Postoperative Hemodynamic Performance after Aortic Valve Replacement Using the Carpentier-Edwards Pericardial Valves / 日本心臓血管外科学会雑誌

ABSTRACT

Postoperative hemodynamic performance after aortic valvular replacement using the Carpentier-Edwards pericardial valve of 19-mm (group A, 10 cases) or 21-mm (group B, 5 cases) was compared with that using the 19-mm St. Jude Medical hemodynamic plus (group C, 13 cases). We evaluated hemodynamic performance by measuring the peak pressure gradient via aortic valve using Doppler echocardiography. Preoperative peak pressure gradients were 80±18.5mmHg in A, 81.6±17.5mmHg in B and 87±36.3mmHg in C. Valvular replacement obviously improved the hemodynamic performance by decreasing the postoperative peak pressure gradient to 24.2±7.3mmHg in A, 14.2±6.2mmHg in B and 26.7±19.0mmHg in C, though no statistically significant difference was present among the three groups. We also applied the dobutamine stress test for 5 cases in group A, 4 in B and 4 in C, who could receive the additional examination. The amount of dobutamine given was 8.2±1.6μg/kg/min in A, 7.2±2.0μg/kg/min in B and 7.7±1.5μg/kg/min in C. Before administration of dobutamine, the peak pressure gradient was 18.1±4.3mmHg in A, 14.2±6.2mmHg in B and 20.9±5.7mmHg in C. Although administration of dobutamine increased the peak pressure gradient to 41.1±15.0mmHg in A, 32.2±9.8mmHg in B and 46.8±14.4mmHg in C, there was no significant difference among the groups. The Carpentier-Edwards pericardial valve of 19-mm and 21-mm thus provided satisfactory valvular function compared with the 19-mm St. Jude Medical in terms of hemodynamics. Therefore, it is concluded that the Carpentier-Edward pericardial valve is a reliable alternative for elderly patients.