252 - HEMODYNAMIC FUNCTION OF CONTEMPORARY SURGICAL AORTIC VALVES 1 YEAR POSTIMPLANT

Background: Data on echocardiographic outcomes of surgical valves are needed to assess hemodynamic functioning of the prosthesis after aortic valve replacement (AVR). Previous publications reporting “normal” hemodynamic valve functioning have been limited by small sample sizes, a lack of contemporary valves, and different study designs (eg, single-center vs multicenter, use vs no use of a core lab, randomized vs single-arm). This study pooled data from 4 large, multicenter clinical trials to evaluate hemodynamic functioning of contemporary surgical aortic valves 1 year after implant.

METHODS AND RESULTS: Data from 2958 patients who underwent surgical AVR for moderate or severe aortic stenosis and/or regurgitation were pooled. Echocardiograms were assessed by a single core laboratory. Twenty patients who received a valve model that had been implanted in < 10 patients were excluded, yielding an analysis cohort of 2938. Ten models of surgical aortic valves were included: 4 stented bovine pericardial, 3 stented porcine, 1 stentless, and 2 sutureless. Baseline mean age in the studies ranged from 70.1±9.0 to 83.3±6.4 years, and the mean STS risk of mortality was 1.9±0.7% to 7.5±3.4%. At 1 year, the population mean aortic gradient ranged from 8.6±3.4 to 16.1±6.2 mmHg, and the mean dimensionless velocity index ranged from 0.39 to 0.56. Figure 1 shows the mean aortic gradient and dimensionless velocity index for the 10 valve models. Rates of no prosthesis-patient mismatch (PPM) ranged from 42.9% to 79.5%; moderate PPM, from 13.6% to 33.3%; and severe PPM, from 2.1% to 23.8%. Figure 2 shows the rate of PPM for each valve model.


Conclusion: This pooled cohort is the largest to date of contemporary surgical aortic valves with echocardiograms analyzed by a single core lab. Overall hemodynamic performance at 1 year ranged from good to excellent. These data can serve as a benchmark for other studies and may be useful to evaluate the performance of bioprosthetic surgical valves over time.