ABSTRACT
BACKGROUND AND AIM OF THE STUDY: The ATS Medical mechanical bileaflet valve is composed of pyrolitic carbon and is available in two forms: Standard and Advanced Performance. The study aim was to evaluate the clinical results and define, in blinded manner, the Doppler echocardiographic characteristics of normally functioning ATS AP prostheses with respect to their size. METHODS: One hundred patients (63 men, 37 women; mean age 63.6 +/- 10.6 years) were studied between January 1996 and February 1999. Doppler echocardiography was performed at least three months after valve replacement (mean 1.68 +/- 0.86 months; range: 3 months to 3 years). RESULTS: The in-hospital mortality was 3%, and there were four late deaths. None of the deaths was valve-related. Thromboembolic and anticoagulant-related hemorrhagic rates were 0.55% per patient-year (pt-yr) and 1.1% per pt-yr, respectively. Maximum and mean gradients were calculated using the simplified Bernoulli equation. Functional valve surface area was assessed using the continuity equation and time-velocity integrals using echographic measurements to calculate the subaortic surface. The Doppler velocity index was obtained from the ratio of subaortic and transaortic velocities. For the most frequently used aortic valve (22 mm), the maximum pressure gradient was 18.67 +/- 8.31 mmHg, the mean gradient 9.97 +/- 3.84 mmHg, functional surface area 1.50 +/- 0.35 cm2, and Doppler velocity index 0.41 +/- 0.08. CONCLUSION: Based on Doppler echocardiographic characteristics, the new ATS Medical AP prosthesis, when implanted in the aortic position, has an excellent hemodynamic profile which compares favorably with that of similarly designed prostheses. The clinical results show a very low rate of thromboembolic and anticoagulant-related hemorrhagic events, perhaps due to the new design of the pivoting area.
Subject(s)
Aortic Valve/surgery , Echocardiography, Doppler , Heart Valve Prosthesis , Adult , Aged , Aortic Valve/diagnostic imaging , Aortic Valve/physiopathology , Aortic Valve Insufficiency/mortality , Aortic Valve Insufficiency/physiopathology , Aortic Valve Insufficiency/surgery , Aortic Valve Stenosis/mortality , Aortic Valve Stenosis/physiopathology , Aortic Valve Stenosis/surgery , Blood Flow Velocity/physiology , Cause of Death , Female , Follow-Up Studies , France , Heart Valve Prosthesis/adverse effects , Heart Ventricles/diagnostic imaging , Heart Ventricles/physiopathology , Humans , Male , Middle Aged , Outcome Assessment, Health Care , Postoperative Complications/etiology , Postoperative Complications/mortality , Postoperative Complications/physiopathology , Prosthesis Design , Survival Analysis , Treatment Outcome , Ventricular Function, Left/physiologyABSTRACT
BACKGROUND: The established treatment modality of acute Stanford type A dissection includes repairing the ascending aorta and a variable part of the aortic arch and leaving the descending aorta untreated. We report a simultaneous approach of open repair of the ascending aorta with the transluminal placement of a stent in the descending aorta to minimize the consequences of an untreated descending aorta. METHODS: Two cases of type A aortic dissection are described, one case with the entry port in the descending aorta and the second case with the entry port in the aortic arch. Both patients were treated by the replacement of the ascending aorta (and the aortic arch in the second case) and the placement of a stent in the descending aorta with a new device as the patients were under circulatory arrest and deep hypothermia. The device consists of a Djumbodis stent mounted on a compliant balloon. This stent is made of 316L stainless steel and can be adapted to the shape of the aortic arch or descending aorta. Three different lengths are available: 4 cm, 9 cm, and 14 cm. The device used in these patients has a diameter of 9 mm. RESULTS: The early results were satisfactory with a completely thrombosed false lumen in one case and a partially thrombosed false lumen in the other, according to immediate postoperative transesophageal echocardiography control. A follow-up computed tomographic chest scan was done at 12 months in the first case and at 7 months in the second case and confirmed the good surgical results. CONCLUSIONS: This preliminary study shows that combined surgical and endovascular treatment of acute type A dissection is feasible and that at least partial thrombosis of the false lumen can be achieved, potentially minimizing the risk of further dilatation or rupture. The early results are encouraging, but more cases and long-term results are required to demonstrate the effectiveness of this new combined treatment modality.
