Dynamic Evaluation of the 21-mm Medtronic Intact Aortic Bioprosthesis by Dobutamine Echocardiography

Background. High residual transvalvular gradients have been reported with the use of small Medtronic Intact aortic valve prostheses. The aim of this study was to evaluate the hemodynamic performance of 21-mm prostheses using dobutamine Doppler echocardiography. Methods. Ten patients (7 women; mean age, 79 years) who had undergone aortic valve replacement with 21-mm Medtronic Intact prostheses 19.1 ± 9.9 (standard deviation) months previously were studied. Dobutamine infusion was started at a rate of 5 μg·kg−1·min−1 and increased to 10 and 20 μg·kg−1·min−1 at 15-minute intervals. Pulsed and continuous-wave Doppler studies were performed at rest and at the end of each stage. Effective orifice area, performance index, and discharge coefficient of each valve were calculated, and peak and mean velocity and pressure drop across the prostheses were measured. Cardiac output was determined by Doppler measurement of flow in the left ventricular outflow tract. Results. Dobutamine stress increased heart rate and cardiac output by 68% and 65%, respectively (both p < 0.005), and mean transvalvular gradient increased from 19.1 ± 5.1 mm Hg at rest to 33.2 ± 7.7 mm Hg at maximum stress (p < 0.0001). Regression analyses demonstrated that maximum-stress gradient was independent of all variables except resting gradients (p < 0.004). Body surface area had no effect on the changes in cardiac output, effective orifice area, or transprosthetic gradient at maximum stress. Conclusions. These data show that the 21-mm Medtronic Intact aortic prosthesis exhibits acceptable hemodynamic performance. Transvalvular gradients remained within a clinically acceptable range, both at rest and at maximum stress. Moreover, overall hemodynamic performance suggests that patient–prosthesis mismatch is unlikely to be a problem of clinical importance when this prosthesis is used.