One-year hemodynamic comparison of Perimount Magna with St Jude Epic aortic bioprostheses.

INTRODUCTION: Cardiac surgeons are using more bioprosthetic valves due to the ageing population as well as to improvements that have been made to these implants. We sought to compare the 1-year hemodynamics of two commercially available valves by echocardiographic parameters. MATERIAL AND METHODS: Retrospective review of our institutional database revealed 69 patients who received either Perimount Magna (n = 33) or St Jude Epic (n = 36) valves in the aortic position with no other valve surgery between June 2004 and March 2006. All patients received transthoracic echocardiography at 1 year. Comparisons between groups were made at baseline and at 1-year follow-up. In addition, a pairwise comparison was performed in each patient to determine the change in echocardiographic parameters between baseline and follow-up. RESULTS: Mean implanted valve size was similar (Magna 24.3 ±2.0 mm vs. Epic 24.1 ±2.2 mm). Pre- and intraoperative patient variables were similar between the two groups. There were lower peak and mean pressure gradients in the Magna group, both at discharge and one year after surgery. This correlated with a larger indexed effective orifice area (Magna 0.8 ±0.2 cm(2)/m(2) vs. Epic 0.67 ±0.2 cm(2)/m(2), p = 0.02). In spite of these findings, left ventricular mass regression was not different. CONCLUSIONS: These findings suggest that in a series with relatively low indexed effective orifice areas, the peak and mean gradients obtained were acceptable. More clinical follow-up of these patients is required to assess the true impact of prosthesis patient mismatch.

Mitral valve repair for advanced myxomatous degeneration with posterior displacement of the mitral annulus.

OBJECTIVE: This study examines the outcomes of mitral valve repair in a defined group of patients with mitral regurgitation caused by advanced myxomatous degeneration. METHODS: Advanced myxomatous degeneration of the mitral valve was defined as a degenerative process whereby both leaflets are voluminous and aneurysmal and the mitral annulus diameter exceeds 40 mm and has posterior displacement, as determined by means of echocardiographic analysis. Over a 16-year period, we identified 183 patients who underwent valve repair in this subgroup of myxomatous degeneration. The repair consisted of relocating the posterior mitral annulus to the endocardium of the left ventricle at the atrioventricular junction, correction of leaflet prolapse, and annuloplasty. Analysis of perioperative variables and postoperative outcomes were undertaken. The mean follow-up was 5.9 +/- 4.2 years and complete. RESULTS: The patients' mean age was 52 years, and 118 were men. All patients had mitral regurgitation preoperatively. There were no early and only 8 late deaths (2 valve-related deaths). The survival at 10 years was 92% +/- 3%. Six patients required reoperation on the mitral valve, 5 for recurrent severe mitral regurgitation. The freedom from reoperation at 10 years was 93% +/- 3%. Six patients had severe and 21 had moderate mitral regurgitation. The freedom from recurrent moderate or severe mitral regurgitation at 10 years was 80% +/- 5%. We could not identify independent predictors of recurrent mitral regurgitation. CONCLUSIONS: Mitral valve repair for advanced myxomatous degeneration on the mitral valve provides excellent early functional results, but late recurrent regurgitation is common, despite correction of dilated and displaced mitral annulus and leaflet prolapse.

Does permanent cardiac stimulation through atrial natriuretic peptide secretion influence the basic parameters of renal function?

BACKGROUND: The aim of this study was to evaluate atrial humoral function and renal function after pacemaker implantation due to atrioventricular conduction disturbances. We analyzed blood atrial natriuretic peptide (ANP) concentration and basic parameters of renal function within 1 month of implantation of VVI and DDD pacemakers. We evaluated correlations between blood ANP values and basic renal function parameters. METHODS: We studied two groups of patients with atrioventricular (AV) conduction disturbances: second-degree AV block and third-degree AV block. Group I comprised 20 patients aged 71-90 years (median 77.5 +/- 5.9 years) in whom permanent VVI pacing was applied, and group II consisted of 20 subjects aged 49-81 years (median 68.9 +/- 11.9 years) in whom DDD/ /VDD pacemakers were implanted. The control group consisted of 15 healthy volunteers aged 58-80 years (median 72.7 +/- 2.8 years). Plasma concentration of ANP was determined by radioimmunoassay. The parameters of renal function we analyzed with Jaffe's colorimetric and kinetic test. RESULTS: Patients in group I showed a significant decrease in blood concentration of ANP from 168.1 +/- 81.9 pg/1000 mL to 118.0 +/- 61.1 pg/1000 mL (p < 0.01) 7 days after implantation. At 30 days, ANP was 121.4 +/- 71.9 pg/1000 mL. In group II, plasma concentration of ANP decreased significantly from 134.9 +/- 8.1 pg/1000 mL to 104.9 +/- 6.1 pg/1000 mL (p < 0.01) 7 days after implantation and to 110.8 +/- 53.3 pg/1000 mL at 30 days. Patients in group I had elevated, albeit insignificantly, clearance of creatinine to 76.1 +/- 17.8 ml/min at 7 days (p > 0.05) which increased significantly to 85.0 +/- 17.9 ml/min at 30 days. In group II, clearance of creatinine increased insignificantly to 84.6 +/- 13.2 ml/min (p < 0.05) at 7 days and was significantly elevated to 96.9 +/- 18.2 ml/min (p < 0.05) at 30 days. In group I, plasma concentration of creatinine decreased significantly (p < 0.05) to 1.15 +/- 0.30 mg/dl at 7 days and to 1.01 +/- +/- 0.21 mg/dl at 30 days. In group II, there was a significant decrease (p < 0.05) to 1.15 +/- 0.24 mg/dl at 7 days and to 1.08 +/- 0.27 mg/dl at 30 days. There was a positive correlation between creatinine clearance and plasma ANP concentration in groups I and II (r = 0.301; p < 0.05). CONCLUSIONS: In patients with a pacemaker implanted due to atrioventricular disturbances, blood concentration of ANP was decreased. Renal function was improved after pacemaker implantation. (Cardiol J 2007; 14: 568-572).

Early and long-term results of surgical treatment of type A aortic dissection.

BACKGROUND: Acute aortic dissection is one of the most serious life-threatening conditions, with mortality during the first 48 hours reaching 50%. AIM: To assess short and long-term effects as well as safety of surgical treatment of aortic dissection combined with aortic valve repair. METHODS: The study group consisted of 57 patients (38 males, 19 females, mean age 47.9 +/- 13 years) with dissection of the ascending part of the aorta (type A aortic dissection) who underwent surgery in our institution between 1985 and 1999. Follow-up duration ranged from 2 to 16 years -- mean 6 years. Control transthoracic or transesophageal echocardiography was performed in 37 patients. RESULTS: Early mortality was 21%. There were 12 perioperative deaths and 3 late non-cardiovascular deaths. Three patients underwent repeated surgery due to (1) aortic valve insufficiency, (2) pseudoaneurysm at the site of the anastomosis between proximal part of the vascular prosthesis and the aorta, and (3) fistula between aorta and right atrium. CONCLUSIONS: Aortic dissection type A is more frequent in males than females. The main causative factor is hypertension. Early mortality is significantly higher in patients undergoing emergency surgery compared with elective procedures. Heart failure symptoms (NYHA class) improve postoperatively in the majority of patients. Aortic valve repair is effective and relatively safe, and is an alternative to the aortic valve replacement with coronary arteries reimplantation.