.

Garcia-Rinaldi.

MD*

of the aortic

arch

involving

the

origins

of

vessels are rare. Replacement requiring techniques and myocardial protection during is thought to be associated with a high In fact, some have felt that the rate.

mortality mortality is so high as to prohibit this form of therapy. This presentation is concerned &ith 20 patients treated during

the past

20 years

for

aneurysms

involving

one

or

more of the great vessels arising from the aortic arch employing techniques available at the time of therapy. The entire arch including origin of the three major vessels were were involved Perfusion the

(cerebral)

former appear

lesions.

techniques

11 patients

in the latter would

involved in 5 patients, in 6, and one vessel

9 with

were

with

survival

survival

in all

to justify

surgical

two major in 9 patients. employed

vessels in 9 of

in 9 (82 70) but not These results cases.

treatment

of these

It is obvious thatimprovementwould

result both from additional experience and the application of newer methods ofperfusion and cerebralprotection because allpatients treated during the past two years have survived.

*From Surgery, Methodist

the

Cora

and

Webb

Mading

Baylor College of Medicine, Hospital, Houston, Texas

Department and

of

The

HEMODYNAMIC EVALUATION OF THE IONESCU-SHILEY BOVINE HETEROGRAFT VALVE Joel Strom, MD; Ronald M. Becker, MD; William Frishman, MD, FACC; CarlosSalazar,MD; Yasu Oka, MO; Gerald Bassell, MD, Yen Tse Lin, MD; Robert W. M. Frater, MD, FACC, Albert Einstein College of Medicine, Bronx, N. Y. The intra-operativehemodynamicperformanceofthe lonescuShiley bovine pericardial heterograft valve was assessed in 28patients who received 30aorticandmitral prosthetic valves (AV and MV). Left atrial, left ventricular, and ascending aortic pressures were recorded while dye-dilution cardiac outputs were obtained simultaneously. The transvalvular gradients (grad) and cardiac outputs were used to estimate the effective orifice areas according to the Gorl in equation. The range of cardiac outputs was 1.50-6.56 L/min, mean 3.95 L/min. Results for AV reolacement: AV Size No. Grad Areas Mean Area 21 mm 5 10.6-37.3 mmHq 0.6-1.3 cm2 .97 cmL 23 mm 10 3.8-20.3 mmHg 1.0-1.9 cm2 1.4 cm2 25mm 4 3.2-13.3 mmHg 1.5-2.1 cm2 I.8 cm2 27mm 1 3.4 mmHg 4.1 cm2 4.1 cm2 Results for MV reolacement: MV Size No. Grad Areas Mean Area 25mm 1 15.3 mmHq 1.30 cm2 1.3 cm2 27 mm 2.7-13.7 mmHg 0.7-3.0 cm2 1.53 cm2 29 mm 7.2-13.0 mmHg 0.9-1.7 cm2 1.29 cm2 The lonescu valve suffers from the same difficulties as other available prostheses, i.e., small effective orifice Effectiveorificeareareas insmallermountingdiameters. as are less predictable in the mitral position but adequate to provide substantial hemodynamic improvement in patients with mitral valve disease. The lonescu valve shares the favorable characteristics (freedom from thrombo-embol ism, relative resistance to infection) of the other bioprostheses available. Further use and study with comparison to other prostheses is recommended.

had heart Since March 1971, 336 patients valve replacement with pericardial xenografts. studies. ThirtyOf these, 69 had hemodynamic six patients with aortic replacement (AR) were investigated at a mean interval of 41.2 (range The results showed sig22-59) months postop. nificant increase in cardiac output (p eO.05) and reduction in pulmonary wedge and LVED pressMean peak systolic ures (p 40.05 and p+ 0.001). gradients were 8.3 at rest and 12.3 mm Hg on exercise with the smallest xenograft (19 mm);and 0 and 1 mm Hg respectively with the largest one Calculated xeno raft surface area (XSA) (27 mm). and 1.3 to 2.4 varied from 1.1 to 2.1 cm 9 at rest Twenty-nine patientswith Clll 2 on exercise. mitral replacement (MR) had hemodynamic studies at a mean interval of 40.2 (range 24-59) months The results showed significant improvepostop. ment in pulmonary artery and wedge pressures (p
COMPARATIVE HEMODYNAMIC ASSESSMENT OF HANCOCK AND CARPENTIER-EDWARDS PORCINE XENOGRAFTS IN THE AORTIC POSITION James A. Joye, MD; Todd M. Grehl, hlD, FACC; Garrett Lee, MD; Anthony N. DeMaria, MD, FACC; Fred Harris, MD; Arthur J. Lurie, MD, FACC; Alan Gorang; Marilyn Hanna, RN; Edward J. Hurley, MD, FACC; Dean T. Mason, MD, FACC, University of California, Davis, California Hancock porcine xenografts (H) have low hemolysis and thromboembolism risks compared to mechanical valves; their flexible stent and glutaraldehyde preservation have extended durability >S years. However hydraulic function is reported compromised by suboptimal internal/external diameter. The thin-walled stent of the Carpentier-Edwards xenograft (CE) provides a potentially larger orifice. Thus this clinical study compares aortic CE to H by post-op catheterization. In 9 patients (pts) CE (annulus diameter 23-27 mm) had peak systolic gradient 20 mm Hg (range 3 to 40), mean gradient 18 mm H (8 to 32). aortic valve area 1.52 cm2 and index 0.80 cm1/M2, left ventricular enddiastolic pressure (LVEDP) 9.4 mm Hp, and cardiac index (CI) 2.94 L/min/M2. In 13 pts H (annulus diameter 21-27) had peak gradient 16 (0 to 24), aortic area 1.51 and index 0.99, LVEDP 10, CI 2.62. In addition, post-op CF and tl angiographic ejection fractions, circumferential fiber shortening velocities, and left ventricular end-diastolic volumes were similar. CE compared to H variables by total group or annulus size: all p>.O5. One CE and 1 H pt had mild aortic regurgitation. Thus, despite recent development of thin-walled stent in CE heterografts, no clinical or objective hemodynamic advantage over H was observed. The possibility remains that improved function may pertain to CE in the 19-21 mm size range.

February 1978

The American Journal of CARDIOLOGY

Volume 41

421