Long-term hemodynamic performance of ATS valves in the aortic position: impact on the progression of late tricuspid regurgitation.

BACKGROUND AND AIM OF THE STUDY: The study aim was to evaluate the long-term hemodynamic performance of ATS bileaflet valves in the aortic position.

METHODS

A total of 132 patients (mean age 54 +/- 13 years) who underwent aortic valve replacement (AVR) using ATS valves between October 1994 and May 2001 was analyzed. Of these patients, 77 underwent isolated AVR (AVR group), while 55 underwent concomitant mitral valve replacement (DVR group). The mean follow up duration was 135 +/- 39 months (maximum 180 months).

RESULTS

The overall mortality was 19.7% (26/132), but no early mortality occurred. Cumulative survival rates at 12 years were 87.0 +/- 3.8% in the AVR group and 71.4 +/- 6.3% in the DVR group (p = 0.093). The AVR group showed a higher cardiovascular event-free survival at 12 years than the DVR group (82.3 +/- 4.7% versus 65.1 +/- 7.3%; p = 0.047). During follow up, the transaortic mean pressure gradient (TMPG) was maintained in the AVR group but increased in the DVR group (p = 0.044). The TMPG at follow up was higher in patients who underwent AVR with small valves (< or =21 mm) than in those receiving large valves (p = 0.001). The tricuspid regurgitation (TR) grade was increased over time in both groups, and was greater in the DVR group (2.1 +/- 1.1 versus 1.4 +/- 1.0; p < 0.001). The progression of late TR correlated with the TMPG (gamma = 0.261, p = 0.022).

CONCLUSION

The study results showed that ATS valves had acceptable long-term outcomes. A high TMPG was observed more frequently in the DVR group and in patients who underwent AVR with a small valve. A high TMPG might be related to the progression of late TR.