The case for a specialist multidisciplinary valve clinic.

Valve disease is common and is increasing in prevalence as the population ages. The delivery of appropriate management is not always straightforward, and better ways of organizing care are required. Here, the argument is made for a specialist multidisciplinary valve clinic, while a description is provided of the authors' model clinic, which incorporates a specialist cardiologist in addition to sonographers and a nurse who carry out the surveillance services. The clinic is based at a cardiothoracic center and one district hospital, but could be generalized. Previous audits have shown that this model can reduce the number of patients seen by a cardiologist, thus improving the safety and quality of treatment compared to conventional clinics.

Bovine pericardial versus porcine stented replacement aortic valves: early results of a randomized comparison of the Perimount and the Mosaic valves.

OBJECTIVE: A stented bovine pericardial valve might be less obstructive than a stented porcine valve. This study compared early hemodynamic function in a prospective series of 99 patients randomized to receive either a Mosaic or Perimount replacement aortic valve. METHODS: Echocardiography was performed early after surgery and at 1 year after surgery. Patients also filled in psychologic questionnaires and underwent a 6-minute walk. RESULTS: The groups were matched demographically. The Perimount valve was significantly less obstructive in terms of mean pressure difference (11 +/- 5 vs 17 +/- 7 mm Hg; P < .0001), with a trend in favor of a larger effective orifice area (1.47 +/- 0.45 vs 1.28 +/- 0.46 cm(2); P = .05) postoperatively. There were no differences in left ventricular mass regression, aortic regurgitation, 6-minute walk, psychologic questionnaires, or mortality and clinical events. CONCLUSION: The stented bovine pericardial valve was less obstructive than the stented porcine valve. Both valves were associated with similar and significant improvements in quality of life, exercise ability, and regression of left ventricular mass.

A randomized comparison of the Cryolife O'Brien and Toronto stentless replacement aortic valves.

OBJECTIVE: A composite stentless valve might be less obstructive than a preparation incorporating the porcine right coronary muscle bar. The aim of this study was to compare early hemodynamic function in a prospective series of 78 patients randomized to receive either a Toronto or Cryolife O'Brien stentless valve. METHODS: Echocardiography was performed early after surgery, between 3 and 6 months, and at 1 year after surgery. RESULTS: The groups were matched demographically. The Cryolife O'Brien valve was significantly less obstructive in terms of effective orifice area (1.81 vs 1.30 cm2; P < .0001), mean pressure difference (7.1 vs 11.7 mm Hg; P < .0001), and peak velocity (1.7 vs 2.2 m/s) assessed at 1 year (P = .001). Bypass time was 91 (SD 22) minutes for the Cryolife O'Brien compared with 125 (SD 22) minutes (P < .0001) for the Toronto. There was a higher incidence of paraprosthetic regurgitation in the Cryolife O'Brien valve (16.7% vs 3.2%). Mortality and clinical events were similar. CONCLUSION: The composite valve was less obstructive than the porcine valve, suggesting that stentless valves cannot be considered as a homogeneous class.

The subcoronary Toronto stentless versus supra-annular Perimount stented replacement aortic valve: early clinical and hemodynamic results of a randomized comparison in 160 patients.

BACKGROUND: A stentless valve is expected to be hemodynamically superior to a stented valve. The aim of this study was to compare early postoperative hemodynamic function and clinical events in a randomized, prospective series of 160 stentless and stented biological replacement aortic valves. METHODS: We randomized 160 consecutive patients on 1 surgeon's list to receive either a Toronto stentless porcine valve (St Jude Medical, Inc, St Paul, Minn) or a Perimount stented bovine pericardial valve (Edwards Lifesciences, Irvine, Calif). Echocardiography was performed at discharge, between 3 and 6 months, and at 1 year after surgery. Statistical analysis was performed by both intention to treat and actual valves implanted. RESULTS: The mean labeled size of both designs of valve was 24.7. There were no statistically significant differences in results at any time interval or whether analysis was performed by actual valves implanted or intention to treat. At 3 to 6 months for the Toronto versus the Perimount valve, the effective orifice area was 1.58 versus 1.66 cm2, the mean pressure difference was 7.54 versus 7.42 mm Hg, and the peak velocity was 2.07 versus 2.0.1 m/s. There was no difference in mortality, regression of left ventricular hypertrophy, or complications other than paraprosthetic regurgitation at 12 months or on follow-up for a proportion of the sample to 8 years. The incidence of regurgitation through the valves was similar for Toronto (10%) and Perimount (13.8%) at 1 year, but mild paraprosthetic regurgitation was found in 5 patients with the Perimount valve and none with Toronto valves. CONCLUSIONS: There were no significant differences in hemodynamic function or clinical events between the stented and stentless biological valves chosen for comparison in the early postoperative period or in preliminary follow-up to 5 years.